UNIVERSITY OF HAWAII INTERNAL MEDICINE RESIDENCY PROGRAM

UNIVERSITY OF HAWAII INTERNAL MEDICINE

RESIDENCY PROGRAM

ELECTIVES FOR MEDICINE RESIDENTS

July 2008

Honolulu, Hawaii

University of Hawai‘i Internal Medicine Residency Program John A. Burns School of Medicine • The Queen’s Medical Center

Kuakini Medical Center • Hawaii Medical Center East • VA Pacific Islands Health Care System

1356 Lusitana Street, 7th Floor • Honolulu, Hawai’i 96813-2427 Telephone: (808) 586-2910 • Facsimile: (808) 586-7486 • Internet: http://uhimrp.hawaii.edu

1-800-55-UHMED • 1-800-558-4633

0BUMEMORANDUM TO: All Internal Medicine Residents FROM: Erlaine F. Bello, MD

Program Director DATE: April 10, 2008 SUBJECT: UElectives for 2008 - 2009 Academic Year (REVISED) This booklet contains descriptions of the electives to be offered for the 2008 – 2009 academic year. Also contained in this booklet is an “Elective Requests” form. Each of you has been assigned to a firm and your firm director will need to review your elective choices. Your firm director must sign your “Elective Requests” form. Return your form to the Omi Kam, in the Program office, and the form will then be forwarded to your firm director, for review and signature.

Residents are assigned the following number of electives: Level 1 = one elective, Level 2 = two electives and Level 3 =

three electives. Preference will be given to more senior residents, and then on a first-come, first-service basis. Electives are arranged only through the Program office. Residents are UnotU to contact the faculty supervisors directly to

arrange electives. Exceptions are research and off-island electives and electives not offered in the Elective Handbook, which are independently-arranged by residents but still require Program approval.

Changes in electives will only be made if a completed “Change in Rotation Schedule” is submitted eight (8) weeks prior to the start of the rotation.

NOTE: For non-U.S. citizens, it takes twelve months or more to obtain computer clearance at Tripler Army Medical Center. Therefore, non-U.S. Interns are not able to schedule TAMC electives in the first year UandU must begin the security process in the intern year.

The “Elective Requests” form must be returned to Omi Kam in the program office by April 30, 2008.

Categorical PGY-1 Preliminary PGY-1 Rotation Duration Rotation Duration Inpatient Medicine (KMC & QMC) 6 blocks Inpatient Medicine (KMC & QMC) 7 blocks

General Internal Medicine (KMC & QMC) 5 blocks Critical Care (HMCE) 1 block Cardiology Selective (QMC) 1 block Queen Emma Clinics 1 block

Critical Care (HMCE) 1 block VA Ambulatory Care Clinics 1 block Queen Emma Clinics 2 blocks Emergency Medicine 1 block VA Ambulatory Care Clinics 1 block Elective 1 block Emergency Medicine 1 block Vacation 3 weeks Elective 1 block Study/Reading Week 1 week Vacation 3 weeks Study/Reading Week 1 week

PGY-2 PGY-3 Rotation Duration Rotation Duration Inpatient Medicine Wards 5 blocks Inpatient Medicine Wards 5 blocks

General Internal Medicine (KMC & QMC) 3 blocks General Internal Medicine (KMC & QMC) 3 blocks Cardiology Selective (QMC) 1 block Hospitalist Consultative Medicine Selective (QMC) 1 block Nephrology Selective (HMCE) 1 block Neurology Selective (KMC/HMCE) 1 block

Critical Care (QMC MICU) 2 blocks Critical Care (QMC MICU) 1 block Queen Emma Clinics 1 block Queen Emma Clinics 1 block Ambulatory Specialties 1 block Oncology 1 block Geriatrics 1 block VA Ambulatory Care Clinics 1 block Elective 1-2 blocks Elective 3 blocks Vacation 3 weeks Vacation 3 weeks Study/Reading Week 1 week Study/Reading Week 1 week

EFB:kn cc: Firm Directors Chief Resident Schedule Coordinator




1-800-55-UHMED • 1-800-558-4633

ELECTIVE SELECTIONS 2008 - 2009

Please list your elective requests in order of preference. Please list as many as possible and be sure to indicate any pertinent information in the Comments section. The guidelines for off-island electives and forms for electives not offered in the July 2008 Elective Handbook are located at the back of this Handbook. The forms may also be obtained through the Department Manuals link on New Innovations: http://www.new-innov.com/Login/Login.aspx. Electives / Faculty in Charge: 1. ___________________________________________________________________________ Comments: ____________________________________________________________________ 2. ___________________________________________________________________________ Comments: ____________________________________________________________________ 3. ___________________________________________________________________________ Comments: ____________________________________________________________________ 4. ___________________________________________________________________________ Comments: ____________________________________________________________________ 5. ___________________________________________________________________________ Comments: ____________________________________________________________________ 6. ___________________________________________________________________________ Comments: ____________________________________________________________________ This form (hard copy or via email) must be submitted to Omi Kam, Receptionist, by April 30, 2008.

__________________________________________ ______________________________ Name (please print) 2008-2009 PGY Level Date ____________________________________________ ______________________________ Firm Director Date

Elective ListDivisionID Faculty in ChargeDivision Elective Title

1 Allergy/Immunology

Belnap, Conrad ScottAllergy Clinical Immunology

Kuo, Philip I.Clinical Research in Allergy and Immunology

Lau, MatthewAllergy/Immunology

McDonnell, John T.Allergy, Asthma & Immunology

2 Cardiology

Azuma, StevenCardiology

Hong, RobertCardiology at The Queen's Medical Center

Hong, RobertSELECTIVE: Cardiology at The Queen's Medical Ctr

4 Critical Care

Gallacher, T. ScottMedical Intensive Care Unit

Ganitano, Jr., EmilioSELECTIVE: Critical Care Medicine

Ganitano, Jr., EmilioCritical Care Medicine

Ganitano, Jr., EmilioCritical Care Medicine: Cardiac Intensive Care

6 Dermatology

Bessinger, G. ToddDermatology

Burroughs, RichardDermatology

Dawson, Kevin L.Clinical Dermatology

Grekin, Jay L.Dermatology

Harada, FrederickDermatology

Johnson, DouglasClinical Dermatology

Matsunaga, JaniceDermatology

7 Emergency Medicine

Oyama, JeneferEmergency Medicine

Shuler, WilliamEmergency Medicine

8 Endocrinology

Arakaki, RichardDiabetes Mellitus and Endocrine Disorders

Francis, ThomasEndocrinology

Thursday, July 24, 2008 Page 1 of 3

DivisionID Faculty in ChargeDivision Elective Title

9 Gastroenterology

Grobe, James L.Gastroenterology

Napierkowski, John J.Gastroenterology

Ona, FernandoGastroenterology

Tsai, Naoky C.S.Hepatology

10 General Medicine

Goshima, Cyril K.Outpatient Care of HIV Patient

Houk, JohnOutpatient Medicine

Jurek, JoycelynAmbulatory Care - Internal Medicine

Kalauawa, ElliotAmbulatory Internal Medicine

Matsumoto, BryanAmbulatory Medicine

Morton, RonaldGeneral Internal Medicine - Private Practice

Onopa, JanetAmbulatory Medicine

Shikuma, Craig Y.Neighbor Island Primary Care Internal Medicine

Thomas, Jr., William L.Rural Medicine

11 Geriatric Medicine

Masaki, KamalGeriatric Medicine

12 Hematology

Berenberg, Jeffrey L.Hematology-Oncology

Loui, William S.Hematology-Oncology

13 Infectious Disease

Chang, Willis J. K. W.Infectious Disease

Eron, LawrenceInfectious Diseases

Ferguson, TomasInfectious Disease

Lau, WilliamInfectious Disease

Shikuma, CeciliaHIV Medicine

Wong, Russell D.Infectious Diseases

Young, RoydenInfectious Diseases

17 Nephrology

Botev, Rossini C.Nephrology

Cheng, Shiuh-Feng "Sherwin"Clinical Nephrology

Na'ai, David A.Clinical Nephrology

Nada, Aaron K.Nephrology

Ng, RolandNephrology

Ng, RolandSELECTIVE: Nephrology


DivisionID Faculty in ChargeDivision Elective Title

18 Neurology

Barthlen, Gabriele M.Sleep Medicine

Chang, CheryleeNeuroscience Intensive Care Unit

Yee, MelvinSELECTIVE: Clinical Neurology

19 Nuclear Medicine

Coel, MarcNuclear Medicine and PET

22 Pulmonary

Grbach, VincentPulmonary Disease

Yim, RogerPulmonary

23 Rehabilitation Medicine

Akau, Cedric K.Physical Medicine & Rehabilitation

24 Rheumatology

Arakawa, KenRheumatology

Finger, DavidRheumatology

John, DavidRheumatology

28 Hospitalist

Yates, RandyHospitalist Service

31 Other

Fischberg, DanielPain and Palliative Care


Elective Title: Allergy Clinical ImmunologyFaculty in Charge: Conrad Scott Belnap, MD

