Off-Service Rotations 

Physical Diagnosis Rotation                                                             Dr. Michael DeLisi
This first-year rotation follows an introductory course in history taking and physical examination required of all incoming PGY-1 residents in the Department of Dentistry. OMS residents spend six weeks (part-time) at the family medicine facility performing H&Ps under supervision.

Goals
1. To contribute to the development of competency in history taking;
2. To contribute to the development of competency in performing complete physical examinations;
3. To expose the resident to the major areas in clinical medicine;
4. To provide a basis for the clinical judgment required when evaluating patients prior to surgery and anesthesia; and
5. To expose residents to published guidelines on preoperative physical assessment and on the management of major entities such as diabetes and hypertension.

Objectives

1. The resident will satisfactorily complete and document 25 H&Ps.
2. The resident will be able to demonstrate the correct use of the tools of physical diagnosis.
3. The resident will be able to discuss published guidelines on preoperative physical assessment and on the management of major entities such as diabetes and hypertension.

Note: Along with the introductory course and the two-month rotation in the Department of Medicine, this rotation provides core training in physical diagnosis. Certification of competence in performing H&Ps is based upon successful completion of this rotation as judged by Dr. DeLisi or his designee, and satisfactory performance during the medicine rotation. Additional training is acquired by performing pre-anesthetic evaluations during the anesthesia rotation. Given satisfactory performance on all of these elements and a positive recommendation by the OMS faculty, the graduating resident will have his/her competency in physical diagnosis certified by the program director.

Anesthesiology                                   Drs. Seth Landa and. Stephen Winikoff (SJ)
This is a four-month rotation during the resident’s first year. The anesthesiology service at St. Joseph’s is staffed by a committed group of clinician-educators and a large group of residents. Sub-specialties represented include pediatric anesthesiology, cardiac anesthesiology, OB anesthesiology and pain management. The OMS resident is absorbed into this academically oriented environment and participates fully in all educational activities. The resident is expected to take evening call during the rotation to gain experience in the evaluation and management of emergent patients requiring general anesthesia. This four-month rotation provides an excellent background in anesthesiology and a wealth of clinical material for training.

The resident is expected to fulfill the responsibilities that would be assigned to a resident in anesthesiology at a comparable level. This includes attendance at seminars and conferences, full participation in any activities of the service and meaningful participation in the on-call schedule as described above.

Goals
1. To contribute to the development of competency in medical risk assessment;
2. To contribute to the development of competency in airway management;
3. To contribute to the development of competency in the administration of anesthetic agents;
4. To contribute to the development of competency in establishing venous access;
5. To expose the resident to fluid management and blood replacement; and
6. To expose the resident to the use and significance of invasive monitoring techniques.

Objectives
1. Perform 25 or more pre-anesthetic evaluations of surgical patients scheduled for general anesthesia (adults and children)
2. Describe the process of assigning risk categories to patients scheduled to receive anesthetics
3. Establish venous access in more than 50 patients
4. Satisfactorily manage the airway in 25 or more patients under general anesthesia (adults and children)
5. Perform 25 or more endotracheal intubations
6. Describe the standard physiologic monitoring used during general anesthesia and the significance of the various measures
7. Participate in the PACU care and discharge process for 25 or more patients who have undergone a procedure under general anesthesia
8. Participate in the anesthesia management of 20 or more medically compromised patients (ASA III or IV)
9. Describe the pharmacologic properties, clinical applications, contraindications, adverse reactions and potential interactions for:

            a. anesthetic gases

            b. intravenous anesthetic agents

            c. sedatives and anxiolytics

            d. opioids

            e. muscle relaxants

            f. reversal agents

            g. local/regional anesthetics

            h. adjunctive agents (vasopressors, blood pressure lowering medications etc.)

General Surgery / SICU                                                                    Dr. Alan Sori (SJ)
This rotation of four months duration takes place at SJRMC, where the OMS resident is fully absorbed into the general surgery service and functions as a team member, including participation in the call schedule. For the first three months, the emphasis is clinical and a large volume and wide variety of surgical cases are encountered. The resident then spends the final month as a surgical intensive care unit resident. Here, didactic elements are reinforced daily on teaching rounds and by the nearly constant contact of the OMS resident with surgical intensivists who run the SICU, with general surgery attendings whose patients are in the unit and with senior-level general surgery residents.

The resident is expected to fulfill the responsibilities that would be assigned to a resident in general surgery at a comparable level. This includes attendance at seminars and conferences, full participation in any activities of the service and participation in the on- call schedule.

Goals
1. To contribute to the development of competency in surgical risk assessment;
2. To contribute to the development of competency in evaluation and management of the trauma victim;
3. To contribute to the development of competency in basic surgical skills;
4. To contribute to the development of competency in medically managing the perioperative patient;
5. To expose the resident to the establishment of central venous access;
6. To expose the resident to fluid management and blood replacement; and
7. To expose the resident to the medical management of the critically ill surgical patient.

