The Hospital
St. Barnabas Hospital is a 458 bed acute care private community hospital affiliated with the New York College of Osteopathic Medicine’s Educational Consortium (NYCOMEC). St. Barnabas Hospital and NYCOMEC associated for the purpose of establishing a cooperative program of medical education, research and improved medical care.
St. Barnabas Hospital is located in the Belmont or "Little Italy" neighborhood of the Bronx, and this area is a tourist attraction because of the many fine shops, bakeries, and restaurants which it harbors. A few blocks away are Fordham University, the New York Botanical Garden, and the New York Zoological Society ("The Bronx Zoo").
The Hospital sits on several landscaped acres adjacent to the recently constructed St. Barnabas Nursing Home. There is a brand new seven-story Ambulatory Care Center immediately across the street. Other ambulatory care sites include the HIP Southern Center at 149th Street, Union Community Health Care Center (UCHC) located at Valentine Ave, 2021 Grand Concourse Ave, and 470 East Fordham Road. The latter serves as the primary care site for the St. Barnabas Family Practice Residency Program.
The Program
The St. Barnabas Family Practice Residency Training Program is designed to accommodate the individual learning needs of osteopathic physicians, who plan to pursue a career in Family Practice. The residency training focuses on the ambulatory aspects of patient care, prepares residents to take the AOBFP certifying board examination, and accommodates individual practice interests. The resident learns the basis for community oriented primary care.
The Department of Family Practice is responsible for:
(1) Structuring and providing guidance for the overall curriculum, and
(2) Rotations through various affiliated institutions.
To this end, St. Barnabas directs the program, oversees its quality and accreditation status through the American Osteopathic Association (AOA).
The St. Barnabas Family Practice Program located at Union Community Health Care Center at Fordham Plaza has been appointed a New York State Designated Priority Program. In keeping with this appointment, the site and the residency program must comply with many standards which benefit both our patients and our residents. This includes the use of an appointment system that accommodates personal appointments, walk-ins and referrals, allows ample time for exam, treatment and patient education. The program’s continuity site also provides comprehensive coverage that provides prompt telephone access to a clinical staff member on a 24-hour basis, operates 40 hours a week including 8 hours on the weekend, and assigns residents to provide care for a specific panel of patients. In keeping with the goals of the NYS Designed Priority Program, the program tracks patients who are referred, sent to the hospital, and also monitors reports and results of consultations.
Purpose, Goals, and Objectives
Purpose
The purpose of the St. Barnabas Family Practice Residency Program is to provide residents with instruction and training experiences such that they acquire the necessary knowledge and skills to manage the large majority of health problems of the general public. This includes:
Treating the presenting complaint in the context of the patient’s overall health and family problems;
Emphasizing the ambulatory aspect with appropriate attention to the pre-hospitalization, and post- hospitalization planning and implementation;
Identifying the role of the family practitioner in health care delivery with other medical specialists;
Imparting a sense of concern for all aspects of the patient's health;
Providing core curriculum material, yet recognizing the individual interest areas characteristic of family practitioners; and
Managing all aspects of patient care over the course of the residency under supervision of board-certified preceptors in family medicine and by actively interacting with other medical specialists.
Goals
To achieve the purpose of the graduate training program, major goals have been developed to guide the education and training of the residents. The goals include:
To provide properly organized, progressive primary responsibility for the care of patients in a family practice environment under the supervision of attending family practitioners. Emphasis is placed upon the longitudinal approach and the educational aspects of the residency program. In addition, special emphasis is placed on osteopathic concepts, along with the psychological, social and somatic aspects of disease, and procedures commonly emphasized in the practice of osteopathic medicine. This is the holistic model of medicine as seen in the tradition of Hippocrates.
To provide additional experience and responsibility in those branches of medicine, surgery, pediatrics, obstetrics/gynecology, behavioral science and osteopathic principles and practice which are of primary importance to the family practitioner.
To provide the basic requirements for eventual certification in family practice by the American Osteopathic Board of Family Practice.
Objectives
The St. Barnabas Family Practice Residency Program is a comprehensive three year program. As such it meets the following objectives:
1 a. During the training period all basic requirements for AOA certification are met.
b. The three year program is designed to allow for the educational objectives of individual residents in accordance with their needs to develop additional family practice skills. These needs may reflect the
practice standards of the potential community in which the resident intends to work.
2.The program conforms to the standards of the AOA's Committee on Postdoctoral Training as set forth in the Residency Training Requirements of the American Osteopathic Association.
3.In-hospital training includes:
a.The acquisition of specialty knowledge and skills needed to function in the ambulatory setting.
b.The gaining of knowledge and skills needed for inpatient care.
c.The learning of the protocols by which other osteopathic specialists assist in total patient care.
