Core Curriculum

Continuity Clinic

The experience and instruction that internal medicine residents receive in their outpatient primary continuity clinics is perhaps the most important part of training for a career in primary care. The Broward Health North Internal Medicine residency program is committed to excellence in outpatient training. We strive for our residents to acquire competence, confidence, and satisfaction in the practice of medicine.

The continuity clinic experience is based on delivering the highest quality care to the residents’ patients. The residents will see new and former patients, perform a history and physical, a diagnosis, and plan that is reviewed with the attending physician. While caring for their patients, residents apply and continue to learn the general competencies as they relate to ambulatory medicine. Residents start their first continuity clinic sessions as interns. There will be exposure to common and uncommon conditions; as well as a focus on preventive care, healthy lifestyle changes, stress reduction, performing a cost-effective and value-based workup, in addition to effective communication and patient satisfaction. The ambulatory medicine continuity clinic experience consists of one half-day clinic every 5th week for all PGY levels except during vacation and night float rotations. The first-year resident also acquires some patients from the class that has immediately graduated to allow continuity for the patient and builds the PGY-1 patient panel. 

Preceptors supervise up to three residents per session. In all continuity sites, the resident physician acts as the primary care physician for his/her panel of patients. Preceptors will provide the supervision and back-up required by each resident. The preceptor closely supervises the care provided by the residents, enabling residents to assume progressive responsibility and autonomy in the management of their patients. Residents are exposed to all facets of ambulatory internal medicine through an integrated curriculum.

Emergency Medicine

The basics of emergency medical decision-making are taught under the supervision of full-time emergency department faculty of Broward Health North. The resident, under the close supervision of the Emergency Department (ED) attending, evaluates both medical and surgical patients, critical and non-critical acute complaints.

Our faculty will provide residents with decision-making support; they also demonstrate and instruct appropriate physical examination skills and assist residents in developing a broad differential diagnosis. The spectrum of disease treated in the ED includes medical, surgical, orthopedic, gynecological, ophthalmology specialties and trauma. Activities include everything from suturing through ACLS protocols. The resident is expected to work 7 am to 6 pm Monday through Friday, with the time given off for Noon Conference 12-1:00 pm.

The focus for PGY1, emphasizes the importance of physical exam and history taking, learning to prioritize, and presenting a concise differential diagnosis. The PGY1 learns the essentials on triaging ED patients.

 Inpatient Wards

The general medical ward rotation is a valuable learning experience during residency. Direct care of hospitalized patients is the cornerstone of developing a resident’s skills as an internal medicine physician.  Residents will receive a broad introduction to the evaluation and management of a wide variety of diseases related to general internal medicine. In addition to the routine case mix for general internal medicine wards, the rotation provides a unique opportunity for residents to consider the complex relationships between health status and poverty including in depth clinical experiences with substance abuse, co-morbid medical and psychiatric disease, geriatrics, HIV/ AIDS, homelessness, international and immigrant health.

The inpatient service functions on the premise of shared responsibility between house officers and attending staff.  Interns (and acting-interns) will admit and manage patients completely, calling upon the resident and attending staff for consent and guidance when indicated.  House officers write all orders. The attending, who may or may not have ongoing relationships with the patients, have legal responsibility for patient care. Residents, as trainees, and attending as teachers will collaborate to guarantee their patients the best medical care, the best learning experience, and the most collegial and satisfying work environment possible.

Residents will be responsible for the initial assessment, examination, write-up-plan, orders, and procedures of all the patients admitted to the General Medicine Service. The residents will generate a differential diagnosis and diagnostic and therapeutic management plans in collaboration with the attending physician of record through daily interaction.

Residents will evaluate patients admitted to the internal medicine teaching services.  A problem list with differential diagnoses will be generated, appropriate studies will be ordered, and management will be initiated. The resident will follow and help dictate the patient’s management plans throughout their hospital stay. 

Adolescent and adult patients of both genders and of various socioeconomic levels with various stages of illnesses comprise the inpatient population seen at Broward Health.