Site: Tripler Army Medical Center (TAMC): Allergy Immunology Clinic, 4th Floor C Wing, Office Telephone 433-6334

Other Faculty: Theodore T. Kim, MD, , , , , , , , , , , , , , , , , ,

Prerequisites: 4th year medical student, intern or resident

Maximum Number of Residents: 2 residents or 1 resident & 1 intern/student

Instructional methods: Meaningful patient responsibility/direct clinical experience

Ambulatory: 30 - 32 Ambulatory Site(s): TAMC Allergy Immunology Clinichrs/wk

Inpatient: 0 hrs/wk Inpatient Site(s):

Consultations: hrs/wk Consult Site(s):

Other Patient Care: Spending one-half day with an allergist seeing patients coming in for immunizations.

hrs/wk Other Patient Care Site(s):

a) Nonpatient focused teaching sessions that address the breadth of the subspecialty: 7 - 10 hrs/wk

b) Required conference attendance: UHIMRP Academic Half-Day: Tuesdays, 12:30-4:30pm, Queen's Conference Center

TAMC Peds or Medicine Morning Conference 0730 - 0900

c) Required reading list: 1) JAMA "Primer on Allergic & Immunologic Diseases"2) MKSAP "Allergy Clinical Immunology"3) Pertinent journal articles

d) Relevant MKSAP questions are reviewed: yes: no:

e) Other Activities:

Sample of a typical day's schedule: 0730 - 0900: Morning Conference (Medicine or Pediatrics)0900 - 1200: Two patients will be scheduled in the morning1300 - 1600: Two patients will also be scheduled in the afternoonOne-half day session will be spent in Immunization Clinic

Evaluation Method(s): a) UHIMRP Resident Evaluation Form

b) Other evaluation: Process used to evaluate/specific method of counseling: case presentations, write-ups. Verbal feedback during rotation and written evaluation at the end of the rotation.

Unique characteristics of this elective:

Methods to achieve goals:

1) Patient history and PE: in-depth discussion, including assessment and management plan.2) Observing allergy skin test, PFT, exercise challenge test.3) Didactic lectures.

Goals and Objectives (also see Curriculum):

1) Learn about common allergic diseases (asthma, rhinitis, sinusitis, food allergy, drug allergy, stinging insect allergy, urticaria/angioedema, anaphylaxis, immunotherapy, common allergic skin diseases and immunodeficiency diseases) and when to refer a patient to an allergist.2) Learn to interpret skin test (prick, I.D.) results and pulmonary function tests, exercise challenge and methacholine challenge tests.3) Learn about immunizations (routine adult & overseas travel).

Other Comments: Patients of all ages will be seen.

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Elective Title: Clinical Research in Allergy and ImmunologyFaculty in Charge: Philip I. Kuo, MD

Site: 1356 Lusitana St., 7th Floor; Private Practice, Physicians' Offices at QMC or Kaneohe; [email protected]

Other Faculty: John McDonnell, MD, James Sweet, MD, , , , , , , , , , , , , , , ,

Prerequisites: None

Maximum Number of Residents: 1


Ambulatory: 0 Ambulatory Site(s):hrs/wk


Consultations: 0 hrs/wk Consult Site(s):

Other Patient Care: See required reading list


a) Nonpatient focused teaching sessions that address the breadth of the subspecialty: 5 hrs/wk


Monday: AM meeting with Dr. KuoWednesday: 10:30AM - 12:00PM conference with Dr. Tam

c) Required reading list: Roth and Shira 1966 article, MKSAP or MedStudy Allergy/Immunology sections, pertinent journal articles


e) Other Activities: Optional allergy clinic experience 4 hours/week

Sample of a typical day's schedule: 1 hour conference/Board review, 6 hours chart review/data analysis, 1 hour reading


b) Other evaluation:



Goals:

1-Learn how to design and conduct a clinical research project.2-Know the current research regarding allergic asthma/rhinitis, with emphasis on Hawaii3-Prepare for the Allergy/Immunology section of the Internal Medicine and/or Pediatric Board exams.

Objectives:1-Perform a retrospective chart review of allergy testing panels on subjects in private practices of local allergists.2-Fulfill the resident research requirement, including conference presentation, if applicable.3-Review/discuss Allergy/Immunology questions from the Internal Medicine/Pediatrics Board exams.

Other Comments:

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Elective Title: Allergy/ImmunologyFaculty in Charge: Matthew Lau, MD

Site: Honolulu Kaiser Clinic, Kaiser Moanalua Medical Center Office Telephone 432-2000

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: Upper-level residents only



Ambulatory: 40 Ambulatory Site(s): Honolulu Clinichrs/wk

Inpatient: 4 hrs/wk Inpatient Site(s): Kaiser Moanalua Medical Center

Consultations: 5 - 10 hrs/wk Consult Site(s): Honolulu Clinic

Other Patient Care:

0 hrs/wk Other Patient Care Site(s):



c) Required reading list: JAMA "Primer on Allergic & Immunologic Diseases"



Sample of a typical day's schedule: Clinic 8:00 AM - 5:00 PM - follow-up, new consultations (inpatient or outpatient)


b) Other evaluation: Multiple choice exam at end of rotation


Residents will chart on Epic Automated Medical Record.


Teach history, PE appropriate for disease (asthma, AR, hives, drug reactions, anaphylaxis), diagnosis/management.

Other Comments: Not available: August & November 2008; January 2009

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Elective Title: Allergy, Asthma & ImmunologyFaculty in Charge: John T. McDonnell, MD

Site: 46-001 Kamehameha Highway, Suite 401, Kaneohe HI 96744 Office Telephone 247-6070

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 0 - 49 Ambulatory Site(s): Officehrs/wk

Inpatient: 0 - 7 hrs/wk Inpatient Site(s): Castle, Kapiolani and QMC

Consultations: 0 - 7 hrs/wk Consult Site(s): Castle, Kapiolani and QMC

Other Patient Care: Hospital rounds, if appropriate, at 6:30 AM




c) Required reading list: JAMA "Primer on Allergic & Immunologic Diseases"



Sample of a typical day's schedule: 8:00 AM - 12 Noon: OfficeNoon - 2:00 PM: Lunch or CME conference2:00 PM - 5:00 PM (7:00 PM Tuesdays and Thursdays): Office8:00 AM - 1:00 PM Saturdays: Office





1) Attendee will understand how to evaluate and treat varying degrees of severity of asthma, allergic rhinitis, atopic dermatitis, urticaria (acute and chronic), stinging insect allergy and other conditions coincident thereto, in a patient friendly setting, usually outpatient. 2) Learn extensive history taking essentials for allergy-immunology workup; learn how and when to order/perform appropriate testing; interpretation of immunological testing; skin prick and intradermal testing; understanding spirometric pulmonary function testing; introduction to complexities of billing/collections in a private office; learn to recognize and appropriately deal with unproven, unorthodox claims of pseudoscientific proponents of non-conventional allergy diagnostics and treatments.