4. Ambulatory Family Practice training includes:
a.Emphasis on osteopathic principles and practices.
b.Provisions for longitudinal patient care.
c.Introduction to outpatient procedures and ambulatory care practice.
d. Provision for the conceptual and practical development of skills in primary care and continuity of patient care.
e.Emphasis on the physician-patient relationship.
f.Introduction of preventive health care delivery.
g. Application of community oriented medicine in total patient care.
h.Evaluation and treatment of outpatient pediatric patients
i. Evaluation and treatment of outpatient GYN patients
5. The program emphasizes the behavioral sciences as well as non-clinical medicine.
a. The acquisition of knowledge and skills in the behavioral sciences (e.g., human development, interviewing and counseling skills, knowledge of psycho-social factors in health and disease, family dynamics, and terminal patient care.)
b. Understanding of areas such as epidemiology, medical ethics, patient education, community and social health services, principles of continuing medical education, and office management and systems.
6. A family practice scientific paper is required to be submitted and approved to complete the program.
Program requirements of the St. Barnabas Family Practice Residency Program address the applicant, the program, the hospital, the program director, and the resident. This section outlines requirements at each of these levels.
The following admission requirements apply to those applicants who desire to be considered as a candidate for the family practice program:
1. The applicant must fulfill the application procedures as follows:
a. Complete the application form either in paper or through the Electronic Residency Application Service(ERAS)..
b. Submit letters of recommendation as requested.
c. Submit copy of college transcript.
d. Submit copy of Board Scores.
e. Arrange for a personal interview with the Program Director, and the Admissions Committee.
2. To become a candidate the applicant must:
a. Be a graduate of an AOA accredited college of osteopathic medicine
b. Be a member in good standing of the American Osteopathic Association.
c. Be eligible for licensure in the state of New York.
d. Be a person of good moral character.
1. Training is provided through in-hospital departments, and the Fordham Plaza Primary Care Center.
2. The St. Barnabas program is conducted at multiple training sites. St. Barnabas hospital offers a program that incorporates all the AOA requirements, but still takes advantage of the uniqueness of training opportunities inherent to the inner city.
St. Barnabas offers a core of required and elective rotations. The following is a Model Sequence for both years of the program:
PGY-2(13 blocks) PGY-3 (13 blocks) Internal Medicine - 3 blocks Internal Medicine - 3 blocks Surgery - 1 block Surgery -1 block Emergency Medicine - 1 block Emergency Medicine - 1 block Obstetrics/Gynecology - 2 blocks Obstetrics/Gynecology - 2 blocks Vacation - 1 block Vacation - 1 block Elective - 2 blocks Elective - 2 blocks ICU - 1 block
During PGY-2 and PGY-3 years, residents are required to continue continuity clinic at Fordham Plaza for 4 sessions a week. The only exceptions include rotation is ICU, outside elective and vacation.
*Behavioral Science and Practice Management are incorporated throughout both years. Residents will see their patients longitudinally during both years of training wherever feasible. The "monthly" designation refers to equivalent time of longitudinal care.
3. The resident is provided with an orderly educational curriculum in each required area of training.
4. The skills necessary for the training of competent family practitioners are emphasized. This includes longitudinal ambulatory patient are in each rotation.
5. The resident is provided with a schedule period for vacation during this year.
All medical subject matter, topic will be discussed in this section for easy reference. Topics inclide:
| Family Practice | ||
| Allergy and Immunology | Cardiology | Critical Care |
| Cultural Competency | Dermatology | Emergency Medicine |
| Endocrinology | ENT | GI |
| Geriatrics | Hem/Onc | Internal Medicine |
| ID | Medical/Ethics | Nephrology |
| Neurology | OB/GYN | OMT |
| Ophthalmology | Orthopedics | Pediatrics |
| Psychiatry | Pulmonology | Radiology |
| Rheumatology | Urology |
Faculty:
Nelson Eng, DO, FACOFP ¨C Director Ext. 6517
The resident shall be able to:
•Elicit an accurate and relevant history.
•Satisfactorily perform a complete or limited (based on the patient’s chief complaint) physical examination.
•Accurately diagnose patients presenting with signs and symptoms of gynecologic, obstetrical, proctologic, urinary, cardiovascular, pulmonary, hematologic, oncologic, endocrine, neurologic, dermatologic, rheumatologic, musculoskeletal, otorhinolaryngologic, podiatric, gastrointestinal, psychiatric, pediatric, and neonatal disease entities. (See specific diagnostic objectives for each of these clinical areas as applicable to a family practice.)
•Demonstrate the proper management of patients with problems in the aforementioned areas. (See special management objectives for each area.)