Intensive Care Unit

The Intensive Care Unit is a dynamic environment that provides the valuable experience needed to complete your medical residency. Critical Care Medicine is a discipline that involves patients with a host of medical problems and is characterized by a multidisciplinary approach to management.

The Intensive Care Unit (ICU) rotation has both surgical and medical ICUs. There be will daily morning multidisciplinary rounds and ICU teaching sessions.  The residents will be exposed to a large variety of pathology including general medical, neurological, cardiovascular, surgical, and neurosurgical patients. The residents will generate a differential diagnosis and an appropriate plan of action that will include ordering diagnostic tests and therapeutic interventions.

Night Float

Night float will be responsible for the initial assessment, examination, write-up-plan, orders, and procedures of all the patients admitted to the General Medicine or ICU Service. The residents will generate a differential diagnosis and diagnostic and therapeutic management plans in collaboration with the attending physician of record. The night float resident is supervised by the senior second or third resident and/or attending. The resident will discuss orders with either the senior or attending and place orders after deemed competent.

Selective Elective Rotations

Allergy and Immunology

This is primarily an outpatient rotation with an occasional evaluation of patients in the inpatient setting. The resident will initially see both new and follow up patients and will present a formal plan of diagnostic evaluation and treatment to the attending physician. The attending physician mentors the residents on their thought processes, appropriateness of the suggested testing profile and review the history and appropriate portions of the physical examination with the residents.

Cardiology

The care of the cardiac patient will be taught both in an inpatient setting and in the outpatient cardiology clinic. Cardiovascular history taking, and physical examination will be emphasized. Differential diagnosis, appropriate use of diagnostic tests, formulation of treatment plans, and familiarity with cardiovascular interventions, medications, complications, and side effects will be taught.  Residents will see predominantly new patient admissions, consultations, under the close supervision of the rotating staff, and will also follow up on the patients assigned to them on the hospital side. In addition, residents will participate in the performance and interpretation of diagnostic cardiac testing, including EKG, telemetry monitoring, treadmill stress tests, stress echocardiograms, and perfusion studies. Opportunities to observe transesophageal echocardiography, cardiac catheterization, and percutaneous coronary intervention will also be offered to interested residents.

Upon completion of the rotation, residents are expected to be capable of providing basic cardiovascular care in accordance with current practice guidelines; understand the indications, risks, and limitations of diagnostic tests; become familiar with cardiovascular drugs, their side effects, and drug interactions; have a solid foundation and understanding of cardiac physiology and be able to form clinical assessment and treatment.

Dermatology

During this rotation, there is a one to one interaction between the resident and the attending physician. The resident sees new and former patients, and after performing the history and physical exam, the resident presents to the attending physician. After the presentation, there is a discussion on the differential diagnosis and treatment plan.

Residents will have the opportunity to see patients with common and uncommon conditions, in addition, will focus on preventive health screening, risk factor modification, behavioral counseling, stress management, with emphasis on being cost-effective and providing value-based care.

Endocrinology

Residents will spend a 2-4-week rotation in inpatient and outpatient Endocrinology. The resident will examine patients as a consultant under the supervision of the endocrinologist. The educational purpose of this rotation is to teach the knowledge and skills within the medical specialty of endocrinology necessary for the management of general internal medicine patients. Residents will acquire skills sufficient to diagnose, follow, and treat patients with common endocrine disorders and recognize those patients that should be referred to endocrinologists. Additionally, residents will also learn to be cost-effective and will develop an understanding of when an endocrinology consult is indicated.

Gastroenterology

The Gastroenterology rotation provides a valuable experience needed to complete your medical training. The purpose of the rotation is to expose the residents to problems commonly encountered in the practice of Gastroenterology. The Gastroenterology rotation provides the opportunity for residents to consult on hospitalized patients referred by their primary care physicians regarding specific issues related to gastrointestinal problems that often include complex cases. This responsibility includes response to consult requests in a timely fashion as required by the circumstances, knowledge of all patients on the service, supervision of senior medical students, participation in provides including patient preparation and disposition following hospital discharge.