Other Comments: Attendees are invited to partake of this elective "cafeteria style" - they can choose what and how much they want of any portion.Not available: July and December

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Elective Title: CardiologyFaculty in Charge: Steven Azuma, MD

Site: 321 North Kuakini Street, Suite 709, Honolulu HI 96817 Office Telephone 528-0005

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None




Inpatient: 20 hrs/wk Inpatient Site(s): KMC, QMC, Castle


Other Patient Care:




c) Required reading list:



Sample of a typical day's schedule: See patients in hospital and office. Follow testing EKG, treadmill, catheterization, interventional.




General interventional cardiology practice with a wide array of types of patients.


Other Comments: Cardiology at Queen's is also a required L2 rotation

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Elective Title: Cardiology at The Queen's Medical CenterFaculty in Charge: Robert Hong, MD

Site: The Queen's Medical Center, Tel: 526-1370

Other Faculty: David Fergusson, MD, Irwin Schatz, MD, Edward Shen, MD, Todd Seto, MD, Lee Guertler, MD, PhD, Chari Hart, MD, Malcolm Haruno, MD, Emilio Ganitano, MD, Larry Kaufman, MD, Various Other Cardiologist,

Prerequisites: Upper-Level residents only



Ambulatory: 4 Ambulatory Site(s): Queen Emma Clinicshrs/wk

Inpatient: 40 hrs/wk Inpatient Site(s): Queen Emma Tower 6

Consultations: 10 hrs/wk Consult Site(s): Queen Emma Tower 6

Other Patient Care: Noninvasive and Echocardiography Lab

week/block) hrs/wk Other Patient Care Site(s): Queen's Noninvasive Lab



Daily teaching rounds, Monthly Cardiac Case Conference, Monthly Cardiac Catherization Conference, Echocardiography Reading Rounds daily while on Noninvasive block

c) Required reading list: Harrison's Principles of Internal Medicine, Cardiac Section and supplemental list to be provided


e) Other Activities: Independent study

The elective will consist of a three week inpatient block where the resident will work under the supervision of a hospital based cardiologist as part of a multidisciplinary team including advance practice nurses. During this section, the resident will be responsible for the admission and management of Cardiac inpatients and inpatient consultative services. The resident will also participate in the care of patients cared for in the Cardiac Intensive Care Unit. The resident is assigned a one week block in Cardiac Noninvasive and Echocardiology during which time the resident will perform and interpret exercise stress tests and participate in the interpretation and performance of echocardiographic studies. Weekly Cardiology clinics in the treatment of patients with heart failure are scheduled.

Sample of a typical day's schedule: Inpatient Service (3 weeks per rotation):07:00-08:00 Residents Report08:00-10:00 Patient evaluation and prerounds10:00-12:00 Attending Rounds M, T, W, F w/ Hospital based Cardiologist; Th w/ Teaching Attending Rounds as needed with CICU staff12:00-16:00 Admissions, consultations, clinical procedures16:00-17:00 Signout rounds, ICU rounds

Noninvasive/Echo Service (1 week per rotation):07:00-11:00 Exercise Stress Testing, Noninvasive Lab11:00-12:00 Echocardiography Reading Session12:00-16:00 Assist with Echocardiography procedures, focused readingTBA Nuclear Medicine Reading and Review16:00-17:00 Echocardiography reading session





Goals:

1) To provide a comprehensive review of the care of cardiovascular patients, specifically focusing on conditions cared for by the general internal medicine practitioner. These conditions include: the treatment of heart failure, coronary artery disease and acute coronary syndromes and the management of cardiac arrhythmias.2) To expose the trainee to the principles and practice of echocardiography and exercise testing, specifically focusing on the choosing appropriate testing and orders.3) To provide the trainee with an exposure to invasive and interventional Cardiology.

Objectives:

1) To understand the pathophysiology of common cardiovascular conditions including: heart failure, arrhythmias and Page 6

atherosclerotic vascular disease.2) To understand the indications and limitations of noninvasive cardiac testing.3) To understand the principles and practice of Echocardiography.4) To participate in the care of Critical Care patients with primary Cardiovascular diagnoses.

Other Comments: Also a required L2 rotation

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Elective Title: SELECTIVE: Cardiology at The Queen's Medical CtrFaculty in Charge: Robert Hong, MD

Site: The Queen's Medical Center; 1329 Lusitana Street, Suite 306 96813; 526-1370, fax: 523-7982; [email protected]

Other Faculty: David Fergusson, MD, Chari Hart, MD, Christian Spies, MD, Todd Seto, MD, Irwin Schatz, MD, Robert Shohet, MD, Edward Shen, MD, , , , , ,

Prerequisites: None

Maximum Number of Residents: 1 PGY-1 & 1 PGY 2-3



Inpatient: 60 hrs/wk Inpatient Site(s): The Queen's Medical Center

Consultations: 10 hrs/wk Consult Site(s): The Queen's Medical Center

Other Patient Care: Echocardiology, Exercise Testing: 1 week of the rotation instead of inpatient care

60 hrs/wk Other Patient Care Site(s): The Queen's Medical Center



Monday: Core CurriculumWednesday: Imaging Cardiac CathFriday: Clinical Conference

c) Required reading list: Harrison's Principles of Internal Medicine, Disorders of Cardiovascular Diseases per rotation


e) Other Activities: Self education with preparation of two presentations on Cardiovascular Diseases per rotation

Sample of a typical day's schedule: 7:00 - 8:00 Patient Rounds8:00 - 9:00 Conferences (Monday & Wednesday)9:00 - 16:00 Clinical Care, including patient admissions, consults, procedural observations for three of four weeks, Echocardiography lab and stress testing for one of four weeks11:00 - 12:00 Clinical Professor Rounds (Fridays)16:00 - 17:00 Sign out rounds





Goals:

1. Reviewing the basics of Cardiovascular Care, including the treatment of ischemic heart disease, valvular heart disease, cardiomyopathies & arrhytmias2. Experience cardiology procedures, including cardiac catherterization, percutaneous interventions, electrophysiology testing and device implantation3. Participate in exercise testing and understand the reasons for obtaining echocardiograms and different cardac stress modalties

Objective: Obtain a basic science and understanding of the pathogenesis and treatment of cardiovascular diseases.

Other Comments:

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Elective Title: Medical Intensive Care UnitFaculty in Charge: T. Scott Gallacher, MD

Site: Queen's Medical Center MICU Telephone 537-7002, Pager: 578-8922

Other Faculty: Reid Ikeda, MD, Gary Kuniyoshi, MD, , , , , , , , , , , , , , , ,

Prerequisites: Completed two blocks in MICU rotation as PGY-2 or equivalent.



Ambulatory: Ambulatory Site(s):hrs/wk

Inpatient: Up to 80 hrs/wk Inpatient Site(s): QMC MICU

Consultations: Up to 20 hrs/wk Consult Site(s): QMC (comprises part of 80-hour inpatient exposure)

Other Patient Care:


a) Nonpatient focused teaching sessions that address the breadth of the subspecialty: hrs/wk


MICU teaching attending conferences. Previously attended didactic sessions can be considered optional.

c) Required reading list: Elective resident will be given a syllabus to keep for their review. If resident already has a syllabus, updates will be made available.


e) Other Activities: (1) Attendance at morning and signout rounds during weekdays. Note that clinic responsibilities will take precedence over signout rounds.(2) Provide a resource for pertinent literature and literature searches for the MICU team as needed. Opportunity to briefly discuss and present literature during bedside rounds to the rest of the MICU team.(3) Provide supervision/assistance with procedures for the MICU team p.r.n.. Opportunity to be signed off on procedures if needed for board eligibility.(4) Provide supervision/assistance to the residents and students in preparation for bedside rounds by enhancing professional growth, presentation skills or their clinical knowledge base.(5) Opportunity to participate in monthly sessions using simulator for patient and procedural scenarios.

