Subspecialty Rotations

Residents Diversify Their Knowledge and Skills

Subspecialty rotations in the Scripps Mercy Hospital Internal Medicine Residency Program are four weeks in duration—except rheumatology, which runs two to four weeks.

We also offer elective opportunities in non-internal medicine subspecialties.

Trainees provide care at Mercy Clinic, inpatient wards and private practice offices, studying the following subspecialties:

Adolescent medicine

Rotation duration: 2 weeks

Educational experience: Residents will develop skills in working with adolescents and diagnosing/managing adolescent syndromes and diseases. This rotation is supervised by board certified adolescent medicine physicians at the Naval Medical Center in San Diego.

Cardiology

Rotation duration: 4 weeks

Educational experience: Residents will develop skills in diagnosing and managing cardiology problems, interpreting ECGs, exercise tests and echocardiograms. Bedside history and physical exam skills are emphasized on the cardiology consult service. Residents have 24/7 access to a Harvey mannequin to develop/enhance these skills. Bedside cardio-vascular limited ultrasound examination (CLUE) and bedside cardio-pulmonary limited ultrasound examination (CLUE+) will also be taught. There is an extensive, on-line, interactive CLUE syllabus with video echo tracings and an extensive on-line cardiac physical examination syllabus. In addition, the rotation will expose residents to invasive diagnostic and therapeutic procedures such as cardiac catheterization and pacemaker/AICD implantation.

Didactic conferences:

  • Weekly cardiology catheterization conference
  • Twice-weekly bedside CLUE practical didactics
  • Monthly, large group CLUE didactics

Dermatology

Rotation duration: 2-4 weeks

Educational experience: Rotations may take place in a Scripps dermatologist’s private office or at UCSD. Resident’s will see inpatients and outpatients under the supervision of a board certified dermatologist and develop skills in dermatologic diagnosis, dermatologic treatment, and dermatologic procedures such as KOH preps, Woods Light examination and skin biopsies.

Didactic conferences:

  • Periodic core noon conferences on dermatology at Scripps Mercy San Diego

Gynecology

Rotation duration: 2 weeks

Educational experience: Residents develop/enhance skills in pelvic examination, breast examination, gynecologic diagnosis, and gynecologic treatment under the one-on-one supervision of a board certified gynecologist at the San Ysidro Health Center.

Didactic conferences:

  • Structured one-on-one didactics covering important gynecologic topics with the attending.

Endocrinology and metabolism

Rotation duration: 4 weeks

Educational experience: Residents will be exposed to a variety of endocrine and metabolic problems both in the hospital and in the outpatient clinic common to primary care internal medicine, as well as the rarer conditions characteristic of a specialty clinic.

Didactic conferences:

  • Weekly ambulatory endocrine lecture to discuss a recent case seen by a resident.
  • Weekly endocrine/metabolism grand rounds are presented at the La Jolla Veterans Affairs Hospital.
  • Special rotation lectures on thyroid, parathyroid, diabetes, hypothalamic-pituitary disorders, adrenal, endocrine hypertension and decision analysis are presented to all the residents on rotation by faculty, as appropriate.

Gastroenterology

Rotation duration: 4 weeks

Educational experience: Residents will develop skills in the diagnosis and management of common and uncommon gastrointestinal (GI) problems. This rotation will also expose residents to invasive diagnostic and therapeutic GI procedures performed by gastroenterologists, such as endoscopy with biopsy, variceal ligation, endoscopic ultrasound and ERCP. There is usually a GI fellow from Scripps Green on this rotation working with both a resident and an attending.

Didactic session: This rotation includes a GI noon conference during which the resident, GI fellow and GI attending will present interesting cases of high teaching value.

Hematology and oncology

Educational experience: Residents will learn how to diagnose and treat various hematologic, coagulopathic and oncologic disorders as well as learn about the administration, side effects and drug interactions of therapeutic agents provided for these diseases.

Additionally, residents will have the opportunity to perform bone marrow biopsies and review blood smears and tissue biopsies in the pathology department.

Work team: Residents will work directly with board certified hematology/oncology attendings seeing inpatients at Scripps Mercy Hospital and outpatients at the Scripps Mercy Cancer Center.

Didactic conferences: Tumor board meetings and pathology conferences, plus periodic core noon conferences.