•Understand the importance of implementing a holistic approach in a family practice. Elicit
•Understand the significance of the family unit.
•Understand the significant role the physician plays as the primary care provider in:
°Evaluating a patient's total health care needs.
°Providing overall control of health care visits.
°Providing continuity of care.
°Evaluating health care costs in respect to cost containment.
•Use current medical knowledge to identify, evaluate and minimize risks for patients and family.
•Balance potential benefits, costs and resources in determining appropriate interventions.
•Understand the relevance of the interaction of biological, psychological, and sociological components when dealing with a patient and his/her support group (family).
•Understand (in reference to above) the differences between the ˇ°biopsychosocialˇ± model vs. the ˇ°biomedicalˇ± model.
•Understand the importance of providing health care to all members of the family regardless of age or presenting complaints.
•Apply the musculoskeletal component of the osteopathic concept as related to the patients off all ages.
•The resident shall be familiar with:
°Modified POMR.
°Chart entries in the S.O.A.P. format.
°The business aspects of family practice.
°Financial management.
°Personnel management.
°Record keeping.
°Costs of setting up a practice.
°Attaining supplies and equipment.
°Insurances/billing.
°Scheduling.
°Group vs. solo vs. partnership practices.
•The resident shall be able to actively take part in:
°Preventive health care and patient education.
°Patient counseling.
°Health maintenance.
•The resident shall be able to:
°Demonstrate competence in academic family medicine:
°Teach (clinical/didactic).
°Perform research design including evaluations of research findings.
°Give professional case presentations.
°Write reports of publishable quality.
•The resident shall:
°Be familiar with community referrals services°Be familiar with the use of allied health professionals as an integral part of medical care.
°Appropriately consult with, or refer patients to, specialty or subspecialty physicians when medical problems arises that is out of the scope of family practice.
Residents are required to:
Read:
1. Appropriate chapters from Taylor’s Family Practice Textbook.
Attend: All family practice conferences and lectures.
Faculty:
Haeyoung hwang, MD ¨C Director Ext. 6625
The resident shall be able to:
•Diagnose and manage anaphylaxis
•Diagnose and manage hives
•Diagnose and manage desensitization
Residents are required to:
Read:
1. Appropriate chapters from Harrison's Internal Medicine.
2. Appropriate chapters from Taylor’s Family Practice Textbook.
Attend: Conferences by Dr. Hwang.
Faculty:
Malconlm Philips,MD –Director of Medicine Ext. 6205
Rubin Silverman, MD – Director of Cardiology
Frank Iacovone Jr., MD – Director of Interventional Cardiology
Schedule:
Daily Schedule begins at 8 am in the cardiac cath. Lab
Clinics –1st and 3rd Tuesday AM
1st and 3rd Thursday AM
Conference – 1st Wednesdayof the month
Morning report – once per month
The resident shall be able to:
•Elicit an accurate relevant cardiovascular history.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations
°Order appropriate laboratory and X-ray studies, EKG, chest
°X-ray, enzyme levels, holter monitoring, echocardiogram, cineangiography, etc
°Accurately interpret laboratory and X-ray results.
•Accurately diagnose patients presenting with signs and symptoms of symptoms of disease entities of the cardiovascular system:
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the cardiovascular system.
°Order priorities to arrive at a diagnosis
°Perform appropriate diagnosis techniques and procedures.
•Demonstrate the proper patient management:
°Initiate appropriate therapy (which may include a cardiology referral or consult).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatment.
°Provide the patient with an adequate understandable description of the diagnosis, treatment, and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
°Be familiar with rehabilitation programs, exercise, diet, life stress reduction, etc.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications.
°Attain vascular access.
•Perform those skills and techniques required for ACLS certification
Residents are required to:
Read:
1. Appropriate chapters from Harrison's Internal Medicine.
2. Appropriate chapters from Taylor’s Family Practice Textbook.
3.Read Dubin's or other EKG text.
Attend: All Cardiology related lectures.
Faculty:
Dr. Ronald Ciubotaru - ICU Director Dr. Darryl Adler – Assist.
Director
Dr. Christopher Grantham Dr. Robert Menkel
Dr. Laurence Miller Dr. Richard Stumacher
Dr. Vanita Gupta Dr. Adey Tsegaye
Schedule:
Each month the housestaff will be divided into 3 teams. During weekdays one team will be short call working 7:45 AM –4:00 PM, a second team will be long call working 7:45 AM- 8:00 PM, the third team will be the night shift working 8:00 PM to 8:00 AM the following day. On weekends shifts will be 24 hours long.The ICU is divided into three “districts” each team will have houseofficers distributed in the three districts. There will be an ICU attending assigned to each district and there will be daily rounds beginning at 8:15 AM. As well there will be sign out rounds at 3:30 PM.