Sample of a typical day's schedule:


b) Other evaluation: Resident must demonstrate mastery of the above educational objectives. The evaluation will reflect the overall professional attitude, behavior and proficiency demonstrated by the resident doing the MICU elective in attaining their monthly objectives.

Weekly quizzes and literature review.


Other Educational Material: Software review for ACLS, clinical hemodynamics, and other pertinent topics will be available for review. Familiarization with presentation software can also be attained.


Other Comments: QMC MICU is also a Preliminary and L2 required rotation.

Optional opportunities include:

(1) Participation in clinical research. Ideally should contact the MICU teaching attending the month before the start of the rotation to explore possible projects that could be started during your elective. Not feasible to try and complete most projects within one month. Initial IRB application and data collection can be initiated during your elective month.(2) Attendance at Professional Services conferences.(3) Participate in a limited way in the on-call schedule and direct patient care. Possible for elective resident to be placed on call schedule (i.e. once a week to slightly decrease call days for rest of team and gain more experience).(4) Review critical care section of MKSAP.(5) Opportunity to run rounds (along with the teaching attending).

MICU Objective Challenges: Elective resident will have the opportunity to challenge any of the MICU learning objective goals that they would want to review.

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Elective Title: Critical Care MedicineFaculty in Charge: Emilio Ganitano, Jr., MD

Site: Hawaii Medical Center - East: 2230 Liliha St., ICU 2nd Floor 96813 / 547-6204, [email protected]

Other Faculty: M. Haruno, MD, L. Kaufman, MD, S. Krishnagopalan, MD, M. Kruger, MD, S. Lee, MD, S. Evans, MD, M. Ross King, MD, , , , , ,

Prerequisites: PGY-2 or higher; resident in good standing; completed one block of MICU




Inpatient: 65 hrs/wk Inpatient Site(s): Hawaii Medical Center - East


Other Patient Care:




MTC Critical Care Rounds: M - F

c) Required reading list: Reading list of selected articles available on site


e) Other Activities: Daily work rounds with attending faculty; daily lectures as time allows

Sample of a typical day's schedule: Monday - Friday6:00 AM - 7:00 AM Round with RN7:00 AM - 8:00 AM Radiology Rounds8:00 AM - 10:00 AM Work Rounds10:00 AM - 11:00 AM MTC Critical Care Rounds11:00 AM - 12:30 PM Critical Care Attending Rounds12:30 PM - 1:00 PM Lunch1:00 PM - 6:00 PM New Consults/Work Rounds/Lecture

Saturday6:00 - 7:00 AM Round with RN7:00 AM - 8:00 AM Radiology Rounds8:00 AM - 12:00 PM Work Rounds/Attending Rounds





Goals:

1-Resident will gain a detailed introduction to being a Critical Care Medicine Consultant in a Multidisciplinary Intensive Care Unit.2-Resident will have a detailed understanding of providing Critical Care in the Multidisciplinary Team Model.3-Resident will gain a detailed experience in medical education in Critical Care.

Objectives:

1-The resident will have participated in the diagnosis and management of common critical care problems including all forms of shock, respiratory failure, ARDS, sepsis, renal failure, brain death, and nosocomial infections.2-The resident will have gained proficiency in mechanical ventilation, vasopressors/inotropes, invasive hemodynamic monitoring, ICU nutrition, sedation and analgesia, bedside procedures including airway management, central venous lines and arterial lines, and ACLS/CPR.3-The resident will have gained a detailed introduction to the perioperative management of Surgical ICU/CV ICU patients including unstable laparotomy, CABG, Valve Replacement, and Liver/Kidney transplant.

Other Comments:

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Elective Title: Critical Care Medicine: Cardiac Intensive CareFaculty in Charge: Emilio Ganitano, Jr., MD

Site: Queen's Medical Center; Cardiac Comprehensive Care Unit Pager: 578-0011, Email: [email protected]

Other Faculty: Malcolm Haruno, MD, Larry Kaufmann, MD, Sreenandh Krishnagopalan, MD, Marc Kruger, MD, Samuel Evans, MD, J.S. Lee, MD, , , , , , , ,

Prerequisites: Upper-level in good standing; must complete at least 1 MICU block




Inpatient: 35 hrs/wk Inpatient Site(s): QMC Tower 3/Tower 6E CCCU

Consultations: 10 hrs/wk Consult Site(s): QMC Tower 3/Tower 6E CCCU

Other Patient Care:

hrs/wk Other Patient Care Site(s): Self study of reading; attending led didactics



c) Required reading list: CCU related critical care articles as provided by faculty.


e) Other Activities: Daily CCU Critical Care Rounds with Multidisciplinary Team; additional Cardiology related experiences (observe cath, echo etc.) as available.

Sample of a typical day's schedule: Monday - Friday

8:00 - 9:00 AM Pre-round9:00 - 11:00 AM CCCU Multi Disciplinary ICU Rounds11:00 AM - 2:00 PM New Consults and required conferences2:00 - 5:00 PM Patient follow-up, didactics, self reading time

Saturday

7:00 - 8:00 AM Pre-round8:00 - 10:00 AM Multidisciplinary ICU Rounds10:00 - 11:00 AM Follow-up





Goals:

1) Resident will gain a detailed introduction to being a Critical Care Medicine Consultant in the Cardiac ICU setting.2) Resident will have a detailed understanding of providing Critical Care in the Multidisciplinary Team Model.

Objectives:

1) The resident will have participated in the diagnosis and management of common Cardiac Intensive Care problems including Acute Coronary Syndrome, Cardiogenic shock, Arrhythmias, decompensated CHF, and Respiratory Failure.2) The resident will have gained experience in "real world" application of hemodynamics including: invasive hemodynamic monitoring, use of vasopressors and intropes, introduction to Intra Aortic Balloon Pumps.3) The resident will have participated in the application of general Critical Care MEDICINE in the Cardiac Intensive Care Setting.4) The resident will have been introduced to the diagnosis and management of the MEDICAL problems associated with the perioperative management of CV Surgery Patients (Shock, Hemorrhage, Respiratory Failure, Renal Failure, Sepsis, etc.).

Other Comments:

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Elective Title: SELECTIVE: Critical Care MedicineFaculty in Charge: Emilio Ganitano, Jr., MD

Site: Hawaii Medical Center East, Critical Care Unit; 2230 Liliha St.; Pgr: 578-0011; [email protected]

Other Faculty: Malcolm Haruno, MD, Larry Kaufman, MD, Sree Krishnagopalan, MD, Samuel Evans, MD, Sunghyun Lee, MD, Marc Kruger, MD, Michelle Ross-King, MD, , , , , ,

Prerequisites: PGY-1 in good standing




Inpatient: 80 hrs/wk Inpatient Site(s): Hawaii Medical Center East, CCU2


Other Patient Care:




HMCE CME Conference (Thurs AM), Basics of Critical Care Lecture Series (4 scheduled sessions)

c) Required reading list: Critical Care articles


e) Other Activities: Daily patient care, teaching rounds, didactic sessions (3 times per week minimum), supplemental experiences (mechanical ventilator workshop, code blue drills)

Sample of a typical day's schedule: DAY RESIDENT:0600-0615 Sign In with Outgoing Team; 0615-0630 Check Out Rounds with Outgoing RN; 0630-0700 X-ray Rounds; 0700-0900 Pre-Rounds; 0900-1600 Bedside Teaching Rounds, Daily Didactic Sessions, New Consult, Patient Follow Up; 1600-1800 Completin of Work, Prepare Sign Out, Basics of Critical Care Lecture Series

NIGHT RESIDENT:1800-1815 Sign In with Outgoing Team, 1815-1830 Check Out Rounds with Outgoing RN, 1830-1930 Night Rounds - Current Patients, 1930-2030 Didactic Sessions, 2030-0545 Patient Care, New Consults, Patient Follow Up, Self-Directed Reading, 0545-0600 Prepare Sign Out





Goals:1-Understand the overall scope, severity and needs of patients in the Critical Care setting.2-Understand the concept of Multidisciplinary approach to critical care.3-Demonstrate an understanding of the basic pathophysiology, diagnosis and treatment of common conditions in the Critical Care Unit including Respiratory Failure, Shock, Severe Sepsis, Acute Kidney Injury in both medical and surgical patients.

