Internal Medicine Residency Program

Outpatient Clinics

Internal Medicine Clinic

Resident continuity clinics in our new Internal Medicine Resident clinic provide for comprehensive quality care for patients in a supervised environment. Residents are expected to gain clinical knowledge in the management of acute, routine, and chronic medical conditions commonly encountered in ambulatory medicine. This environment also stimulates the development of office-based technical skills, decision making, and problem solving in the outpatient setting. Special emphasis is made on patient education, anticipatory guidance, and indications for referral to a consultant or sub specialist. Each resident is expected to carry a cohort of continuity patients during their 3 year residency. All house staff are usually assigned one half-day/week clinics in the morning or afternoon. In each year of the program there are month-long rotations in the Outpatient Internal Medicine Clinic doing a specially designed Ambulatory Care Rotation aimed at enhancing skills in new patient evaluations, acute care management, and health maintenance evaluations for bone density, women’s health, men’s health as well as cancer screening.

Allergy and immunology

The allergy/Immunology service offers a rotation to residents and medical students. Approximately 1/4 of our patients come from pediatric referrals. We consult on patients with the following medical problems: Asthma, Immune deficiency, Food Allergy, Allergic and Non-Allergic Rhinitis, chronic Uticaria, Angioedema and Anaphylaxis, Medication Reactions, Sting Hypersensitivity. The rotation will include evaluation of new patients as well as the management of chronic patients. There will be teaching sessions to review and discuss topics and questions likely to be found on board exams. You will also have the opportunity to observe and interpret skin testing, pulmonary function testing, and delayed-type hypersensitivity skin testing.

Cardiology

The Cardiology service provides comprehensive care of all adult patients with cardiovascular disease in the supervised environment of the Coronary Care Unit, inpatient cardiac ward, and outpatient clinic. The Cardiology service performs 750-900 heart catheterizations and about 120 PTCA/Stents each year. House staff on elective will be exposed to the diagnostic procedures and therapeutic intervention necessary in the care of cardiac patient, gain proficiency in EKG interpretation, and be comfortable in evaluating adult cardiac patient in an outpatient setting.

Pulmonary Clinic

The Pulmonary Clinic at WBAMC operates out of the Pulmonary clinic, and Pulmonary Functions Lab. There are 4 full time board certified pulmonary sub specialists. Approximately 350-550 patient contacts are made in the clinic each month. A wide spectrum of pulmonary diseases are encountered.

About 10-20 fiberoptic bronchoscopy procedures are done each month. In addition, the lab performs 400-500 pulmonary function studies each month to include bronchial challenge testing with methacholine and exercise. There are more than 150 arterial punctures/month performed for ABG [Arterial Blood Gas] analysis. Also located in the clinic area is a fully equipped state of the art exercise physiology lab where cardiopulmonary exercise testing is performed when clinically indicated and for research purposes.

Several of the Staff are actively engaged in clinical research projects with multiple publications and residents may have the opportunity of being co-authors when time allows. This is an excellent rotation for improving outpatient diagnosis and management of common pulmonary diseases. Also, residents are responsible for inpatient consults as well which adds to the learning experience.

Dermatology

Dermatology service offers a one month outpatient rotation for house officers and medical students. This is a high volume clinic, serving patients across the life span with skin disorders including outpatient skin surgeries.

During their rotation a rotator will become familiar diagnosis and treatment of skin conditions including melanoma and non-melanoma skin cancers, infectious skin diseases, psoriasis, contact dermatitis, atopic dermatitis, autoimmune skin dz such as discoid lupus and sarcoidosis, lichen planus, acne, drug exanthema, and psuedofolliculitis barbae. They will also get hands-on experience with performing cryotherapy, laser treatments, phototherapy, biopsies, simple excisions, and suturing.

Endocrine Clinic

The Endocrinology Service offers a one month outpatient rotation for William Beaumont house officers and medical students. The patient mix consists of about 25% diabetes (of the diabetic patients roughly 1/3 are insulin pump users), 25% thyroid disorders (hypothyroidism, hyperthyroidism, nodular thyroid disease, and thyroid cancer), and 50% general endocrinology (pituitary disorders, parathyroid disorders, adrenal disorders, hypogonadism, metabolic bone disease, and unusual lipid abnormalities). The Clinic is active in research and publication.

Gastroenterology

The gastroenterology service provides inpatient and outpatient consultative services to the military population. The GI endoscopy suites are co-located with the clinics where diagnostic and therapeutic upper endoscopies and colonoscopies are performed. The residents are exposed to the full range of gastrointestinal and liver diseases to include hepatitis C. Residents rotate through the clinic where they are exposed to the full range of gastrointestinal diseases.

