Med-Peds Teaching Services
Inpatient Teaching Services
Medicine
Seven inpatient-teaching services are offered; each has an average of 15 to 20 patients. Four General Medicine servicesand two combined pulmonary/critical care services are part of the training. The general medicine service is staffed by a senior resident and one to two interns. The pulmonary/critical care service is staffed by two senior residentsand two interns. Additionally, an inpatient cardiology service is staffed by a cardiologist and two senior residents.
Inpatient teaching services also respond to calls for consultation on patients admitted to other services. On all the services, the PGY1 house officers are responsible for all decisions, with guidance from upper-level residents and faculty.
The General Medicine, Pulmonary and Critical Care ward services are designed to introduce interns to the care of hospitalized patients with internal medicine problems of variable severity. Our focus is to improve the basic skills of obtaining accurate and relevant information from history, physical examination, and laboratory studies and integrating the data into a prioritized problem list. For each problem, a differential diagnosis and management strategy will be formulated.
Medicine Inpatient Attending-Resident Supervision By Residency Level
Each PGY1, PGY2, PGY3, and PGY4 has a member of the faculty as his/her attending physician on all rotations. Daily inpatient rounds occur in the Adult ICU’s and the general/subspecialty wards with the attending physician.
PGY1
The first year house officer on a general medicine ward will work under the direction of a Senior Resident in Medicine or Med-Peds and a supervising Medicine attending. The first year house officer is responsible for a complete history and physical examination on all patients admitted that will be reviewed by the Senior Resident and the Attending.
When a diagnostic or therapeutic procedure is considered necessary, it should be approved first by the Senior Resident in charge of Ward Service. The procedure should be reviewed in the procedure guide and the technique discussed with the attending. The procedure guide is available in the office of the Director of Internal Medicine and in the resident’s work room. All procedures are to be supervised by either a resident or an attending who is certified in the procedure.
PGY2, PGY3, PGY4
The first year house officers on the ward service are responsible both to the Senior Resident and the Attending on the service. The Senior Resident mentors and directs the PGY1 resident. An attending for the service is available both during rounds and at all other times.
Pediatrics
The Greenville Hospital System Children's Hospital serves as the tertiary referral center for upstate South Carolina. A new Children's Hospital within the tertiary care centered opened in April of 2003.
The inpatient teaching service includes the following:
- General ward - 52 beds, annually averages 3,500 admissions
- Pediatric ICU - staffed by four board-certified pediatric intensivists, six beds, annually averages 370 admissions
- Neonatal ICU - staffed by six board-certified neonatologists, 41 beds, annually averages 1,050 admissions, 350 supported by mechanical ventilation
- Term Newborn Nursery - 50 beds, annually averages 5,200 admissions
While rotating through inpatient services, residents gain experience in complex medical and/or surgical diseases and trauma patients, some of whom require subspecialty consultation. Ample opportunity to develop procedural skills is emphasized. Both Intensive Care Units are engaged in several areas of clinical research. The Prenatal Center is a high-risk service with 5,200 deliveries annually. This is the largest delivery service in the Carolinas.
Outpatient Teaching Services
Medicine
Another of the unique strengths of our program is the on-campus Medical Center Clinics, private offices, and satellite clinics that are sites for our program's outpatient component. These experiences offer our residents a chance to encounter and learn about a variety of patients and illnesses. PGY1 residents will spend half a day each week in their Med-Peds continuity clinic and provide follow-up care to patients originally seen in the hospital and to patients who are followed for ongoing ambulatory care. Upper-level residents spend two half-days in continuity clinic when not on inpatient services.
During the one-month outpatient assignments, regularly scheduled morning conferences emphasize important outpatient topics, such as preventive care, health maintenance, vaccinations, and screening procedures. Treadmill stress testing, flexible sigmoidoscopy, and pelvic examinations are procedures learned on these rotations. Residents attend subspecialty clinics while rotating in their respective subspecialties.
Pediatrics
The Pediatric Ambulatory Care Center averages 19,000 visits each year. Residents also are assigned to a rural satellite clinic, a mobile medical van, and private pediatricians' offices to provide additional outpatient experience. In addition, there are more than 23,000 yearly visits to the Pediatric Emergency Center. The Pediatric Emergency Center is a freestanding emergency room staffed 24 hours a day by board-certified pediatric emergency physicians.
Ambulatory care rotations provide residents with experience in common and complex medical, emotional, developmental, and psychosocial problems. Routine well-child care, anticipatory guidance, and developmental assessment receive strong emphasis. Patient visits include both well and acutely ill children. Residents provide longitudinal comprehensive care in weekly continuity clinics. There is a strong emphasis on treating both medical and psychosocial needs of the child and family unit. Support from Nursing, Social Services, and Child Life departments contribute to a family-centered care philosophy. Residents also attend outpatient subspecialty clinics in allergy/immunology, behavior/development, cystic fibrosis, cardiology, infectious diseases, endocrinology, nephrology, genetics, neurology, gastroenterology, pulmonology, psychiatry, hematology/oncology, and cleft lip and palate clinic. There is also an ongoing program in the area of child abuse and neglect.
Medicine Outpatient Attending-Resident Supervision
PGY1 and PGY2
PGY1 and PGY2 residents must present each patient to an attending who is present and available at all times during the clinic.
PGY3 and PGY4
PGY3 and PGY4 residents see the patients and present any problem or patient as needed to an attending who is present and available at all times during the clinic.
Pediatric Outpatient Attending-Resident Supervision By Residency Level
An attending is present and available for questions as well as reviewing all charts on patients seen in the clinic.
PGY1
PGY1 residents in the Center for Pediatric Medicine must present each patient to an attending or to a PGY3 resident until permission to evaluate patients independently is granted by an attending.
PGY2
PGY2 residents in the Center for Pediatric Medicine may see patients independently, but have immediate faculty backup by an attending at the Center.
PGY3
PGY3 residents in the Center for Pediatric Medicine provide teaching to medical students, prepare brief morning lectures and provide back up to the triage nurse for walk in patients and phone calls. Attendings are always assigned to the Center for Pediatric Medicine during all office hours.
PGY4
PGY4 residents in the Center for Pediatric Medicine provide teaching to medical students, prepare brief morning lectures and provide backup to the triage nurse for walk in patients and phone calls. Attendings are always assigned to the Center for Pediatric Medicine during all office hours.
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