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Subspecialties

The IMRS philosophy has always strongly encouraged residents to rotate through each of the subspecialties of medicine. While this certainly is very beneficial to pass ABIM boards, it is most important for each resident physician to have a working knowledge of each field to provide the best in patient care. Several years ago, the senior residents discussed this issue and decided that each resident should rotate through each subspecialty (whenever possible) and we have gone forward with that decision.

Cardiology (R1, R2 year)
An active contingent of cardiologists and cardiovascular surgeons has made Spokane a prominent center for the diagnosis and treatment of cardiovascular disease. Residents work with one of the teaching cardiologists.

For the R1, one month is a hospital service with both ward and CCU patient management experience.

The R2 gains additional experience in outpatient cardiology consultations and procedures when working with the teaching cardiologist in an ambulatory clinic.

Gastroenterology (R1 year)
The R1 on this hospital rotation works one-on-one with a faculty gastroenterologist seeing patients initially referred for consultation. A broad spectrum of clinical GI problems is covered. (An outpatient GI rotation is also available as an elective.)

Management of patients on the service is the responsibility of the resident with supervision and direction from the attending gastroenterologist.

Pulmonary (R2 year, R3 year)
The senior resident supervises an R1 transitional resident on a pulmonary service during the morning and then sees outpatient pulmonary consultations in the pulmonary clinic in the afternoon. Both activities are performed under the direction and supervision of one of the faculty pulmonologists.

Since this rotation involves both a hospital and a clinic component, the senior resident gains a broad spectrum experience of patients with both acute and chronic problems. The resident learns diagnostic and management techniques.

Rheumatology (R2 year or R3 year)
The rheumatology rotation occurs in an outpatient setting. The resident is exposed to common rheumatologic diseases and often perform many joint-based procedures for diagnostic and therapeutic reasons.

Endocrinology (R2 year or R3 year)
This outpatient based rotation focuses on assisting residents to diagnose endocrine diseases. The majority of the rotation is devoted to helping residents hone their treatment of diabetes and thyroid disease in particular.

Infectious Disease (R2)
This primarily inpatient rotation is mostly a consultative service. The resident learns to perform a thorough physical exam with infectious etiologies in mind. The resident also learns to communicate his/her conclusions to the referring physician succinctly. Each resident physician leaves this service with a secure “framework” for choosing antibiotics.

Geriatrics (R2 year or R3 year)
The geriatrics rotation has two components. Initially, the resident works with an inpatient physiatrist evaluating patients as well as working with PT, ST, OT in geriatric assessment. After that first week, the resident completes the remainder of the rotation at St. Luke’s Rehabilitation Institute (SLRI) with special attention to the needs of the elderly such as mobility, toileting, ADL’s, cognitive issues, etc.

Nephrology (R2 year or R3 year)
Primarily an inpatient rotation, this rotation does allow for several afternoons in the nephrology office. The resident assists with admissions and consultations for critically ill patients. The intricacies and indications for dialysis are explored. Chronic care of the chronic kidney disease patient from an internist’s perspective is an important aspect of this rotation.

Oncology/Hematology (R2 year or R3 year)
Primarily an office based rotation; this rotation explores the diagnosis and treatment of common oncologic and hematologic diseases. The resident works with all aspects of the care team to provide care – nursing, social workers, oncologists and radiation oncologists.

Neurology (R1,R2 year or R3 year)
The resident works several weeks in an outpatient setting understanding and treating common conditions such as headache, Parkinson’s Disease, MS. Then during the inpatient portion of the rotation, the resident is challenged to learn and perform a thorough neurologic exam and aggressively (and rapidly) diagnose and treat coma, CVA, tumor, etc.

Hospice/Palliative Care (R2)
The Spokane community is blessed to have not only an excellent Hospice organization but also a Hospice House. The residents are welcomed to the House to assist in the care of the dying patients. They also make home visits with M.D.s, RNs, chaplains and social workers. The residents participate in delicate discussions concerning end of life issues and code status discussions. Our residents have found that this rotation has really helped their communication skills.