Overview:
Residents, interns, or students participating in this rotation will be expected to learn and practice diagnostic and therapeutic methods of critical care medicine, within a multidisciplinary ICU team. They will be responsible for evaluating and treating inpatients with medical and surgical problems, under the supervision of the intensive care attendings.
The resident shall be able to:
•Developing a logical and timely approach to clinical problems in critical care medicine, while treating patients and their families with respect, empathy, and ethics.
•Understanding indications for, and the interpretation of, diagnostic methods used in critical care medicine, such as arterial blood gases, hemodynamic measurements, radiographic studies, electrocardiography, echocardiography, and pulmonary mechanics.
•Acquiring skill in performing basic procedures in critical care medicine, as well as becoming familiar with more advanced procedures.
•Learning to interact professionally with members of allied services essential to the successful care of the critically ill such as other subspecialists, nurses, respiratory therapists, pharmacists, chaplains, social workers, and others.
Principal Teaching and Learning Activities:
Direct Patient Care (DPC): Residents and students will often perform the initial evaluation of a critically ill patient transferred to the ICU from various settings, e.g. the Emergency Department, inpatient floors, and the operating room. The housestaff team will be responsible for assessing the patient, identifying and prioritizing critical problems, and deriving a plan for management. Appropriate documentation of the evaluation and plan is required, both to aid in the attendings’ evaluation of the housestaff’s performance, as well as to communicate findings to other members of the ICU team. Thorough, timely, and reliable implementation of the plan is also expected. Since patients who are critically ill often cannot themselves participate in their own care, the ICU team will also be responsible for interacting with patients’ families .
Attending Teaching Rounds (ATR): Daily rounds will be conducted by Critical Care Attendings. These cases will serve as springboards for the discussion of many topics in critical care medicine, including cardiac, pulmonary, neurologic, metabolic, renal, gastrointestinal, hepatic, neoplastic, hematologic, and endocrine emergencies involved in the care of postsurgical and trauma cases as well. Review of relevant x-ray studies, lab studies, hemodynamic measurements, and other diagnostic modalities will be included in rounds. Ventilator management will also be taught at the bedside.
Procedure Experience (PE): Residents are strongly encouraged to personally perform basic procedures such as central venous and arterial line placement, Swan-Ganz catheterization, endotracheal intubation, arterial blood sampling, thoracentesis, chest tube placement, etc. All such procedures are done under the personal supervision of the Attending. Emphasis will be placed in understanding proper technique, such as sterile prep, local anesthesia, and knowledge of anatomy. If the resident needs credentialing in a particular procedure, the ICU attending will make every possible effort to ensure the resident’s success. Procedures done by the resident will be documented in the chart. Residents and students may also attend more advanced procedures done in the ICU, such as transesophageal echocardiography, electrical cardioversion, bronchoscopy, and gastrointestinal endoscopy.
Didactic Presentation (DP): Residents and students may be asked by the Attending to give a didactic presentation on a relevant article or topic on any aspect of critical care medicine. This mainly serves as an opportunity to demonstrate knowledge of available literature databases, ability to organize and critique evidence, and facility with communication.
Team 1 (T1): The members of the ICU team will be the first responders to cardiopulmonary arrests in the hospital. As such housestaff and students will have real time experience in how to provide appropriate ACLS care.
Residents are required to:
Read:
1.Pulmonary/Critical Care MKSAP
2.Cecil (via Merck Medicus): http://www.merckmedicus.com
3.UpToDate: http://www.utdol.com
4.Critical Care Medicine - Parrillo/Dellinger
5.Intensive Care Medicine - Irwin/Rippe
6.The ICU Book – Marino
7.Reference to be posted on the ICU website
Attend: All ICU lectures.
Faculty:
Dr. Elena Padilla Ext. 6205
Dr. Nelson Eng, D.O., FACOFP Ext. 6517
Each year, residents complete approximately eight hours of instruction in cultural competency. The main speakers are Dr. Nelson Eng and Dr. Elena Padilla, Scholar-In-Residence .
By the end of this curriculum, residents will know :
•Definition of the culturally competent physician
•Strategies to optimize the use of an interprete
•Usefulness of Kleinman's "explanatory model
•How to elicit the patient's "explanatory model" indirectly.
•The usefulness of the "social context"
•CLAS standards
Residents are required to:
Read:
1. Judy Ann Bigby’s text on cultural competency .
View:
1. Videotaped vignettes from AmericanAcademy of Family Practice
Attend: Cultural Competency core conferences.
