1. Internal Medicine Residency ProgramCURRICULA 2005 / 2006
John H. Stroger, Jr. Hospital of Cook CountyDepartment of
Medicine
2. CURRICULA forInternal Medicine Residency ProgramTABLE OF
CONTENTSCORE PATIENT CARE EXPERIENCES HIV Inpatient Service
.........................................................................3
Ambulatory Medicine.......6 Coronary Care Unit (CCU)
.........................................................................9
Critical Care (MICU)...13 Emergency Medicine...16 General Medicine
Clinic.18 Medicine Short Stay Unit (SSU) ...21
Geriatrics/Rehabilitative Medicine ...34 Inpatient Medicine ...37
Womens Health ......41SUBSPECIALTY ROTATIONS Cardiology ...43
Endocrinology & Metabolism...47 Gastroenterology ...56 General
Medicine Consultation ...60 Hematology ...65 Infectious Disease
...68 Nephrology/Hypertension ...73 Oncology...77 Pulmonary ...80
Rheumatology ...84ELECTIVES Adolescent Medicine ...87 Dermatology
...89 Neurology ...92 Occupational Medicine ...95 Toxicology
...98ADDITIONAL INSTRUCTIONS Hospice/Palliative Medicine and
End-Of-Life Care .......100 Otolaryngology..102 Ophthalmology..104
Orthopedics...106 Psychiatry..108 Evidence Based Medicine ....110
Laboratory Medicine & I Skills ......111 Medical Ethics ....113
Medical Procedures 114 Physician Impairment ....117 Principles of
Legal & Governmental Regulations .119 Socioeconomic & Cost
Effectiveness Issues .120 3. CURRICULUM OUTLINECurriculum Topic:
HIV Inpatient Service1. Educational Purpose and Rationale for the
Curriculum The HIV Inpatient Service is a four-week intensive
training of housestaff on the inpatient managementof HIV infected
patients. The attending physician is an Infectious Disease
Specialist. This wardpromotes a multidisciplinary approach to the
health care of the HIV infected patient. The goal of thisrotation
is to provide the housestaff with the skills to be the primary
physician in the inpatient care ofpatients with advanced HIV
disease. Instruction is given by a specialist trained in this area
withassistance from a clinical pharmacist and Physician Assistant
(PA). The care of HIV infected patients with advanced disease is a
complicated issue. Management ofmultiple medications with their
high incidence of adverse events and diagnosis and therapy
ofmultiple opportunistic and nosocomial infections can be an
overwhelming challenge. Additionalproblems such as nutritional
depletion, psychological manifestations of HIV disease, social
serviceissues, and rapid FDA release of agents used in the care of
HIV infected patients makes the inpatientcare of the HIV infected
patient a daunting challenge. The HIV Inpatient Service provides
anenvironment where the house staff can concentrate on the issues
affecting HIV infected patientsunder the direct supervision of
specialists trained in this area.2. Principal teaching methods a.
Didactics/lectures: Lectures, by the Infectious Disease Division,
are given 3 days a week. Additional lectures may be given regarding
specific patients.Infectious Disease fellows assigned to the HIV
ward assess points of interest regarding cases on the unit and do a
literature search and give a more formal presentation to the
housestaff the following day. The clinical pharmacist gives formal
lectures to the housestaff regarding antiretroviral agents and use
of these medications in HIV infected patients. Additional formal
conferences are held regarding the care of Infectious Diseases and
HIV+ patients' 2x per week. Case presentations and formal lectures
are rotated in these conferences. b. Self study: Housestaff are
encouraged to self study. Attendings, PAs, and Clinical Pharmacists
provide housestaff with literature and try to stimulate reading by
providing questions (e.g., MKSAP format) for housestaff. The house
staff's' medical background and improvement in the rotation is
evaluated in an end of the rotation evaluation form completed by
the attending physician. Attending physicians also communicate
periodically with housestaff about housestaff progress, areas of
weakness, and ways to improve their clinical skills. c. Other:
Patient care rounds are teaching rounds involving informal
instruction on the care of the patients on the ward. These rounds
are geared to management issues and discussion of the differential
diagnosis and diagnostic workup of HIV infected patients. d.
Microbiology Rounds are held once a week. Topics reviewed during
these sessions include: HIV diagnostics, Blood cultures,
Mycobacterial testing, Susceptibility testing. Patient specific
results may also be reviewed during that session.3. Educational
content a. Major objectives --10-15 most important subjects
covered: 1. Use of common antimicrobial agents in the management of
HIV infected patients (i.e., antiretrovirals and OI prophylaxis).
2. Differential diagnosis of fever in the HIV infected patient. 3.
Use of common diagnostic procedures in the inpatient management of
HIV infected patient (CXR, standard blood tests, PPD). 4. Use of
advanced diagnostic procedures in the diagnostic management of HIV
infected patients (viral cultures, MRI, CT scans). 5. Use of
empiric antibacterial agents in the treatment of suspected
bacterial infection. 6. Use of antimicrobial agents specific to
AIDS patients. 4. 7. The pathogenesis of HIV and its effect on the
immune system.8. Adverse drug effects commonly seen in HIV infected
patients (e.g., Bactrim, Pentamidine toxicity).9. Use of cytokines
in the management of AIDS related anemias and
neutropenias.10.Principles of timely and meaningful diagnostic
workup of HIV infected patients and relation of OIs to level of
immune suppression.11.Psychological problems in HIV infected
patients.12.Nutritional problems in management of HIV infected
patients.13.Use of viral load and CD4 counts to assess HIV disease
progression..14.HIV salvage therapy.16.Knowledge of mechanisms for
failure of HAART therapy.17. Orientation for specific history and
physical findings in the HIV infected patient.18. Understanding of
issues around confidentiality of medical information for the HIV
infectedpatient. b. Patient characteristics: All patients seen by
housestaff will be HIV infected. The overwhelming majority will
haveadvanced HIV disease (