Objectives
1. Participate meaningfully in the comprehensive surgical management of 25 or more (non-OMS) surgical patients
2. Participate meaningfully in the comprehensive management of 12 or more trauma victims
3. Demonstrate satisfactorily the acquisition of basic surgical skills
4. Describe all the anatomy imaged on a standard chest film and identify common pathologic findings noted on these films in surgical patients
5. Participate meaningfully in the comprehensive care of 10 patients admitted to the SICU 
6. List the indications for mechanical ventilation and the parameters for weaning patients off of the ventilator
7. Discuss the indications and techniques for establishment of emergent and non-emergent surgical airways

Internal Medicine                              Drs. Anees Kahn and Robert Amoruso (SJ)
This two-month rotation takes place at SJRMC. The OMS resident is fully absorbed into the medicine service and participates in all of its clinical and educational activities, including the on-call schedule. The resident is assigned to a team that follows patients from admission through discharge. The team comprises senior and junior residents as well as medical students. Each team is supervised by attending physicians from the Department of Medicine.

The resident is expected to fulfill the responsibilities that would be assigned to a resident in internal medicine at a comparable level. This includes attendance at seminars and conferences, full participation in any activities of the service, including the code team and meaningful participation in the on-call schedule.

Goals
1. To contribute to the development of competency in history taking;
2. To contribute to the development of competency in conducting a complete physical examination;
3. To expose the resident to a wide variety of medical conditions that may require treatment;
4. To provide clinical material for further development of physical diagnosis skills acquired in the ICS course;
5. To expose the resident to medical urgencies and emergencies and their management; and
6. To expose the resident to critically ill patients and their management.

Objectives
1. Perform more than 25 complete H&Ps on patients admitted for medical management
2. Participate meaningfully in the comprehensive management of 10 medical patients
3. Evaluate and manage 20 or more patients with medical emergencies
4. Describe the impact of HIV infection on all of the major human organ systems
5. Describe the appropriate initial management of:

            a. ventricular tachyarrhythmias

            b. bradycardia with hypotension

            c. stable and unstable SVT

            d. asystole

6. Discuss the pathophysiology and clinical manifestations of major disease processes, which may include:

            a. asthma

            b. pneumonia

            c. hypertension

            d. coronary artery disease

            e. congestive heart failure

            f. valvular heart disease

            g. diabetes mellitus

            h. thyroid dysfunction

            i. hyperparathyroidism

            j. tuberculosis

            k. the infectious hepatitides

            l. alcoholic liver disease and cirrhosis

            m. congenital and acquired coagulopathies

            n. bleeding diatheses

            o. Crohn’s disease and ulcerative colitis

            p. peptic ulcer disease

            q. sarcoidosis

            r. rheumatoid arthritis

            s. psoriasis

            t. myasthenia gravis

            u. multiple sclerosis

            v. primary malignancies of the lungs, stomach, pancreas, colon, rectum, prostate, breast, esophagus, liver                     and kidney

            w. anemias

            x. leukemias

            y. lymphomas

            z. multiple myeloma

7. Describe the significance of each of the more commonly ordered laboratory tests

Orthopedic Surgery                                    Drs. V. McInerney and F. Ghobadi (SJ)
This rotation of one month’s duration takes place at SJRMC, where the OMS resident is fully absorbed into the orthopedic surgery service and functions as a team member, including appropriate involvement in the call schedule and in departmental didactic programs.

The resident is expected to fulfill the responsibilities that would be assigned to a resident in orthopedic surgery at a comparable level. This includes attendance at seminars and conferences, full participation in any activities of the service and participation in the on- call schedule.

Goals
1. To contribute to the development of competency in surgical risk assessment;
2. To contribute to the development of competency in evaluation and management of the trauma victim;
3. To contribute to the development of competency in basic surgical skills;
4. To contribute to the development of competency in medically managing the perioperative patient;
5. To contribute to the development of competency in assessing and managing fractures, dislocations, and other bone and joint injuries;
6. To contribute to the development of competency in arthroscopic surgical techniques; and
7. To expose the resident to joint replacement procedures.

Objectives
1. Participate meaningfully in the comprehensive surgical management of 12 or more orthopedic surgical patients
2. Participate meaningfully in the comprehensive management of 8 or more trauma victims
3. Demonstrate satisfactorily the acquisition of basic orthopedic surgical skills
4. Compare and contrast various methods of fracture management
5. Discuss the integration of maxillofacial and orthopedic management of the patient with multiple traumatic injuries
6. Describe the techniques and instrumentation utilized in arthroscopic surgery of various joints

Elective Rotations
One month is available for each resident to choose an elective rotation from among the following:

• Orthopedic Surgery
• SICU/Trauma
• MICU/ Critical Care
• Any other valid educational opportunity cleared by the program director.          

Alternatively, the resident may create an elective not on the list pending approval of the program director and his success in securing satisfactory arrangements. The duties of the resident are based on the nature of the rotation and may not involve on call for this month. The resident is to be fully absorbed into the assigned service for the duration of the rotation and is expected to fulfill the responsibilities that would normally be assigned to a resident with comparable training and experience.

Rotation Evaluations

Residents are evaluated by the individuals named above (or their designees) for each rotation. Off-service mentors are asked to evaluate residents based upon the goals and objectives that are supplied prior to the arrival of an assigned resident. Off-service chiefs are periodically asked to comment on these goals and objectives, and provide their opinions about the value of the rotation and its success in meeting its stated goals. In addition, clinical rotations are evaluated by each resident at the conclusion of each rotation.