Internal Medicine-Psychiatry Residency
Clinical Rotations
Internal Medicine Clinical Rotations
Internal Medicine Clinical Rotations
Allergy-Immunology
Over the course of the rotation, residents work with faculty physicians in an outpatient setting to gain experience in caring for patients with acute and chronic allergic and immunologic disorders. The rotation includes exposure to a wide spectrum of diseases, including allergic rhinitis, chronic rhinosinusitis, asthma, urticaria, angioedema, eosinophilic disorders, food allergies, and insect sting reactions, as well as a spectrum of immunodeficiency disorders. Furthermore, the resident gains experience with procedures such as allergy testing, allergy immunotherapy, and drug and food challenges.
Cardilogy (Inpatient, Outpatient, CVICU)
Cardiology - Outpatient
Residents work weekdays with various assigned faculty physicians in an outpatient clinic. In the clinic, residents learn the finer points of long-term management of patients with a broad variety of cardiovascular disease. Residents may also spend time in electrophysiology clinic, gaining experience with the indications and management of implantable devices. Additionally, time is also scheduled for residents in the echocardiography lab so that residents can learn advanced interpretation of echocardiograms.
Cardiology - Inpatient
A faculty physician, a senior resident, and two junior residents diagnose and manage patients with acute cardiovascular illnesses that are not qualified for the cardiovascular intensive care unit, including acute coronary syndromes, decompensated heart failure, valvular disease, pulmonary hypertension, pericarditis, and endocarditis. The team admits patients daily, with no overnight call for team members. Overnight admissions are managed by non-teaching hospitalist teams and are not added to the teaching team census.
Cardiovascular Intensive Care Unit
A faculty physician, cardiology fellow, and four senior residents manage manage up to 16 acute cardiac patients whose conditions include cardiogenic shock, myocardial infarction, and aortic dissections. Each resident takes overnight call every fourth night.
Dermatology
Residents see patients with faculty physicians in an outpatient setting to gain experience in caring for patients with a variety of diseases that include malignant and pre-malignant skin lesions, acne, rashes, and allergic skin disorders. Residents will also encounter patients with dermatologic manifestations of systemic illness. The resident will become familiar with common procedures used in dermatology, including skin scrapings, punch and shave biopsy, and cryotherapy.
Emergency Treatment Center (UI Health Care and VA Medical Center)
Emergency Room - University of Iowa Health Care
Residents spend four weeks in the emergency room at UI Health Care. They are supervised by faculty physicians from the Department of Emergency Medicine and participate in every aspect of emergency room medicine with the exception of Level I trauma.
Emergency Room - Veterans Affairs Medical Center
Residents work in the emergency room at the Veterans Affairs Medical Center. They are supervised faculty physicians from the Department of Internal Medicine and evaluate a variety of acute complaints that range from minor musculoskeletal injuries and chronic back pain to chest pain, sepsis, and stroke.
Endocrinology
Residents spend four weeks in endocrinology, including one week on endocrine consults and three weeks in the endocrine clinic. During this rotation, residents gain experience with diabetes management, thyroid disorders, pituitary disorders, adrenal disorders, and learn the intricacies of osteoporosis and disease of the bone. Residents may also spend time in the polycystic ovary syndrome clinic, the lipid clinic, and the renal stone clinic. Residents rotate through the diabetes education and diabetes nutrition clinics to acquire experience with the aspects of diabetes self-care that may not be sufficiently emphasized in clinic.
Gastroenterology
Based on personal interests, residents have the opportunity to tailor their outpatient gastroenterology clinic experience. Residents may work in clinics that specialize in general gastroenterology, general hepatology, transplant hepatology, hepatitis C, motility disorders, and inflammatory bowel disease. Residents also have the opportunity to rotate with the inpatient liver and gastroenterology consult teams, if desired.
Geriatrics and Palliative Care - Outpatient
Residents spend two weeks in the geriatric clinic and two weeks on the palliative care consult service during this one-month rotation.
In addition to treating common medical problems, residents in the geriatric clinic gain confidence managing a variety of challenges unique to the geriatric population, including cognitive impairment and dementia, urinary and bowel incontinence, gait, falls and balance disorders, and polypharmacy. Off-site nursing home rounds educate residents about the facilities to geriatric patients are commonly referred.
On palliative consult service, residents learn the intricacies of end-of-life care. As a member of the consult team, residents may facilitate family meetings, assist a patient and their family with clarifying goals of care, and recommend treatments that maximize patient comfort.
