Director: Erik Polan, DO
The transitional year residency at PCOM is a one-year program with intensive training in a multitude of aspects of medicine.
It stresses not only training a complete physician with a broad-based education in clinical medicine and surgery, but also a physician who practices medicine with kindness and compassion; who communicates with respectful, logical actions and words; and who integrates osteopathic philosophy into the care of the entire person. By continued example, the resident is taught to nurture growth, research, teaching and best standards of practice.
It is believed that this thorough grounding in fundamental knowledge and the solidification of the many facets of medicine will lead to improved patient care, public instruction and a confident physician ready to move towards his or her career path. To provide diversification of patient experience and teaching attendings, transitional year residents will rotate at several sites.
The transitional year provides a solid foundation in the fundamental clinical skills of medicine, resulting in the graduate being well prepared to start residency in their field of choice. Our standard curriculum includes:
The transitional year program also includes:
All residents are to develop the following competencies:
The transitional year resident will be precepted by a faculty member specializing in ophthalmology and optometry through the office location(s) of Dr Kenneth Heist and colleagues. The resident will work alongside the ophthalmologist/optometrist and will be on a one to one basis so didactic material is delivered to the resident on an informal basis throughout the rotation. The resident will be exposed to ophthalmic procedures and diseases commonly encountered by primary care physicians, and gain insight into the field of ophthalmology itself. The resident with contact Dr. Heist at least one week prior to the beginning of the rotation to confirm, and obtain a schedule for the month.
Renal disorders are commonly evaluated by general internists. Disorders may be primarily renal in origin or systemic diseases that have profound secondary effects on the kidney, such as diabetes, vasculitides and atherosclerosis. General internists must be able to recognize, evaluate and initiate treatment for common renal disorders as well as understand the relationship between systemic processes and the kidney. Prevention of renal disease assumes paramount importance in decreasing the burden of chronic kidney disease. Occupational exposures in the dialysis unit to blood borne pathogens such as Hepatitis B and C and HIV are discussed. Caring for chronic renal patients involves occupational risks to the practitioner. The socioeconomic aspect of chronic kidney disease on overall health care spending is important for the residents to understand. Environmental, nosocomial iatrogenic causes of renal disease are considered including the use of contrast dye, drug induced renal disease and medication induced changes in initiating renal hemodynamics and drug disposition. The difficult ethical issues of withholding renal replacement therapy and discontinuing renal replacement therapy are encountered.
Hematologic problems are extremely common in hospitalized patients and patients with chronic illnesses in the outpatient setting. These diseases may be primarily hematologic or may be secondary to other illnesses or conditions. It is important for the internist/family practitioner to appreciate these abnormalities and know the appropriate work-up and therapies available. Internists/family practitioners may use these hematologic abnormalities to uncover primary disease elsewhere in the body. Thus, it is incumbent upon the internist/family practitioner to have a working knowledge of typical hematologic conditions.
End of life issues, aggressiveness of care issues in patients with incurable malignancies, use of hospice programs and discussion of pain control are regularly encountered and discussed during this rotation. Universal precautions include the handling of blood products; the complications of blood transfusions, including antibody reactions and infectious complications such as HIV and hepatitis care, are reviewed. Occupational and environmental exposures to hydrocarbons and benzene containing compounds are reviewed when patients present with leukemias.
The resident will be exposed to a range of health issues within the elderly population. The role of the physician as part of a multidisciplinary health care team will be demonstrated in a variety of clinical experiences, Residents will have clinical exposure in a number of sites depending on the focus and objectives of the resident. These may include community assessment visits, inpatient and outpatient rehabilitation services, acute care consultations, and ambulatory clinics. The resident will acquire competence in the assessment and management of specific diseases common in the elderly and gain experience providing clinical care to frail elderly.
The general surgery rotation is done during the PGY-1 year. The surgical team provides care for general surgery patients, and patients with trauma and vascular issues. The resident is exposed to a wide spectrum of surgical illness.
The resident will gain experience with the resuscitation of patients from blunt and penetrating trauma as well as patients with general surgical needs. Instruction will occur in ventilator management, fluid management, and pre- and post-op evaluation of the surgical patient.
Pulmonary diseases are very common. Acute respiratory disease are among the most common illnesses affecting humans and are responsible for more absences from work and school than most other types of illnesses. Chronic respiratory diseases, especially bronchitis, COPD, and emphysema, are exceeded only by cardiovascular diseases as causes of disability payments. Malignancies of the lung rank first among deadly neoplasms. Because of these high rates of pulmonary diseases, it is important for the internist to be able to identify clinical manifestation of pulmonary disease and to be aware of the diagnostic methods, therapeutic options and preventative strategies of these diseases. The impact of cigarette smoking as well as other environmental toxins will receive early emphasis. Learning how to increase cessation rates among cigarette smokers provides powerful prevention tool for pulmonary as well as many other disorders. End of life care discussion commonly occurs in patients with end stage lung diseases.
The pulmonary rotation is a month-long elective rotation, with a focus on outpatient Pulmonary and inpatient pulmonary consults.. During this rotation, the residents will admit patients to the pulmonary service, perform inpatient consults and assist in the longitudinal management of patients with common pulmonary problems. During the rotation, the Transitional year resident will gain a broad knowledge base in the care of patients with pulmonary diseases. The resident will be expected to recognize, diagnose, evaluate and treat pulmonary disease commonly encountered by a practicing internist. The resident will be introduced to some of the major pulmonary ailments, discuss the major pathophysiologic mechanisms of disease and use these mechanisms to better understand therapeutic modalities.
The goal of this rotation is to expose the trainee to the concepts of the pharmacology and principles of regional and general anesthesia, the pathophysiology of pain, as well as procedural skills crucial to airway management and invasive cardiac monitoring. Basic airway management skills will be emphasized, but the trainee will gain experience with more advanced techniques like the Glidescope
Transitional year residents will be exposed to and learn to care for internal medicine patients in the ambulatory setting, as well as, additional inpatient exposure on Dr. Polan’s inpatient service at Roxborough Memorial Hospital. In addition to learning and practicing medical management of ambulatory patients, residents will be exposed to additional aspects of running a clinic/outpatient office—such as preventive visits, medical coding and billing. The experience will occur over one, four-week block. A schedule will be provided at the time of elective choice.