Faculty:
Charles GropperM.D. Ext– 6205
Schedule:
Dermatology Clinic from 8:30 am – noon 5th floor of the SBHClinicBuilding
The resident shall be able to:
•Elicit an accurate relevant dermatologic history.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations (patterns of distributions, etc.).
°Order appropriate laboratory and X-ray studies (KOH preps, tzcank smears, etc.).
°Accurately interpret laboratory and X-ray results.
•Accurately diagnose patients presenting with signs and symptoms of disease entities of the integument systems:
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the integumentary systems:
°Order priorities to arrive at a diagnosis.
°Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include dermatologic referral).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatment.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications.
°Attain vascular access.
°Perform basic surgical skills: suturing, suture removal, wart removal, skin biopsies, l+D.
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
5.Stamford On Line: http://www.telemedicine.org/stamford.htm
6.Johns Hopkins: http://dermatlas.med.jhmi.edu/derm/
7.Iowa: http://tray.dermatology.uiowa.edu/ImageBase.html
8.Harvard’s Carl J. Shapiro Derm Case Studies: http://research.caregroup.org/VPtutorials/DERM_dswmedia/initDerm.htm
9.Federman on coetaneous signs of malignancy: http://www.postgradmed.com/issues/2004/01_04/federman.htm
Attend: All Dermatology related lectures
Faculty: Ext. 6103
Ernest Patti, D.O., – Director
Juan Acosta, D.O., – Residency Director
Daily schedule: Assigned each rotation
The resident shall be able to:
•Elicit an accurate relevant history
•Satisfactorily perform a complete or limited physical examination:
°Order appropriate laboratory and X-ray examinations.
•Accurately diagnose patients in an emergency setting:
°Perform diagnostic techniques and procedures.
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the major organ systems.
°Order priorities to arrive at the diagnosis.
•Demonstrate proper patient management:
°Evaluate risks of alternative treatments.
°Initiate appropriate therapy.
°Recognize and evaluate effectiveness of the therapy chosen.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Demonstrate knowledge and skills of airway maintenance.
°Demonstrate knowledge and skills of cardiopulmonary resuscitation (ACLS Certification).
°Perform surgical skills such as repair of lacerations and removal of foreign bodies.
°Obtain vascular access (e.g., by IV catheter, IV cut down, and IV and IA needle).
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Related Topics in Rosen’s Emergency Medicine
4.Cecil (via Merck Medicus): http://www.merckmedicus.com
5.Up-To-Date http://www.utdol.com
6.ER Medicine: http://www.emedmag.com/html/cur/cov/cov.asp
View:
1. NEJM Videos in Clinical Medicine (procedures):
http://content.nejm.org/misc/videos.shtml?ssource=recentVideos
Attend: All lectures
Faculty:
Director - James Hellerman, MD Ext. 6205
Schedule:
Monday afternoon: Endocrine private practice at Bronx Park Suite 302 (822-1515)
Thursday AM: Medical Grand Rounds
Thursday PM: Endocrine Clinic 5th Floor
The resident shall be able to:
•Elicit an accurate relevant history as related to endocrinology.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations.
°Order appropriate laboratory and X-ray studies.
°Accurately interpret laboratory and X-ray results.
•Accurately diagnose patients presenting with signs and symptoms of disease entities of major organ systems:
°Achieve knowledge in the diagnosis of disease of functional or organic origin of endocrine organs and systemic effects.
Order priorities to arrive at a diagnosis.
°Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include an endocrinology referral or consult).
°Recognize and evaluate the effective treatments.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications
°Attain vascular access.
°Perform basic surgical skills – FNA
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
Faculty: Ext. 6202
Dr. Michael Burnett
Dr. Sheila Apicella
Schedule:
ENT Clinic is open to residents on
Thursday mornings from 9:00 - 12:00, please contact regarding other clinic days
The resident shall be able to:
•Elicit an accurate relevant surgical history as related to Otorhinolaryngology
•Satisfactorily perform a complete or limited physical examination:
°Perform and orthopedic examination of specific joints:
°Cervical spine, shoulder, elbow, wrist and hand, lumbosacral spine, hip, knee, ankle and foot.
°Order appropriate laboratory and X-ray examination
°Be familiar with anatomic and physiologic correlations.
•Accurately diagnose those patients presenting with signs and symptoms requiring surgical attention:
°Achieve knowledge in the diagnosis of disease of functional or organic origin.
°Order priorities to arrive at a diagnosis.
°Differentiate between those problems requiring immediate surgical intervention and other non-emergency situations.
•Demonstrate proper patient management:
°Design suitable management plans.
°Recognize the situations that require patient referral.
°Communicate findings, management plan, and prognosis to the patient and/or family.
°Accurately communicate the associated risks and benefits of surgical procedure, including anesthesia (informed consent).