Infectious disease

Educational experience: Residents will develop skills in the diagnosis and management of many common, uncommon and exotic infectious diseases. Residents will also learn about the mechanisms of infectious diseases and applied microbio-pathophysiology.

Particular focus is placed on tailoring antibiotic therapy to choose the narrowest spectrum drug possible, such as to preserve as much of the symbiotic flora as possible—and to reduce the development of antibiotic resistance.

Didactic conferences: Monthly infectious diseases core noon conference.

Nephrology

Educational experience: Resident will gain experience and knowledge in the appropriate preliminary diagnostic work-up and management for renal disorders, acid/base and electrolyte abnormalities, indications for dialysis, and long-term care of patients with chronic kidney disease under the supervision of board certified nephrologists. Patients will be seen in the hospital, in the Mercy Clinic, and at dialysis centers.

Didactic conferences: Periodic core noon nephrology conferences.

Neurology

Educational experience: Residents will see a wide variety of neurologic disease pathology and develop knowledge in the management of seizure disorders, movement disorders, cognitive disorders, neuropathies, cerebrovascular disease and more. Patients will be seen under the supervision of a board certified neurology attending in the hospital, in the Mercy Clinic Neurology Clinic, and in the private office of the neurology attending.

Particular focus is placed on the neurologic physical examination and appropriate indication for and interpretation of diagnostic studies such as lumbar puncture, EEG, EMG, CT and MR

Didactics: Periodic neurology core noon conferences

Palliative Medicine/Geriatrics

Rotation duration: The palliative medicine and geriatrics rotation is split into two-week blocks for each specialty.

  • Palliative medicine rotation. Residents provide inpatient consultative services under the supervision of board certified pain and palliative care subspecialists to patients who need assistance with symptom control and/or help discussing goals of care. Residents will become proficient in assessing and treating symptoms and developing communication skills with patients and family members in both the wards and ICU setting.
  • Geriatric rotation. Residents see patients who are scheduled for comprehensive geriatric evaluations in the Continuity Clinic. Residents also round with board certified geriatricians providing care for patients at long-term acute care, skilled-nursing facilities, and nursing homes.

Pulmonology

Educational experience: Residents will evaluate and treat patients in the ICU, on the wards, and in the Mercy Pulmonary Clinic under the supervision of board certified pulmonary/critical care specialists. Residents will learn and gain proficiency in pulmonary procedures such as airway management, ventilator management, ABG interpretation, thoracentesis and spirogram performance and interpretation.

There is a wide spectrum of pulmonary pathology at Scripps Mercy, including infectious diseases, malignancy and primary pulmonary diseases that enable residents to gain a solid foundation of medical knowledge in the workup of pulmonary diseases. Scripps Mercy pulmonologists use very up to date diagnostic and therapeutic techniques including endobronchial ultrasound.

Didactic conferences: A monthly pulmonary pathology conference and a pulmonary/critical care journal club every three to four months.

Rheumatology

Educational experience: Residents will evaluate and treat patients in the hospital, in the Mercy Rheumatology Clinic, and in attending private offices under the supervision of board certified rheumatology attendings. Residents will have ample opportunity to perform rheumatologic procedures such as diagnostic arthrocentesis, joint injection therapy and soft tissue injection therapy. Weekly rheumatology conferences are held in the Mercy Clinic for residents on this rotation.

Conferences: Weekly rheumatology conferences are held in the Mercy Clinic for residents on this rotation. Periodic core noon didactics on rheumatology are also presented.

Sports Medicine

Educational experience: Residents will develop skills in the diagnosis and management of common and uncommon musculoskeletal syndromes, which may or may not be sports related.

Residents will learn how to:

  • Enhance their orthopedic history and physical examination skills
  • Develop their skills in selecting and interpreting diagnostic tests
  • Acquire their skill in choosing appropriate therapies for various sports medicine-related syndromes
  • Learn the application of rehabilitation medicine for both orthopedic and sports medicine-related syndromes

Opportunities to perform orthopedic procedures such as diagnostic arthrocentesis, joint injection therapy, soft tissue injection therapy, taping and splinting are available.

Work team: Residents will see patients under the supervision of a board certified internal medicine/sports medicine specialist at UCSD.