Objectives:1-Residents will be proficient in data gathering, physical examination and documentation for patients in the Critical Care Unit.2-Residents will understand the role of the Critical Care Medicine consult in the CCU setting.3-Residents will understand the indications, contraindications, potential complications, and basic aspects of common ICU procedures including Central Venous Line Placement, Arterial Line Placement, and basic airway management.4-Residents will understand basic CCU concepts including mechanical ventilation, use of vasopressor/inotropic agents, the use of invasive hemodynamic monitoring, sedation, and nutrition in the CCU.5-Residents will participate and understand the role of the physician in both Rapid Response Teams and Code Blue Teams.

Other Comments:

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Elective Title: DermatologyFaculty in Charge: G. Todd Bessinger, MD

Site: 1029 Kapahulu Ave, Ste 305 96816, 218-7889, fax: 218-7891

Other Faculty: Cole Altman, DO, , , , , , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 30 Ambulatory Site(s): TAMChrs/wk

Inpatient: 0 hrs/wk Inpatient Site(s): TAMC

Consultations: 5 hrs/wk Consult Site(s): TAMC

Other Patient Care: Hawaii Dermatological Society

3 hrs/mos hrs/wk Other Patient Care Site(s): Queen's Medical Center



Hawaii Dermatological SocietyPeds DermatologyDermpath conference (2x/month)

c) Required reading list: Fitizpatrick "Atlas & Synopsis of Clinical Dermatology"


e) Other Activities: (1) Review sessions highlighting common dermatology diagnoses and treatments.(2) Learn common biopsy techniques.(3) Checklist of common dermatoses that resident must be familiar with by end of rotation.(4) Residents will be given the task of presenting patients at rounds once a month.(5) End-of-rotation exam (open-book)

Sample of a typical day's schedule: Clinic is scheduled Monday - Friday, 0800 - 1600.8 clinics (some specialty, I.e., peds dermatology, complication dermatology) per week; two surgery morning per week; one focused academic session per week. Inpatient consultations will be seen as they are received.


b) Other evaluation: Quiz at end of rotation


Residents should become familiar with common dermatology terminology, common dermatoses, simple surgical and biopsy techniques.


(1) To acquire the knowledge and develop the skills to diagnose common skin diseases and institute proper treatment.(2) To acquire the knowledge and develop the skills to diagnose systemic or life-threatening diseases with cutaneous manifestation and institute proper treatment.(3) Learn appropriate dermatologic vocabulary to describe skin conditions orally and in writing.

Other Comments: Teaching sessions are conducted daily in the examination rooms and in small informal teaching sessions. There are also three scheduled slide conferences with staff on a weekly basis.

Page 17

Elective Title: DermatologyFaculty in Charge: Richard Burroughs, MD

Site: Tripler Army Medical Center, Dermatology Clinic. Ph: 433-3086, Fax: 433-7457

Other Faculty: Christina Lyons, MD, , , , , , , , , , , , , , , , , ,

Prerequisites: None




Inpatient: hrs/wk Inpatient Site(s):


Other Patient Care: Hawaii Dermatological Society

3 hrs/wk Other Patient Care Site(s): Queen's Medical Center



Hawaii Dermatological SocietyPeds DermatologySelected Department of Medicine ConferencesDermpath Conference (2x/month)

c) Required reading list: Fitzpatrick "Atlas & Synopsis of Clinical Dermatology"


e) Other Activities: (1) Review sessions highlighting common dermatology diagnoses and treatments.(2) Learn common biopsy techniques.(3) Checklist of common dermatoses that resident must be familiar with by end of rotation.(4) Residents will be given the task of presenting patients at rounds once a month.(5) End-of-rotation exam (open-book)

Sample of a typical day's schedule: Clinic is scheduled Monday - Friday, 0800 - 1600.8 clinics (some specialty, I.e., peds dermatology, complication dermatology) per week; two surgery morning per week; one focused academic session per week. Inpatient consultations will be seen as they are received.




Residents should become familiar with common dermatology terminology, common dermatoses, simple surgical and biopsy techniques.


(1) To acquire the knowledge and develop the skills to diagnose common skin diseases and institute proper treatment.(2) To acquire the knowledge and develop the skills to diagnose systemic or life-threatening diseases with cutaneous manifestation and institute proper treatment.(3) Learn appropriate dermatologic vocabulary to describe skin conditions orally and in writing.

Other Comments: Teaching sessions are conducted daily in the examination rooms and in small informal teaching sessions. There are also three scheduled slide conferences with staff on a weekly basis.

Page 18

Elective Title: Clinical DermatologyFaculty in Charge: Kevin L. Dawson, MD

Site: Private office & Outpatient clinics Office Telephone 599-3780

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None

Maximum Number of Residents: 1 resident or student


Ambulatory: 40 Ambulatory Site(s): Office, QEC, VA Clinichrs/wk

Inpatient: 2 hrs/wk Inpatient Site(s): QMC


Other Patient Care:




Hawaii Dermatologic Society Grand Rounds






b) Other evaluation: Pre-test and post-test



Residents will be able to describe, diagnose and treat common skin ailments.Residents will be familiar with basic dermatologic procedures.

Other Comments:

Page 19

Elective Title: DermatologyFaculty in Charge: Jay L. Grekin, MD

Site: Straub Clinic & Hospital, Inc., 888 South King Street, Honolulu HI 96813 Office Telephone 522-4000

Other Faculty: Roman Glamb, MD, Jenny Stone, MD, , , , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 35 Ambulatory Site(s): Straub Clinichrs/wk


Consultations: 5 hrs/wk Consult Site(s): Straub Hospital

Other Patient Care:




Hawaii Dermatological Society

c) Required reading list: "Andrew's Dermatology Text"



Sample of a typical day's schedule: Outpatient clinic with inpatient consultation 8:00 AM - 5:00 PM





Other Comments:

Page 20

Elective Title: DermatologyFaculty in Charge: Frederick Harada, MD

Site: 1380 Lusitana Street, Suite 909, Honolulu HI 96813 Office Telephone 585-7771

Other Faculty: Kevin Mott, MD, , , , , , , , , , , , , , , , , ,

Prerequisites: None

Maximum Number of Residents: 1 resident or student





Other Patient Care:






e) Other Activities: Review of UHIMRP "Dermatology CD-ROM"

Sample of a typical day's schedule: Patients from 9:00 AM - 4:30 PM





Other Comments: Not available: Blocks 1, 3, 5, 7, 9, & 11

Page 21

Elective Title: Clinical DermatologyFaculty in Charge: Douglas Johnson, MD


Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 42 Ambulatory Site(s): POB 1, Suite 401hrs/wk



Other Patient Care:

2-1/2 hrs/wk Other Patient Care Site(s): Aloha Medical Mission



Monthly Hawaii Dermatological Society Meeting

c) Required reading list: "Primer of Dermatology"



Sample of a typical day's schedule: Monday, Tuesday & Thursday: 8:00 AM - 5:00 PMWednesday: 9:00 AM - 12 NoonFriday: 8:00 AM - 1:00 PMSaturday: 8:00 AM - 12 Noon




Medical dermatology


Describe cutaneous findings.Diagnose common dermatological conditions.Treat common dermatological conditions.

Other Comments: Expected to attend all clinicsNot available: August, November, December, March and June

Page 22

Elective Title: DermatologyFaculty in Charge: Janice Matsunaga, M.D.


Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 40+ Ambulatory Site(s): officehrs/wk

Inpatient: variable hrs/wk Inpatient Site(s):

Consultations: variable hrs/wk Consult Site(s):

Other Patient Care:


a) Nonpatient focused teaching sessions that address the breadth of the subspecialty: variable hrs/wk









Clinical assessment of patients, developing treatment plans, history taking, follow-up in outpatient setting.