°Evaluate the risks and/or benefits of alternative procedures.
°Give reassurance and provide appropriate patient and/or family counseling when necessary.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Perform surgical skills such as suturing, handling of instruments, removal of sutures, etc.
°Demonstrate sterile surgical techniques.
°Demonstrate proper bandaging techniques.
°Perform such techniques as nasal packing, indirect laryngoscopy, etc.
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
5.SBH On Line References: http://www.teacherweb.com/NY/StBarnabas/Law-PublicPolicy/ent-dt-pwd.htm
6.ENT Online resources: http://www.bcm.edu/oto/othersa2.html
Attend:required ENT Core lectures.
Faculty: Ext. 6205
Dr. Fred FallickDr. Carl Guillaume Dr. Robert Sable
Dr. David Stein Dr. Andrea Culliford Dr. Jeremiah Kurz
Schedule:
Tuesday AM: GI Clinic
Wednesday AM: Liver Clinic
Thursday AM: (after GR) GI Clinic
Liver Pathology: First Wednesday of month
GI Radiology: Last Tuesday of month, 4th floor 4 PM
GI Surgery: Last Thursday of month, Osteo Ed 4th Flr.
GI Journal Club: monthly
GI IM noon time conference: monthly (Core Lecture Series)
All residents are expected to begin their day at 8:30am. On Mondays, Tuesdays and Fridays any undone consults remaining in the consult box outside of the GI office on the 7th floor are to be picked up. Once the patient has been evaluated and examined, the GI attending should be paged to review the case and formulate an assessment and management plan. If there are not any consults pending then residents are expected to report to the endoscopy suite on the 5th floor.
The resident shall be able to:
•Elicit an accurate relevant history as related to GI system
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations.
°Order appropriate laboratory and X-ray studies.
°Accurately interpret laboratory and X-ray results.
°Perform or assist with procedures such as anoscopy, sigmoidoscopy, endoscopy, and paracentesis.
•Accurately diagnose patients with signs and symptoms of disease entities of gastrointestinal system:
°Achieve knowledge in the diagnosis of disease of functional or organic origin in the gastrointestinal system.
°Order priorities to arrive at a diagnosis.
°Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include Gastroenterology referral).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatment.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications
°Attain vascular access.
°Be familiar with the insertion and uses of various tubes (NG, Salem Sump, Miller-Abbott, Sengstaken-Blakemore).
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
Specialty Texts:
1.Sleisenger and Fordtran's Gastrointestinal and Liver Disease
2.Yamada's Textbook of Gastroenterology
3.Schiff's Diseases of the Liver
Attend:Clinics and lectures as above
Faculty: Ext. 6205,6517
Dr. Joel Sender Dr. Robert Sable Dr. Shaparak Motjabi
Dr. Brian Delaney Dr. Edgar Pimentel Dr. Galina Bendich
The resident shall be able to:
•Elicit an accurate history the geriatric patient
•Satisfactorily perform a complete or limited physical examination of the geriatric patient.
•Understand the normal physiologic process of aging.
•Recognize the special problems of the elderly patient.
•Understand the different interactions of biological, psychological and sociological components when dealing with the elderly patient and his/her patient and his/her support group (family).
•Balance potential benefits, cost and resources in determining appropriate intervention.
•Understand the legal and ethical considerations in areas such as the “Right to Die” or “A Living Will”.
•Principles of the geriatric interview including MSE
•Geriatric assessment including common problems
•Geriatric rehabilitation
•Geriatric prescription writing
•Specific geriatric topics (hip fracture, overactive bladder, behavior disturbances, osteoporosis, low back pain, capacity for decision making, dementia evaluation, delirium, feeding tubes, weight loss, depression, failure to thrive, orthostatic BP changes, pneumonia.
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
Faculty: Ext. 6205
Dr. Simeon SchwartzDr. Stuart FeldmanDr. Wanda Noguera
Schedule:
H-O Clinic 8:30 am - 12:00 Mon, Tues, Wed, Thur
Radiation Onc Clinic Fri AM with Dr. Adler
Tues Noon - Tumor Board (except 2nd Tues of month)
The elective is structured to provide residents with active experience in the management of patients with hematological/oncological disorders. The structure of the rotation includes hospital consultations, care of patients in clinic and outpatient setting, preparation of material for hospital-wide conferences, and setting independent goals for review of the literature and acquiring approved database of knowledge in Hematology/Oncology. The elective is a full-time commitment with attending rounds four days a week. On the first day of the rotation, the orientation will include review of the schedule, and review of resident responsibilities During the elective, the residents will divide amongst the various members of the team, consults that are called in. These consults are called into the Department of Medicine and the residents are required to check with the Department of Medicine, two or three times daily, to look for any new consultations. When consults are called in, they require a comprehensive evaluation of the patient. This includes a written history and physical, the elements of which should include an appropriate sub-specialty history of the present illness, notations for past medical and surgical histories, current medications, allergies, social history, and a comprehensive review of systems spelled out. A complete physical examination, including a neurological examination and a complete rectal examination, is part of a comprehensive Hematology/Oncology Physical including a stool for occult blood.
