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:

Cardiology

Rotation duration: 4 weeks

Educational experience: Residents will develop skills in diagnosing and managing cardiology problems, interpreting ECGs, exercise tests and echocardiograms. The rotation will also expose residents to invasive diagnostic and therapeutic procedures such as cardiac catheterization and pacemaker/AICD implantation.

Didactic conferences:

  • Weekly cardiology catheterization conference
  • Twice weekly cardiology teaching rounds in the ICU and cardiac limited ultrasound exam (CLUE) rounds in the ICU

Endocrinology and metabolism

Rotation duration: 4 weeks

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

Lectures/Grand rounds:

  • 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 and GI fellow will present an interesting case 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 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.

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 microbiopathophysiology.

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.

Nephrology

Educational experience: Resident will gain experience and knowledge in the appropriate preliminary diagnostic work-up and management for renal disorders, indications for dialysis and long-term care of patients with chronic kidney disease.

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.

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

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 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 physicians providing care for patients at long-term acute care and skilled-nursing facilities.

Pulmonology

Educational experience: 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.

Didactic conferences: A monthly pulmonary pathology conference and a pulmonary/critical care journal club every other month.

Rheumatology

Educational experience: 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.

Work team: Residents will work directly with a rheumatologist in their outpatient clinic, seeing patients at Mercy Clinic and consulting on patients with rheumatologic diseases admitted to Scripps Mercy Hospital.

Conferences: Weekly rheumatology conferences are held in the Mercy Clinic for residents on this rotation.

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

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 with an internal medicine/sports medicine specialist at UCSD.