Year I Curriculum (categorical and preliminary residents)

• 5-7 months general internal medicine
• 1 month emergency medicine
• 1 month elective community medicine rotation
• 3-5 months subspecialty electives
• Optional ICU rotation

Year II Curriculum

• 5-7 months subspecialty electives
• 1-2 months intensive care
• 1-2 months in Grand Island or Fremont
• 3-5 months general internal medicine supervisor experience, including the hospitalist service
• Optional research month

Year III Curriculum

• 3-5 months general internal medicine supervisor experience, including the hospitalist service
• 5-7 months subspecialty electives
• 1-2 months intensive care
• 1 month ambulatory care
• 1 month Internal Medicine Board Review or International Rotation
• 1 week Internal Medicine Board Review course conducted by University of Nebraska fellows and attendings
• Optional research month

General Internal Medicine Wards (University Hospital)

     Ÿ  There are four general ward teams at the university (Red, Yellow, Green, and Blue) in addition to the Hospitalist team.  Each team is composed of two interns, a supervisor, an attending, and two or three medical students.  The hospitalist service is composed of 2 upper level residents, an attending, and no students. 

Ÿ         The call schedule is based on a four-day rotation:

§         ON-call:  1 intern and the supervisor are responsible for admissions between 5pm and 7am.  The intern also covers cross-cover call on all IM patients after 5pm.  The team’s non-call intern is usually finished around 6 or 7pm.

§         POST-call:  The team rounds, finishes floor work, checks out, and usually leaves the hospital following noon conference.

§         SHORT-call:  The team shares the daytime admissions with the hospitalist team until 5-6 pm (Monday-Friday). 

§         PRE-call:  The team rounds, finishes floor work, does not take new admissions, and usually has the afternoon free. 

Ÿ         On University wards, intern call is every 8^th night and the supervisor call is every 4^th night.  We do not have a night float system, ensuring continuity of care and limiting “patient hand-offs”.  While on wards, residents generally average 55-70 hours per week. 

Ÿ         Residents do not begin supervising wards until the latter half of the PGY-2 year, ensuring a greater level of comfort and confidence in both patient care, resident supervision, and teaching skills.

General Medicine Wards (VA Hospital)

• The responsibility of the general medicine wards at the VA hospital is shared by University of Nebraska residents and Creighton University residents.   There are 3 University of Nebraska teams (Gray, Orange, and Yellow), also made of 2 interns, a supervisor, 2 medical students, and a University of Nebraska attending.  All teams that are not post-call take admissions between 8am-4pm.  After 4pm, the on-call team takes all admissions overnight and as well as covering cross-call on all patients covered by the University of Nebraska teams.  Because the admission days alternate with Creighton University, the call schedule varies a bit.  In general, an intern and supervisor at the VA take call about every 5^th night.  As with the university hospital, there is no night float system at the VA.  Residents on wards at the VA average about 55-65 hours per week. 

Hospitalist Rotation

• This is a relatively new addition to the inpatient services.   Briefly, in response to increasing interest in hospital medicine and increasing numbers of patients on our general internal medicine services, we developed a 5^th inpatient team to gain more experience and alleviate the patient load on the traditional inpatient teams.  The hospitalist service is comprised of two upper level residents and an attending.  One of these residents will take all calls from the ER, transferring MDs, etc. regarding admissions from 7 am until 5 pm.  They will take roughly half of these admissions, and short call will take the rest—thus protecting the on-call team from taking many admissions until after 5 pm.  The hospitalist resident is also expected to assist with any procedures if the supervising resident is not available.  After 5 pm, the patients on the hospitalist service will be checked out to the on-call medicine intern.  On weekends, the hospitalist service will take 2-3 admissions in the morning, round on the service, and have the remainder of the day call-free.

Subspecialty Electives Include:

Ÿ         Cardiology (University or VA)

Ÿ         Community Medicine (primarily outpatient rotation with a Methodist Hospital affiliate clinic, a private hospital group in Omaha)

Ÿ         Diabetes, Endocrine, & Metabolism

Ÿ         Evaluation Unit (pre-op evaluations, complex patient evalutations, and procedure clinic at the VA)

Ÿ         Gastroenterology (University or VA)

Ÿ         Geriatrics

Ÿ         Hematology/Oncology

Ÿ         Infectious Disease-General Service

Ÿ         Infectious Disease-Immunocompromised

Ÿ         Nephrology-General Service

Ÿ         Nephrology-Transplant

Ÿ         Neurology

Ÿ         Pulmonology

Ÿ         Rheumatology

The subspecialty rotations are either “call-free” or “home call”.  During home-call months, the residents are free to leave the hospital in the evening, but may be called back to evaluate an inpatient or admit a new patient.  There is a call room available for the home-call residents if they prefer to stay.  Home call can vary from no calls, to a simple question about blood sugars or nursing home calls, to a few admissions or a sick patient that requires more hands-on care. 

Grand Island or Fremont Rotation

• Grand Island is a community of approximately 40,000 located 2 hours west of Omaha.  Fremont has a population of approximately 25,000, and is located about 40 minutes from Omaha. During the PGY-2 year, residents rotate for 1-2 months at either the Grand Island or Fremont site.  During the rotation, the resident works as a community-based internist, admitting and following patients in the hospital, seeing clinic patients during the day, and covering inpatient and outpatient call overnight.  This is traditionally a very valuable rotation, allowing the PGY-2 resident to have a great deal of autonomy as well as exposure to the role of an internist in a rural community-based practice.

• During the PGY-3 year, residents can either have a month of time to study for the Internal Medicine Board Exam or rotate on an elective in South Africa.  The residency covers the cost of airfare, transportation within the country, and housing for the one month rotation.  Residents stay in Constantia, a suburb of Capetown, South Africa.  Rotations at Tygerberg Hospital, Victoria Hospital, and the Constantiaburg Clinic provide a striking view of contrasting healthcare provided in the area, the South African medical system, and the endemic diseases of the country.  Residents have 1 week of vacation time to take a safari or travel to nearby countries as well as free evenings and weekends to explore Capetown and the surrounding area. 

Ÿ         Residents are free to craft their own international experience if they would prefer to explore a different healthcare system.  Recent residents have traveled to El Salvador and India.    www.aboutcapetown.com

Ambulatory Month

Ÿ         During the PGY-3 year, the residents rotate through a variety of outpatient clinics.

Ÿ          Additional (optional) outpatient experiences can be arranged during the PGY-2 or 3 year in any of the following clinics:

§         Dermatology

§         Women’s health

§         Geriatrics

§         Sports medicine/orthopedics

§         Allergy/Immunology

§         Hematology/Oncology

§         Infectious Disease/HIV

§         Hepatitis

§         Gastroenterology

§         General Medicine

§         Pulmonary/cystic fibrosis

§         Nephrology

§         Transplant

§         Travel health

§         Rheumatology