Understand basic dermatologic terms, lesion and treatment.

Other Comments: Available Blocks: 4, 5, 9, & 11

Page 23

Elective Title: Emergency MedicineFaculty in Charge: Jenefer Oyama, MD

Site: Queen's Medical Center Emergency Department Telephone 597-8791

Other Faculty: Christopher Ganir, MD, Dale Oda, MD, Wynn Wakuzawa, MD, Mark Magelssen, MD, E. Howard Klemmer, MD, Mitchel Rosenfeld, MD, Carlyn Ko, MD, Dan Smith, MD, Andy Schwartz, MD, ,

Prerequisites: None

Maximum Number of Residents: 2 per rotation





Other Patient Care:




c) Required reading list: Recommended "Emergency Medicine" Tintinalli



Sample of a typical day's schedule: ER 7:00 AM - 7:00 PM or 7:00 PM - 7:00 AM




Opportunity for one-on-one teaching with immediate feedback, and opportunity for supervised procedural skills, as well as diagnostic and therapeutic skills.


Other Comments: Emergency Medicine is also a required L1 rotation.

One-on-one clinical evaluation of patient followed by discussion of that disease or injury and differential diagnosis, emergency intervention and disposition.

Page 24

Elective Title: Emergency MedicineFaculty in Charge: William Shuler, MD

Site: Kapiolani Medical Center at Pali Momi Emergency Department Telephone 485-4300; Fax 485-4388; [email protected]

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites:

Maximum Number of Residents: 1 at a time





Other Patient Care:







Sample of a typical day's schedule: 10-12 hours of ER patients - evaluation and treatment


b) Other evaluation: Evaluation of performance by staff attendings - all UH clinical faculty


Work-up, care, treatment and disposition of a unique variety of patients and disorders.


Other Comments:

Page 25

Elective Title: Diabetes Mellitus and Endocrine DisordersFaculty in Charge: Richard Arakaki, MD

Site: (1)677 Ala Moana Boulevard, #1024 Honolulu HI 587-8622; and (2) Hawaii Medical Center West #213 Ewa Beach HI

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: PGY-3, PGY-2, or end of PGY-1 training



Ambulatory: 28 Ambulatory Site(s): Both combinedhrs/wk


Consultations: 4 hrs/wk Consult Site(s): HMCE, QMC

Other Patient Care:

hrs/wk Other Patient Care Site(s): 2 -3 of 1/2 hours each didactic sessions per week





e) Other Activities: Open discussion and questions about patients; review of 1-2 key journal articles

Sample of a typical day's schedule: Clinic schedule - diabetic and endocrine patient care, evening inpatient consultations




Multi-disciplinary approach to diabetes care. Multiple endocrinopathies in the outpatient clinic. Interaction with other professionals, i.e. CDE, dietitian


Other Comments: Not Available: Block 7, 10 & 13

Page 26

Elective Title: EndocrinologyFaculty in Charge: Thomas Francis, MD

Site: Tripler Army Medical Center (TAMC): Endocrine Department Telephone 433-6520

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: PGY 1 graduate






Other Patient Care:




0730: TAMC Medicine Conference (Monday - Friday)

c) Required reading list: UHIMRP reading list


e) Other Activities: Case presentations by staff

Sample of a typical day's schedule: 0730: Morning Report1215 - 1300: Medicine lecture Monday thru Friday0900 - 1200: Outpatient clinic1300 - 1600: Inpatient consults; Resident Internal Medicine clinic; Department education




Pacific Island patient population access


Other Comments:

Page 27

Elective Title: GastroenterologyFaculty in Charge: James L. Grobe, MD


Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None

Maximum Number of Residents:


Ambulatory: 25 - 30 Ambulatory Site(s): Officehrs/wk

Inpatient: 5 - 10 hrs/wk Inpatient Site(s): QMC

Consultations: 5 - 10 hrs/wk Consult Site(s): QMC

Other Patient Care:




c) Required reading list: "The Gut"



Sample of a typical day's schedule: Hospital rounds, AM clinic, endoscopy/consults, PM clinic





Increase knowledge of GI.

Other Comments:

Page 28

Elective Title: GastroenterologyFaculty in Charge: John J. Napierkowski, MD

Site: Tripler Army Medical Center (TAMC): GI Department Telephone 433-6508; Fax 433-2707

Other Faculty: Fernando Ramos, MD, Roger Polish, MD, , , , , , , , , , , , , , , ,

Prerequisites: Successful completion of at least one outpatient rotation as housestaff






Other Patient Care:

8 hrs/wk Other Patient Care Site(s): TAMC



TAMC Morning Report, TAMC Department of Medicine Conference

c) Required reading list: MKSAP plus selected articles


e) Other Activities: Self-instructional materials:1) AGA slide series2) The Gut, University of Washington series

Sample of a typical day's schedule: 0730 - 0810 Morning Report0815 - 0900 Medical conference0900 - 1215 Inpatient consults and procedures1215 - 1600 Outpatient clinic


b) Other evaluation: Pre- and post-testsInteraction on patient cases and procedures. Brief, clinically-related lectures provided by housestaff



Other Comments: Availability dependent on TAMC residents' scheduled

Page 29

Elective Title: GastroenterologyFaculty in Charge: Fernando Ona, MD

Site: VA Pacific Islands Health Care System, 459 Patterson Road, Honolulu HI 96819 Office Telephone 433-0064

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: Resident status



Ambulatory: 40 Ambulatory Site(s): VA, TAMChrs/wk



Other Patient Care: Research opportunities

Variable hrs/wk Other Patient Care Site(s):



c) Required reading list: Selected gastroenterology readings



Sample of a typical day's schedule: AM: proceduresPM: clinic visits





Increase knowledge of gastroenterology

Other Comments:

Page 30

Elective Title: HepatologyFaculty in Charge: Naoky C.S. Tsai, MD

Site: Hawaii Medical Center: East Telephone 547-6541/263-5174

Other Faculty: Steve Buto, MD, Robert Jao, MD, , , , , , , , , , , , , , , ,

Prerequisites: Resident



Ambulatory: 28 Ambulatory Site(s): Hawaii Medical Center: Easthrs/wk

Inpatient: 10 hrs/wk Inpatient Site(s): Hawaii Medical Center: East


Other Patient Care:




Hepatobiliary Tumor ConferenceGI-Hepatology Conference

c) Required reading list: Sheila Sherlock's Diseases of the Liver and Biliary System


e) Other Activities: Outpatient consultations 20 cases/day; twice a week discussion with attendings






1. Learning and understanding of physiology and pathophysiology, clinical manifestations and current management of common hepatobiliary diseases including tumors, viral hepatitis, autoimmune hepatitis.2. Prepare resident to use knowledge about common hepatobiliary disease so that they can manage and workup those patients independently and formulate treatment plans and time to refer for specialist care.

Other Comments:

Page 31

Elective Title: Outpatient Care of HIV PatientFaculty in Charge: Cyril K. Goshima, MD

Site: 3221 Waialae Ave., Suite 382; Telephone 737-7947, Fax 732-9463, Email [email protected]

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites:



Ambulatory: 32 Ambulatory Site(s): Private Officehrs/wk



Other Patient Care:




CME programs provided by the AIDS Education Project

c) Required reading list: CDC Guidelines for Treatment HIV



Sample of a typical day's schedule: Office M, Th, W, F 9:00 AM - 5:00 PM; Evening CME programs





Goal:Exposure to outpatient treatment of HIV

Objectives:1) Identify primary care issues in HIV2) Beginning advanced therapy/changing therapy3) monitoring test including resistance tests - when/how to use

Other Comments:

Page 32

Elective Title: Outpatient MedicineFaculty in Charge: John Houk, MD

Site: (1) 1329 Lusitana Street, Suite 308, Honolulu HI 96813 Office Telephone 599-8922 and (2) Arcadia Retirement Residen

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None

Maximum Number of Residents: 1 resident per year


Ambulatory: 36 Ambulatory Site(s): Office and Arcadia Retirement Residencehrs/wk



Other Patient Care:

4 hrs/wk Other Patient Care Site(s): Arcadia Retirement Residence






Sample of a typical day's schedule: 7:30 AM - 12:30 PM and 130 PM - 4:00 PM: Patient careCase presentations to Dr. Houk; assigned readings





"In the trenches" experience. Resident will provide ambulatory care for diabetes, HTN, HLD, CAD, depression, OA and a variety of other ailments.