Hematology-Oncology
A faculty physician, senior resident, and two junior residents diagnose and manage patients with a wide range of hematologic and oncologic conditions. A clinical pharmacist supports the team in the administration of chemotherapy. The team admits patients daily, with no overnight call for team members. Overnight admissions to the team census are supported by a night float senior internal medicine resident and intern.
Infectious Diseases Consultation Service
A faculty physician, fellow, and two to three residents provide consultative services for inpatients hospital-wide on a variety of known or potential infectious illnesses including HIV management, tuberculosis, endocarditis, meningitis, wound infections, osteomyelitis, vector-borne illnesses, and fungal infections.
Internal Medicine-Psychiatry Unit
Faculty physicians, a senior resident, and two junior residents care for up to 15 patients with medical and psychiatric illness. The team admits patients daily, with no overnight call for team members. Overnight admissions to the team census are supported by a night float senior resident and junior resident.
Internal Medicine Inpatient (UI Health Care, VA Medical Center, and MICU)
Internal Medicine - University of Iowa Hospitals & Clinics - Inpatient
Three teaching teams (each consisting of one faculty physician, one senior resident, three junior residents, and two to three medical students) diagnose and manage adults of all ages and backgrounds with a wide range of medical illnesses. Support staff (social workers, nurses, and unit clerks) assist with discharge planning and arranging follow-up appointments. Junior residents rotate on overnight call when their respective teams are admitting patients, taking an average of four to five call nights per month.
Internal Medicine - Veterans Affairs Medical Center - Inpatient
Three teaching teams (each consisting of one faculty physician, one senior resident, and two junior residents) diagnose and manage a largely male population of veterans with conditions that span the full breadth of internal medicine. The team takes care of patients on the general inpatient unit and in the ten bed intensive care unit. Patients in the intensive inpatient unit are staffed with a pulmonary-critical care faculty and fellow during daily intensive care rounds. Each inpatient team admits daily, with a team cap of 14 and a junior resident daily cap of five. Each junior resident takes an overnight call every sixth night with a night float senior.
Medical Intensive Care Unit
A faculty physician, two pulmonary-critical care fellows, and four senior residents take care of up to 26 critically ill patients. Senior residents take overnight call every fourth night with a junior resident in the Medical Intensive Care Unit. Residents on overnight call admit patients, assist with cross-cover of patients on the intensive care unit, and participate in morning teaching rounds.
Neurology
Residents work with faculty physicians and residents from the Department of Neurology during this rotation. They spend four weeks on the inpatient consult service and four weeks in general and subspecialty neurology clinics. Outpatient case mix includes chronic migraines, neuromuscular disorders, sleep medicine, multiple sclerosis, amyotrophic lateral sclerosis, and stroke follow-up. Inpatient case mix ranges from myasthenia gravis crisis to evaluation of altered mental status and stroke. If a residents would like more exposure to stroke, they may request an additional rotation with the stroke inpatient service.
Pulmonology Consultation Service
Residents will work with one faculty physician and one pulmonology fellow to respond to consultations from both medical and surgical services on a variety pulmonary conditions. This may include hypoxemia and dyspnea of unclear etiology, pleural effusions, interstitial lung disease, severe chronic obstructive pulmonary disease and asthma, infiltrates/nodules in both immunocompetent and immunocompromised patients, lung masses/suspected malignancy, mediastinal adenopathy, and granulomatous diseases. Residents may participate in thoracentesis procedures and observe chest tube placement. Residents also have the opportunity to observe bronchoscopy procedures (including standard airway exams, bronchoalveolar lavage, biopsies under fluoroscopy and endobronchial ultrasound, and super-dimension navigational bronchoscopy).
Renal Consultation Service
A faculty physician, two nephrology fellows, and two to three residents provide consultative services for inpatients hospital-wide on a variety of acute and chronic problems, including acute kidney injury, end-stage renal disease, hemodialysis, continuous renal replacement therapy, lupus nephritis, and pulmonary-renal syndromes.
Rheumatology
Residents spend four weeks in rheumatology to gain experience in the evaluation and management of common clinical presentations including joint pain and swelling, muscle aches, musculoskeletal weakness, regional pain, and non-articular signs and symptoms of rheumatologic conditions such as Raynaud’s phenomenon and skin rash. Working closely with faculty physicians, residents diagnose and manage diseases including fibromyalgia, rheumatoid arthritis, osteoarthritis, and crystalline and infectious arthropathies, as well as systemic conditions like scleroderma, systemic lupus erythematosus, and various forms of vasculitides. Three weeks of this rotations are spent in an outpatient setting. One week of this rotation is spend on the rheumatology consult service.