Any hematology case should have a peripheral blood smear made and stained. It should be in the possession of the resident at the time the case is presented. If the residents are not familiar with preparing peripheral blood smears, they should contact the supervisor in the Hematology Lab for personal instruction. The resident is expected to review all radiological studies with either a resident in Radiology, or an Attending Radiologist, as part of the evaluation of the patient. Both current and previous histology should be reviewed with an attending pathologist. The conclusions of the consultation, as well as the recommendations, will be written only by the attending after the case is presented, and the patient examined by the attending. It is best that each resident take one or two consultations a day, as opposed to one resident being assigned to all of the consults for a given day. The residents on the Hematology/Oncology Rotation are responsible for reviewing transfusions that do not meet the guidelines. This is part of an educational program in understanding the importance and implications and Transfusion Medicine. The forms for review are available on a daily basis in the Blood Bank. The resident will devise a schedule to be certain that one resident goes every day to pick up the information. This will be reviewed with Dr. Noguera on Mondays and Dr. Feldman on Thursdays.
Attending Rounds occur on Monday starting at 8:00 a.m., Tuesday at 8:00 a.m., Wednesday at 8:00 a.m., and Thursday at 9:00 immediately following Grand Rounds. On Fridays, the residents will see consults and then report to Dr. Adler in the basement of the clinic building for Introduction to Radiation Oncology. On the last Friday of the month, the residents will joinDr. Feldman at the Surgical Tumor Board at 8:OO AM in the Breaker Board Room. Residents will be responsible for PowerPoint presentations (utilizing PowerPoint templates) of patients chosen to be discussed at the Hematology-Oncology Tumor Boards which are scheduled on Tuesdays at 12 noon. When a resident is unable to attend rounds for that day, they need to contact the attending and explain the reasons for their absence. At the conclusion of the rotation, Drs. Feldman and Dr. Noguera are interested in a personal interview with each resident to discuss their accomplishments during the month, as well as suggestions for improvement of the rotation. At this time, the residents will receive feedback concerning their performance and evaluation forms will be completed simultaneously. In order to pass this rotation you have to work up cases.
For example: If you have a patient with CML, go to UpToDate.com to read about the diagnosis and management of CML. Other websites, which may be consulted, include PDQ on the cancer.gov site and the treatment guidelines on the NCCN.org site. You should follow this protocol for all the cases in Hematology & Oncology rotation.
The resident shall be able to:
•Elicit an accurate relevant hematologic/oncologic history.
•Satisfactorily perform a complete or limited physical examination:
°Be familiar with anatomic and physiologic correlations.
°Order appropriate laboratory and X-ray studies.
Accurately interpret laboratory and X-ray results.
°Demonstrate familiarity with cancer screening techniques.
•Accurately diagnose patients presenting with signs and symptoms of hematologic or oncologic disease entities:
Achieve knowledge in the diagnosis of disease of functional or organic origin in the major organ systems.
Order priorities to arrive at a diagnosis.
Perform appropriate diagnostic techniques and procedures.
•Demonstrate proper patient management:
°Initiate appropriate therapy (which may include an oncology or hematology referral or consult).
°Recognize and evaluate the effectiveness of the therapy chosen.
°Evaluate the risks of alternative treatments.
°Provide the patient with an adequate understandable description of the diagnosis, treatment and prognosis.
°Give reassurance and provide appropriate counseling to the patient and/or family when indicated.
°Design suitable management plans.
°Demonstrate sensitivity and psychological needs of the cancer patient and their family (especially when dealing with a dying patient).
•Demonstrate the ability to select and employ the proper treatment modalities:
°Know indications and contraindications for use of various medications (chemotherapy regimens).
°Attain vascular access.
°Be familiar with various methods of alleviating protracted pain.
Residents are required to:
Read:
1.Appropriate chapters from Harrison’s Internal Medicine
2.Appropriate chapters from Taylor’s Family Practice Textbook.