Other Comments: Experience general internal medicine solo practice in Queen's POB 2. Resident will provide ambulatory care for diabetes, HTN, HLD, CAD, and depression. Weekly rotation to Arcadia Retirement Residence (average age in SNF >90).

Page 33

Elective Title: Ambulatory Care - Internal MedicineFaculty in Charge: Joycelyn Jurek, MD

Site: 1329 Lusitana St., #204 Honolulu 96813l Ph: 524-2100, Fax: 534-0593; Email: [email protected]

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites:



Ambulatory: 32 Ambulatory Site(s): Private officehrs/wk



Other Patient Care:

hrs/wk Other Patient Care Site(s): Private office



c) Required reading list: Selected journal articles



Sample of a typical day's schedule: 9:00 AM - 5:00 PM See approximately 15-20 patients with common chronic medical conditions (e.g., diabetes mellitus, hypertension, hyperlipidemia) and acute conditions (e.g., upper respiratory infection, urinary tract infection, low back pain). Research select issues using EBM techniques.





Goal: Develop sound outpatient clinical skills necessary to provide continuity of care.

Objectives:1. Focus on developing "appropriate", culturally sensitive bedside manners.2. Acquire patient-centered approach to compliment clinical skills.3. Work effectively with staff and team.4. Develop efficiency without compromising quality of care.

Other Comments: Not avaiable: Blocks 7 & 13

Page 34

Elective Title: Ambulatory Internal MedicineFaculty in Charge: Elliot Kalauawa, MD

Site: Waikiki Health Center: 277 Ohua Ave. 96815 / 922-4787, F: 922-4950, [email protected]

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites:



Ambulatory: 40 Ambulatory Site(s): Waikiki Health Centerhrs/wk



Other Patient Care:




c) Required reading list: Patient-based



Sample of a typical day's schedule: 9:00 AM - 6:00 PM (12:30 - 1:30 PM lunch)





Goals:

1-To develop competence & comfort in managing patients from diverse ethnic, socioeconomic and sexual backgrounds.2-To develop competence in primary care for patients with HIV infection.

Objectives:

1-To diagnose and manage the medical issues of homeless patients.2-To develop skills in caring for patients with limited financial resources.3-To learn principles of antiretroviral therapy.

Other Comments:

Page 35

Elective Title: Ambulatory MedicineFaculty in Charge: Bryan Matsumoto, MD

Site: Pearl City Medical Associates: 98-1079 Moanalua Rd, #500 Aiea 96701, 488-0990, fax: 486-4696

Other Faculty: Alvin Fuse, MD, Fred Tanabe, MD, Michael Mihara, MD, Francis Buto, MD, , , , , , , , , , , ,

Prerequisites: 1 year of continuity clinic



Ambulatory: 35 Ambulatory Site(s): Pearl City Medical Associateshrs/wk

Inpatient: 3 hrs/wk Inpatient Site(s): Kapiolani Medical Center at Pali Momi

Consultations: 2 hrs/wk Consult Site(s): Pearl City Medical Associates

Other Patient Care:




Monday noon conference at Kapiolani Medical Center at Pali Momi



e) Other Activities: Direct care in ambulatory setting

Sample of a typical day's schedule: 7:00 - 8:00 AM Hospital Rounds (typically 1 patient)8:00 AM - 12:00 PM, 2:00 - 5:00 PM (weekdays); 8:00 - 11:00 AM (continuity clinic day)8:00 AM - 12:00 PM Saturdays





Goals:

1) Familiarity with care of diabetes, hypertension, hyperglycemia and cardiovascular diseases.2) Outpatient evaluation and work-up of serious disease.3) Assessment and management of "acute minor illness".4) Develop a notion of continuity of care in primary care.

Objectives:

1) Skills in time management, test ordering, prescription medication orders in an outpatient setting.2) Interact with nursing staff in an outpatient setting.

Other Comments:

Page 36

Elective Title: General Internal Medicine - Private PracticeFaculty in Charge: Ronald Morton, MD

Site: 1380 Lusitana St., #202 Telephone 531-4445 Fax: 531-4593 Email: [email protected]

Other Faculty: , , , , , , , , , , , , , , , , , , ,


Maximum Number of Residents: 3 residents/year





Other Patient Care:






e) Other Activities: Private study, review of pertinent clinical data

Sample of a typical day's schedule: Office patients Monday through Friday




This elective is primarily for residents who want to pursue private practice in Internal Medicine.


Goals:1) Exposure to private practice of medicine2) Clinical care of day-to-day patient problems in internal medicine

Objectives:1) Ability to manage common outpatient patient care issues2) Evaluation of different models of clinical practice

Other Comments:

Page 37

Elective Title: Ambulatory MedicineFaculty in Charge: Janet Onopa, MD

Site: The Queen Emma Clinics

Other Faculty: C.S. Chan, MD, Judy Rudnick, MD, Rosa Igno, MD, Gerard Akaka, MD, , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 40 Ambulatory Site(s): The Queen Emma Clinicshrs/wk


Consultations: 15 hrs/wk Consult Site(s): Telephone consultation

Other Patient Care:




Geriatrics, Coding, Psychiatry, HIV, IDC Diabetes, Ambulatory Journal Club, Pain Management, Medical Grand Rounds




Sample of a typical day's schedule: See "Guide for Residents and Students"





1. See QEC Ambulatory Care Rotation Curriculum.2. Resident will be given the opportunity to assess and participate in ancillary services, e.g., diabetic teaching, social work services.

Other Comments:

Page 38

Elective Title: Neighbor Island Primary Care Internal MedicineFaculty in Charge: Craig Y. Shikuma, MD, CMD

Site: 82 Pu'uhonu Pl., Suite 207 / Hilo 96720, Phone: (808) 935-5522

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: PGY-3 status




Inpatient: 10 hrs/wk Inpatient Site(s): Hilo Medical Center

Consultations: 0-1 hrs/wk Consult Site(s): Hilo Medical Center, including Emergency Room

Other Patient Care: Extended Care Rounds at Hilo Medical Center Emergency Care, Life Care Center of America in Hilo and Hale A

2-4 hrs/wk Other Patient Care Site(s):





e) Other Activities: Community activities, Directorship meetings

Sample of a typical day's schedule: 7:00 AM - 8:00 AM Inpatient Care9:00 AM - 5:00 PM Outpatient Care6:00 PM - 7:00 PM Extended Care Rounds/Acute Care Admissions/Rounds/ER




Neighbor Island General Internal Medicine Care in a solo practice setting offering quality care in an environment with limited specialty backup. Family care from adolescent to geriatric age ranges. Unique experience with working with patients in a continuum of care from clinic to inpatient setting to extended care to hospice care, subspecialty care coordination and orchestration. Primary diagnostic workups and treatment encompassing all specialties of medicine including, but not limited to endocrinology, infectious disease, cardiology, oncology, hematology, neurology, etc.


Front line experience in a busy complex solo primary care internal medicine practice on a neighbor island integrated into the Hilo community.

Other Comments: Resident must complete HRP off-island US elective paperwork.

Housing and transportation possible but not guaranteed. Both needs to be discussed with the hospital administrator when scheduling elective.