Hematology/Oncology

The WBAMC Hematology/Oncology Service prepares house staff to evaluate and manage patients with cancer and hematologic abnormalities. The setting spans the entire range of inpatient and outpatient hospital and clinic care at the home of terminally ill cancer patients. Skills are honed with characteristic presentations of common cancers and strengthened with a challenging mix of unusual presentations of common malignancies and less commonly seen cancers.

A wealth of diverse opportunities allows for the gaining of additional expertise. Medical and Surgical inpatient consults, outpatient follow-up of cancer patients or evaluation of common hematological abnormalities, pain management, management of cancer complications and end-of-life issues and terminal cancer patient care are vital areas of expertise that the practicing Internist of today must possess.

Infectious Disease

During a one-month rotation with the Infectious Disease Clinic, residents will gain an understanding of the diagnostic approach to infectious disease problems, the treatment of recognized infections, and empirical therapy for presumed infectious processes. Particular attention is directed towards the following common ID problem/topics:

Antibacterial, Antiviral, and Anti-fungal therapy Principals Interpretation of the Gram's Stain, AFB stains, Fungal preparations, Pneumonias, Upper Respiratory Infections, Skin and Soft Tissue infections, Urinary Tract Infections, Intraabdominal Infections, Menigitis, Encephalitis, Brain Abscess, Endocardits, Vascular infections, Diarrheal Diseases, Hepatitis, Diabetic Foot infections, Infections in the HIV-positive patient, HIV infection, Infections in Transplant Recipients, Antibiotic Prohylaxis Fever of Unknown Origin, Travel Medicine Immunization Recommendations, Nosocomial Infections and Principals of Infection Control.

Residents will learn to integrate medical history, physical examination, radiographic studies, and laboratory tests to evaluate and treat infectious diseases. Principals of regular re-examination and/or more detailed and directed history-taking are emphasized.

Residents will learn:

  1. Proper collection and handling of clinical microbiological specimens
  2. Proper procedure for Gram's Stain performance
  3. How Acid-Fast, Giemsa, Silver, and other stains are performed.
  4. Various methods for detection of fungi.

Nephrology

The Nephrology service offers an inpatient and outpatient clinical rotation for medical trainees. Rotating trainees are responsible for evaluating patients under the supervision of a staff nephrologist. Educational goals are to provide experience in the evaluation, diagnosis, and treatment of patients with kidney disorders. Didactic lectures and clinical exposure are provided to cover major nephrology topics.

Neurology

The Neurology Service engages rotating medical students and WBAMC house officers in a patient-focused didactic program. Despite the setting within a military hospital, the patient population mirrors that of a civilian neurological practice in that the majority of patients (approximately 55-60%) are retirees. Upon completion of the rotation, the diligent student will be knowledgeable in the management of a variety of headache disorders, seizure disorders, and stroke. The rotator will also become adroit in the performance and interpretation of the mental status and neurological examinations. The rotator will receive an extensive collection of up-to-date review articles on the various common neurological disorders, as well as exposure to outpatient neurology and inpatient consultative neurology. In addition, the Neurology Service (including a pediatric neurologist) works closely with the Neurosurgery and Physical Medicine Services.

Rheumatology

The Rheumatology Service provides a 4-week rotation for William Beaumont house officers and medical students. During this time period, rotators will participate in the supervised evaluation of outpatients and hospitalized patients with rheumatic disease. Rotators will gain familiarity with rheumatic ailments including rheumatoid arthrithis, systemic lupus erythematosus and other connective tissue diseases, crystalline arthropathy, the vasculitides, the seronegative spondyloarthropathies, and osteoarthritis. In addition, rotators will be instructed in diagnostic arthrocentesis and therapeutic injection for various rheumatic diseases. House officers will attend morning report and didactic lectures. Rheumatology specific rotation teaching will be comprised of short didactic lectures, patient encounter specific teaching, case based questions, radiology rounds, and joint simulator instruction. House officers are encouraged to engage in an aggressive reading program and will complete a pre and post rotation quiz to assess incoming knowledge, guide didactic teaching while on the rotation, and assess knowledge acquisition.

Geriatrics

During the R2 and or R3 year, resident will rotate at the Southern Arizona VA Medical Center in Tucson, AZ for a geriatrics rotation. Housing at the Embassy Suites and per diem is provided in agreement the VAMC. The primary purpose is to educate the residents on the art of caring for the elderly, disabled, and terminally ill patients.

Educational goals are:

  1. Demonstrate an understanding of the diagnosis and treatment of Geriatrics related problems.
  2. Demonstrate an understanding for the normal aging physiology, pharmacology, and sociology of the elderly patients.
  3. Recognize the common diseases of the elderly and when special geriatrics consultation is indicated.
  4. Assessment of functional performance from both a physiological and sociomedical perspective.
  5. Resident will provide competent, respectful and compassionate care of the elderly patients in all health care settings.

Residents will be exposed to inpatient hospice care, home based primary care, dedicated geriatrics lectures, and supervision by board-certified geriatricians.