3.Cecil (via Merck Medicus): http://www.merckmedicus.com
4.Up-To-Date http://www.utdol.com
5.NCI: http://www.cancer.gov/
6.NCI-Trials: http://www.cancer.gov/clinicaltrials/
Attend:Clinics and lectures as above
Faculty:
Dr. Judith Berger, Chief of ID, Beeper **000
Dr. Victoria Bengualid, Attending in ID, Faculty Advisor in Research, Beeper **612
Dr. Michelle Dahdouh, Attending in ID, Beeper **329
Dr. Carol Epstein, Attending in ID, Beeper **521
You will report to 7th Floor Department of Medicine from Monday to Friday at 9 AM except Wednesday when youwill report to 4th Floor DAC clinic at St. Barnabas Hospital Ambulatory Center at 9 AM.
Introduction
Welcome to the Infectious Diseases Elective. As part of the rotation, you will be expected to participate in the Inpatient consultation service and our HIV DAC ambulatory clinic.
Residents and students on service will be expected to perform thorough infectious diseases evaluation of patients in the hospital, perform thorough HIV outpatient primary care at DAC clinic, attend conferences and lectures, and complete outside reading and self-study. You will also have the opportunity to participate in ongoing research projects in Infectious Diseases if you wish. During the rotation, you will become knowledgeable and proficient in treating infections in general medicine, emergency room, geriatric, hematology oncology, intensive care, OB/GYN, surgical, trauma, HIV patients, and HIV outpatient primary care.
At the beginning of the rotation, you will be given a packet including up to date St. Barnabas Hospital/ Nursing home antibiogram, empiric antimicrobial therapy guide, and state of the art Infectious Disease articles. There will be an ID quiz available on line. Please complete the quiz by the end of the rotation as part of your evaluation. During the rotation, we will give you feedback on your performance and at the end we will fill out an evaluation on your performance according to ABIM guidelines. If you are having any problems, please alert us as soon as possible to try to remedy the situation. Included in the packet, there will be an evaluation of the elective for you to fill out and return to us. Please let us know what you like and dislike about the rotation. All feedback is welcome.
Schedule:
Grand Rounds: Outside speakers on various ID topics and CPCs on ID cases.
Morning Report: Inpatient cases with ID issues discussed with Attending.
DAC & ID Conference: Outside speakers include topics such as Resistant Organisms and New Antibiotics, HIV Resistance and New Treatment, Metabolic Complications of HIV and HAART, HIV Updates, etc.
Noon Conference includes lectures given by our faculty: Acute HIV Infection, Opportunistic Infections, What is HAART and When To Start, HIV Resistance and Resistance Testing, HIV and Pregnancy, Complications of HAART Therapy, HIV Jeopardy, HIV path physiology, virology and HAART class targets, Post exposure Prophylaxis, ID Jeopardy, Travel Medicine, Empiric Antibiotic Coverage, Resistant Bacteria, Community acquired Pneumonia, Bioterrorism, Meningitis, Mycobacteria, Soft Tissue Infections, Necrotizing Fasciitis, Osteomyelitis, Central Venous Line Infections.
Suggested Resources: Residents and students have access to Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, Harrison’s Principles of Internal Medicine, The Sanford Guide to Antimicrobial Therapy, The Sanford Guide to HIV/AIDS Therapy, St. Barnabas Hospital Intranet Library On Line, Up To Date, Medscape, and medical journals through St. Barnabas Medical Library located on the 5th Floor Braker Building.
Internet sites on HIV topics:
1.International AIDS Society- USA at http://www.iasusa.org
2.AIDS Info at http://www.aidsinfo.nih.gov
3.The American Academy of HIV Medicine at http://www.aahivm.org
4.HIV Drug Resistance Database at http://www.hivdb.stanford.edu
5.AIDS Research at http://www.amfAR.org
6.HIV Clinical Resource ¨C NYSDOH AIDS Institute at http://www.hivguidelines.org
7.John Hopkins POC-IT ¨C HIV Guide at http://www.hopkins-hivguide.org
8.John Hopkins AIDS Service at http://www.hopkins-aids.edu
Internet sites on Infectious Diseases topics:
1.International AIDS Society- USA at Emerging Infectious Diseases Links at http://www.cdc.gov/ncidod/id_links.htm
2.Infectious Diseases Society at http://www.idsociety.org
3.CDC and Bioterrorism at http://www.bt.cdc.gov/agent/agentlist.asp
4.CDC and Travel Medicine at http://www.cdc.gov/travel
5.John Hopkins Infectious Diseases Antibiotic Guide at http://www.hopkins-abxguide.org
6.BMJ on Handwashing: http://bmj.bmjjournals.com/cgi/content/full/325/7360/396/a
7.Appropriate chapters from Harrison’s Internal Medicine
8.Appropriate chapters from Taylor’s Family Practice Textbook.
9.Cecil (via Merck Medicus): http://www.merckmedicus.com
Attend:All related lectures
Faculty: Ext. 6205
Dr. Richard Stumacher
Dr. James Croll
Medical Ethics (a component of Professional