Residents will spend time in the hospital seeing primary Gastroenterology patients or referrals from medical and surgical subspecialties, and they will also rotate in the ambulatory setting.  Residents will also participate in relevant invasive procedures such as paracentesis when appropriate and observe endoscopic procedures

Geriatrics

Outpatient Geriatric Medicine focuses on the comprehensive care of frail elderly patients with chronic medical problems. Emphasis will be placed on the special needs of this group with specific attention to elements such as functional status, polypharmacy, altered mental function, disturbed psychosocial abilities, normal aging changes, and multiple coexisting medical illnesses. Methods of blending the highly sophisticated and technological medical system with the special needs of frail elderly individuals will be explored. Resident training in inpatient geriatric medicine includes inpatient consults and admissions as well as follow-up at rehabilitation centers and nursing homes. There is emphasis during the geriatric rotation of the importance of following the recommendations made by the American Geriatrics Society, The American College Physicians, and the Society of General Internal Medicine.

Gynecology

The residents will have the opportunity to observe and participate in the work-up and treatment of patients with a wide variety of women’s health problems commonly encountered in the office as a General Internist.  Such problems include fertility, amenorrhea, hirsutism, vaginal bleeding, UTI, incontinence, abnormal PAP, preventative health measures, contraception, abnormal mammogram.

Hematology/Oncology

The Hematology/Oncology rotation is both inpatient and outpatient. Residents will be responsible for new consultations and follow-up of inpatients under the close supervision of the attending. The resident will also spend the remainder of the morning and the afternoon in the clinic seeing both new and follow-up patients.

Spending time in the chemotherapy unit observing patients receiving treatment as well as going to the radiation facility is encouraged. There is a tumor board noon conference every monthly on Tuesday.

Infectious Diseases

The infectious diseases rotation is both inpatient and ambulatory. It provides resident physicians with the knowledge necessary to evaluate and treat a diverse group of patients with common and uncommon infectious diseases. The emphasis will be on how to diagnose and treat infectious diseases commonly encountered in the practice of internal medicine. The unique aspects of our population include tropical and subtropical infectious disease experiences, HIV, and travel medicine. It also allows the resident to learn how to manage patients in the hospital and intensive care unit setting

Nephrology

The Nephrology rotation is a consultative, inpatient, and outpatient experience. The objective is to ensure that the residents acquire adequate experience in the evaluation, diagnosis, and treatment of patients with all forms of kidney diseases. The resident should gain competence in the treatment of hypertension, electrolyte disturbances, acute renal failure, chronic renal failure, and acid-base abnormalities. The resident gains knowledge of renal problems managed by the general internists and should become familiar with the indications for dialysis and referral to a nephrologist.

Neurology

The Neurology rotation is both in the inpatient and outpatient setting along with the Neurology attending. The resident rotating in Neurology has the opportunity to be exposed to acute neurological disorders encountered in ED, Intensive Care Units, and Neurointerventional radiology. The resident will have exposure to patients with various neurological symptoms, illnesses seen in hospitalized patients, and to a variety of new or old neurological entities seen in the outpatient setting. The resident will participate in staff rounds and review neuroimaging studies. Residents will participate during the stroke alert process.

Palliative Care Medicine

Palliative care is an inpatient and outpatient medical experience intended to assist the resident’s transition from didactics to integrated clinical evaluation, decision-making, and management of patients. In addition, the resident should continue to develop skills in systematic clinical problem- solving and patient management abilities, establish and reinforce patterns of independent learning and self-evaluation, and improve skills in communication and medical record keeping.

Physical Medicine and Rehabilitation

The rotation is 50% inpatient and 50% outpatient with the Physical Medicine and Rehabilitation (PM&R) division. The residents will see inpatient consultations and spend time in the outpatient setting.

The expectation is that the residents become knowledgeable about learning the indications for inpatient and outpatient Physical Medicine and Rehabilitation as well as the contraindications. The rotation is designed to provide a quality teaching relationship with a Physiatrist.