Surgical Co-Management Service
Two faculty physicians and two to three residents provide internal medicine consultative services for surgical and psychiatric inpatients with acute and chronic medical problems. This rotation also includes outpatient pre-operative evaluations in a clinic setting.
Psychiatry Clinical Rotations
Child and Adolescent Psychiatry
Residents spend one month in the Child and Adolescent Psychiatry Outpatient Clinic and one month in the inpatient child and adolescent psychiatry unit during their fourth year of training. Under the supervision of board-certified child psychiatry faculty, residents perform diagnostic evaluations and provide follow-up care. Residents maintain their Internal Medicine continuity of care clinics during these rotations.
Consultation-Liaison Psychiatry
Residents rotate on the consultation-liaison psychiatry service for two months. The service provides psychiatric consultation for inpatients throughout University of Iowa Hospitals & Clinics and University of Iowa Stead Family Children's Hospital. Common clinical problems managed by this service include delirium, questions of capacity, mental health commitments, and identifying patients who would be optimally managed on an inpatient psychiatry or medicine-psychiatry unit.
James Amos, MD, UI Clinical Professor of Psychiatry, operates a blog called The Practical Psychosomaticist, which includes presentations related to consultation-liaison psychiatry.
Neuromodulation
Residents spend a month on the neuromodulation service. At University of Iowa Hospitals & Clinics, electroconvulsive therapy, transcranial magnetic stimulation and deep brain stimulation is available to inpatients and outpatients. The resident, under faculty supervision, administers therapies and also spends time evaluating patients referred for this treatment.
IMPACT
IMPACT stands for integrated medical and psychiatric assertive community treatment. This program is an interdisciplinary service that provides intensive outpatient care for people with serious mental illness. Residents can spend a month with the IMPACT program, during which they participate in interdisciplinary rounds, attend patient activities, do home visits with staff, and may see some patients in the clinic.
Medicine-Psychiatry Inpatient Unit
Residents spend one month of their first year on the Medicine-Psychiatry Inpatient Unit, which counts as one of their psychiatry inpatient months. Patients on this service are being treated simultaneously for active psychiatric and active medical problems. The unit is usually staffed with a dual-trained internal medicine-psychiatry faculty member, but some months are staffed jointly by an internal medicine faculty physician and a psychiatry faculty physician. While on the Medicine-Psychiatry Inpatient Unit, residents take psychiatry call.
Neurology - Outpatient
Residents spend one month on a neurology outpatient rotation. Most of the rotation is spent in the Neurology Outpatient Clinic, where residents may work in the seizure disorder clinic, sleep clinic, movement disorder clinic, or other specialty clinics. Residents may also participate in some neurology consultation during this rotation. While on the neurology outpatient rotation, residents take psychiatry call.
Psychiatry - Outpatient
Residents spend 12 consecutive months in the psychiatry outpatient clinics. During this longitudinal experience, residents spend time each week in the Adult Psychiatry Outpatient Clinic at the University of Iowa Hospitals and Clinics, the Outpatient Psychiatry Clinic at the Veterans Affairs Medical Center, and six months at the Community Mental Health Center for Mid-Eastern Iowa. Residents also have a weekly psychotherapy clinic, psychotherapy supervision, and weekly didactics during this rotation. Residents engage in a quality improvement project during this rotation. Residents maintain their Internal Medicine continuity of care clinic.
Psychiatry - Inpatient
Residents do a total of seven months of inpatient psychiatry during their training. Residents rotate on all of the adult psychiatry units at University of Iowa Hospitals & Clinics and on the psychiatry unit at the Veterans Affairs Medical Center. The units at University of Iowa Hospitals & Clinics include a mood disorders unit, a psychotic disorders unit, a geriatric psychiatry unit, an eating disorders unit, and a medicine-psychiatry unit.
Psychiatry - Float
Residents in this position will assume care of all inpatients in psychiatric units for the evening and overnight hours during the week and after the inpatient team has rounded on the weekends.
Continuity of Care Clinic
Residents maintain a panel of patients in an outpatient setting through a Internal Medicine continuity of care clinic at University of Iowa Health Care or the Veterans Affairs Medical Center for all five years of training. Working as a team with faculty physicians, nurses, and medical assistants, residents provide comprehensive care to patients with an emphasis on chronic disease management. During inpatient psychiatry rotations, residents are scheduled for one half-day per week in their continuity of care clinic.
During medicine rotations, the continuity clinic is built in with a 4+1 model, where you will spend an entire week dedicated to the ambulatory experience. See the Internal Medicine page about the 4+1 system for more information.