Rotations

Sample Schedule

Rotation  Type PGY 1 PGY 2 PGY 3
Floors 6-7 Blocks 3-4 Blocks 1 Block
Nights 1-2 Blocks 1-2 Blocks 1 Block
MICU 1 Block 1-2 Blocks 1-2 Blocks
Vacation 1 Block 1 Block 1 Block
Electives 2-3 Blocks 3-4 Blocks 5-6 Blocks
Hospitalist N/A N/A 1 Block
Admitting Resident N/A N/A 1-2 Blocks

Rotations

Program Structure: The academic year at Lincoln Medical Center is divided into thirteen rotations (four-week blocks).

Medical Ward Rotation:

General Teams Structure

  • There are a total of 8 Medical Ward Teams who care for inpatients in General Medicine.
  • Each team consists of one PGY2 resident, three PGY 1, and one or two medical students from St. George’s University Medical School.  Some teams will have PGY-3 as a junior attending.
  • The average number of patients carried by each team is 14-20 (interns are capped at 10 patients).
  • PGY 3 residents work on the in-patient units as either Junior Attendings (during day time) or Hospitalists (during evening time) which allows significant autonomy in patients care.

On-Call Structure

  • While on the ward rotation, teams admit patients every day (interns are on-call every third day until 8 pm). There is no overnight call for Interns and residents rotating on ward services.
  • At any given day all teams are on call. They admit patients until 7 pm. At 8 pm night float takes over the admitting duties.
  • Interns and residents are ensured at least one full day off every weekend (either Saturday or Sunday).
  • MICU calls during the weekend are covered by residents in the elective rotation. There are no 24h calls. The longest call for residents at all levels is 14 hours.

Night Float Rotation: Team consists of two PGY-2 residents and four/five interns who provide cross coverage for patients on the medical ward services. Schedule is six days per week for a total of two weeks rotation. All the admissions to the medical wards are supervised by the on call Hospitalist and they are available in case of emergency. The night float shift starts at 8 pm and ends at 7 am.

ICU – CCU / UF Rotations: There are 22 ICU beds on the medical service. The MICU teams consist of two Pulmonary and Critical Care Attending, One Pulm/Critical Care Fellow, One senior resident, two PGY2 and four PGY1, for a 1 month period Day and night teams work in 12 hour shifts (7am-7pm), eliminating overnight calls in MICU during weekdays. UF teams consists of one senior resident, one PGY2, two PGY1. Schedule is five days per week for a total of two weeks. There is 24 hour attending coverage in the ICU.

MAR (Medical Admitting Resident): MAR is a unique rotation done by PGY3 residents giving them the opportunity to quickly assess the patient’s condition based on available data and triage the patients accordingly. Once patients are admitted by the ED, house staff from ER presents the patient to MAR.

MAR will triage the patient based on the severity and assign the patient to one of the on call teams or will consult MICU for admission. Besides supervising all admissions, MARs provide consultation services to all other departments in the hospital. They work in 12 hour shifts for a total of 14 shifts in the month.

Simulation Laboratory: Lincoln Medical Center is proud of its Simlab which was opened in 2012. All residents and medical students will go through training sessions in the Simlab including clinical scenarios, procedures, team work, communication skills, embedded patients and megacodes. The lab has state of art equipment and it has shown to enhance the educational aspect of the residency program during their residency training.

Bellevue Rotation: Residents rotate in the CCU of Bellevue hospital to get exposure to management of pre and post Cardiac Cath patients.  

Practice Based Learning (PBL) Rotation: Residents will teach junior residents, interns and medical students and participate in Simlab activities. Their teachings will follow a schedule depending on the time of the year. PBL rotation will be given to mainly PGY3 and to some PGY2 residents.

Electives: For subspecialty rotations, residents divide their time between outpatient clinics, pre-operative clinics and inpatient consultation services. When rotating on the Subspecialty Services, interns and residents work closely with Subspecialty Attending. On average, 33-50% of the elective is devoted to outpatient subspecialty work and the remainder to inpatient (consultation) work. Residents on the elective rotation get one or two MICU weekend calls. Electives are very good rotations to get direct exposure to special procedures  and get hands on experience of many outpatient procedures like Bone marrow Biopsy, Arthrocentesis and joint injections, Hemodialysis, EGD/colonoscopy, PAP smear.

Ambulatory Care: Quality ambulatory care training is a critical part of our program. We have on-site ambulatory care pavilion and two satellite clinics: Belvis and Morrisania, that are about 10-15 minutes away. Faculty practices are now completely integrated with the resident practices, and the house staff works side by side with their preceptors. Each resident spends one half day per week in their continuity practice and one to two months in an ambulatory block rotation each year of their residency. This greatly improve residents experience in continuity of care practice as well as focused learning of the special skills needed for competence in outpatient medicine. These rotations offer ample time to experience and gain skills in medical areas such as gynecology, ENT, ophthalmology, women’s health, adolescent medicine and allergy clinic. Third year residents manage their own patients independently and are supervised by attending physicians indirectly.

Point of Care Ultrasound (POCUS) Rotation: It is a new two weeks rotation started in July 2019 supervised by one of three faculty members trained in hospitalist POCUS. The department has 3 US machines and 3 hand held devices. The resident will do POCUS of lungs, heart, IVC, aorta, kidneys and bladder among other organs. The resident will have exposure to normal and abnormal findings. Also, POCUS has been used for many years during procedures.

Ventilators Management Rotation: This is a two weeks rotation done by PGY3 residents. They oversee the care of all patients who are on ventilator on the telemetry unit along with the primary medical teams and under the supervision of the ICU team. They also conduct daily teaching sessions for residents regarding ventilator management and alarms. 

Research Rotation: It is a two weeks rotation. The resident should discuss his/her project with Dr. Vidhya Menon, the Research Director of the department, one month before the rotation and develop a clear plan on the work flow during the rotation. The expectations are to be involved in clinical researches, QI projects and writing case reports and posters.