Psychiatry

This is an inpatient and outpatient rotation; and consists of a one to one relationship between a resident and an attending Psychiatrist that mentors the resident on the thought processes, appropriateness of the suggested testing profile and review the history of the patients. The resident will be exposed to a wide range of psychiatric diagnostic modalities, services provided in the office. Pathology commonly seen include; anxiety disorders, depression, dysthymia, adjustment disorders, personality disorders, schizophrenia, and bipolar disorders as well as family counseling indications.

Pulmonary and Sleep Medicine

The rotation is 50% inpatient and 50% outpatient with the pulmonary division.  The rotation is designed to provide a quality teaching relationship with a Pulmonary Consultant.  The residents will see inpatient consultations and spend time in the outpatient setting. Residents will have the opportunity to learn the interpretation of Pulmonary Function Tests and to learn procedures such as thoracentesis, reading chest x-rays, understanding the basics of CT chest and bronchoscopy.

The expectation is that the residents become knowledgeable in diagnosing common pulmonary problems likely to be seen by the Internist such as cough, dyspnea, COPD, bronchial asthma, interstitial lunch disease, lung cancer, and sleep disorders.

Rheumatology

Rheumatology is primarily an outpatient rotation. Disease processes that will be reviewed include; but are not limited to: crystalline arthropathies, degenerative joint disease, rheumatoid arthritis, occupational and sports-related overuse syndromes, regional pain syndromes, fibromyalgia, septic arthropathies, reactive arthropathies, vasculitis, myositis, and scleroderma.

This rotation provides the residents with a broad overview of rheumatology and familiarizes them with the diagnosis and treatment of rheumatological entities commonly encountered in the practice of internal medicine.

Additional Rotations

Addiction Medicine

The purpose of the Addiction Medicine rotation is to supplement residents learning by providing the specific knowledge, attitude, and skills needed to manage patients with alcohol and other substance use disorders including prescribed medications and other non-proprietary drug use. The goal is that residents will be able to recognize addiction problems, perform referrals appropriately and effectively, manage patients who refuse referral, work in conjunction with addiction medicine specialists for patients who accept the referral, and integrate addiction medicine with the management of the numerous co-morbid medical and psychiatric disorders these patients often exhibit.

Non-operative orthopedics

Residents will be exposed to office-based experience in musculoskeletal medicine. The mission of this rotation is to provide exposure to and education in various areas of orthopedic including the common orthopedic conditions seen by internal medicine physicians such as fractures, proper use of supports, braces, casts, and the basics of rehabilitation, diagnosis and treatment of osteoarthritis, shoulder, elbow, hand, ankle, and foot, and exercise therapy for the orthopedic patient.

Ophthalmology

This rotation has the objective of providing training in the appropriate diagnosis, management, and treatment of the patient with ophthalmologic conditions; as well to provide education in the area of routine screening evaluation within the primary care setting. Knowledge should include recognition of commonly encountered eye disorders, their relationship to other medical diseases, and proper performance of diagnostic and therapeutic procedures along with knowledge of associated risks, benefits, and costs

Otolaryngology

This is an outpatient rotation with infrequent in-patient consultations. Residents will become familiar with common ENT conditions like otitis, sensorineural hearing loss, acute labyrinthitis, benign positional vertigo, sinusitis, epiglottitis, hoarseness and dysphagia, head and neck malignancies, and diagnosis of retropharyngeal abscess.

The resident performs a complete history and physical and becomes familiar with the use of direct flexible laryngoscopes, nasal speculums, and headlamps. Attending physicians will mentor the residents on their thought processes.

The resident is encouraged to accompany the audiologist in their evaluations, including a complete hearing test in the soundproof booths. The resident is encouraged to accompany the speech pathologist in their evaluations, including modified Barium Swallow, Acoustic Voice Analysis, and Laryngeal Video Stroboscopic. They may assist in minor laser and surgical procedures in the office. The resident will review all the radiology pertaining to the patients including films, CT scans, and MRI studies.