Page 39

Elective Title: Rural MedicineFaculty in Charge: William L. Thomas, Jr., MD

Site: Molokai General Hospital & Rural Health Clinic: 280 Homeolu Pl. / (808) 553-3121, fax: (808) 553-3112, wthomasmd@q

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites:



Ambulatory: 40 Ambulatory Site(s): Molokai General Hospital & Rural Health Clinichrs/wk

Inpatient: 0-5 hrs/wk Inpatient Site(s): Molokai General Hospital & Rural Health Clinic


Other Patient Care:




c) Required reading list: Selected articles on Native Hawaiian health



Sample of a typical day's schedule: Clinic Hours 4 days/week: 7:30 AM - 5:30 PMInpatient admissions when required





Medicine on the island of Molokai presents many interesting experiences and challenges. The residents will provide outpatient care for conditions commonly encountered in an internal medicine practice including diabetes, hypertension, heart disease, lung disease, and musculoskeletal diseases. Learning objectives include gaining an understanding of the barriers to, and limitations of, healthcare in a remote rural area. The residents will experience the unique approach to patients in a small island community, understanding how socioeconomic factors and family dynamics affect the health of an individual. The population of Molokai is 60%+ Native Hawaiian and the residents will gain an appreciation of the health status of Native Hawaiians. The residents will also experience the use of telemedicine in the delivery of health care to a remote rural area including our innovative outpatient chemotherapy clinic. The residents will also come to appreciate the lifestyle, rewards and challenges of rural medicine.

Other Comments: Not Available: Blocks 3 & 4Free Housing: Shared 3-bedroom country duplex on hospital property. Two single-beds and one double-bed. If resident brings a spouse, the double-bed room will need to be reserved in advance.Other Housing: Starting at $1800/month, cost incurred by resident.

Page 40

Elective Title: Geriatric MedicineFaculty in Charge: Kamal Masaki, MD

Site: Kuakini, Queen's, HMCE, Teaching Nursing Home, VA Outpt Clinic & Ctr for Aging

Other Faculty: Lam Nguyen, MD, Michael Carethers, MD, Shari Kogan, MD, Kentaro Nishino, MD, James Epure, MD, Craig China, MD, Elizabeth Rhee, MD, Bruce Tamura, MD, Aida Wen, MD, Various Geriatric Medicine Faculty,

Prerequisites: None






Other Patient Care:




All didactic sessions in geriatrics

c) Required reading list: Curriculum handbook for residents provided



Sample of a typical day's schedule: -Two weeks at an ambulatory or inpatient site (32 hours/week)-Two weeks at long-term care facilities (32 hours/week)-Didactics two half-days/week

Schedule varies each day. Sites will vary according to availability.


b) Other evaluation: During the 4 weeks of this rotation, you will be evaluated over several performance measures in order to determine how you are progressing toward achieving the basic goals of the rotation and ultimately, whether or not you achieve the basic goals at the end of the rotation.

You are required to take the written final exam for geriatric and palliative medicine at the end of your rotation. The palliative medicine portion is 20% of the exam. Your exam schedule will be provided on the rotation calendar.

Final written examination = 30%Evaluation of clinical performance = 50%Participation in seminars = 20%


This elective gives the residents a balanced overview of geriatric medicine. The resident will work in multiple settings, including outpatient, inpatient, home care and nursing homes. Residents will learn about comprehensive care of frail elderly patients in an interdisciplinary team.


-To understand the difference between normal aging and disease.-To understand that many older people live active, independent lives and demonstrate remarkable problem-solving behavior.-To understand the greater variability in mental and physical functioning with increasing age, and the difference between chronologic and physiologic age.-To learn to diagnose and treat, with proper consultative assistance, the major medical and psychiatric illnesses of late life.-To learn to prioritize treatment needs based on the severity and urgency of the problems, paying special attention to the adverse outcomes inherent in multiple drug regiments.-To refine knowledge of pharmacology in older people: appropriateness, clearances, adverse effects, compliance, costs, errors, forms of preparations, and drug-drug interactions.-To learn to communicate with older adults, taking into account possible hearing and vision impairments.-To learn to evaluate geriatric medical problems and become familiar with the atypical presentation of illnesses in older patients.-To learn to work well in an interdisciplinary team.-To learn to provide, with assistance from other professionals, a comprehensive patient assessment, including medical, psychiatric and social aspects.-To develop skill in organizing a care plan with the participation of the patient, family and other members of the interdisciplinary team.

Page 41

-To develop a familiarity with various components, capabilities and limitations of different levels of long-term care.-To learn about social and demographic issues in the aging population with a special emphasis on intercultural differences.-To learn about health care costs and financing with an emphasis on cost containment mechanisms and their effects on older people.-To consider the legal and ethical issues which influence behavior and decisions in medical settings.

Other Comments: Also a required PGY-2 rotation.

Important Contact Information:

-Misty Yee, MS (Resident & Medical Student Education Coordinator): 523-8461; [email protected] Masaki, MD (Course Director): 523-8461; [email protected]

Not available: Blocks 1, 6, 7, 8, & 13

Page 42

Elective Title: Hematology-OncologyFaculty in Charge: Jeffrey L. Berenberg, MD

Site: Tripler Army Medical Center (TAMC): Hematology-Oncology Wards/Clinic Telephone 433-6507/4089

Other Faculty: Eleanor Hastings, MD, , , , , , , , , , , , , , , , , ,

Prerequisites: PGY-1

Maximum Number of Residents: 1 resident & 1 student





Other Patient Care: Pathology

2 hrs/wk Other Patient Care Site(s):



TAMC Morning reportTAMC AM teaching conferenceTAMC Hematology oral lectures

c) Required reading list: See curriculum summary


e) Other Activities: (1) Pathology slide review(2) 4-hour rotation in radiation oncology

Sample of a typical day's schedule: 07:30 - 08:10 AM Report08:15 - 09:00 Morning Conference09:00 - 12:00 Clinic1300 - 1400 Heme Oncol Didactic1400 - 1700 Inpatient consultation rounds




QMC Oncology with Dr. Carl Higuchi is also a required L3 rotation.

Opportunity to see new patients with blood diseases and cancer. Pathologic correlative. Participation in multidisciplinary TAMC conferences. Includes internet-based telemedicine Tumor Center.


Other Comments: Availability dependent on TAMC residents' scheduled; resident must be committed to this elective (will not cancel later)

Page 43

Elective Title: Hematology-OncologyFaculty in Charge: William S. Loui, MD

Site: POB II, 1329 Lusitana Street, Suite 307, Honolulu 96813; Telephone: 524-6115

Other Faculty: Paul Palalay, , , , , , , , , , , , , , , , , , ,

Prerequisites:



Ambulatory: 30 Ambulatory Site(s): Officehrs/wk

Inpatient: 5 hrs/wk Inpatient Site(s): QMC, HMCE

Consultations: 5 hrs/wk Consult Site(s): QMC, Office

Other Patient Care:




Tumor conferences; Oncology journal club

c) Required reading list: Harrison's or Cecil's texts


e) Other Activities: Clinicopathologic cases






Goal:

Follow up care during chemotherapy.

Objectives:

1. Provide outpatient experiences for medical oncology and benign hematology.2. Provide greater exposure to benign hematology coagulation thalassemias.3. Opportunity to be involved in stem cell transplantations and follow-up.

Other Comments: 1. There will be extensive outpatient experience.2. New patient evaluation for hematology, oncology and transplantation.

Page 44

Elective Title: Infectious DiseaseFaculty in Charge: Willis J. K. W. Chang, MD

Site: Various hospitals on Oahu, Private Office Telephone 671-2456

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None





Consultations: 48 hrs/wk Consult Site(s): Various Oahu Hospitals

Other Patient Care:




c) Required reading list: Mandell "Principles & Practice of Infectious Disease"


e) Other Activities: Case discussions

Sample of a typical day's schedule: Rounds on patients resident is followingConsultations as requested by others and as appropriate for resident involvementCase discussion/lectures in between





Give overview of infectious disease practiceImprove diagnostic capabilities of resident with regard to infectionsTeach rationale use of antibioticsDevelop expertise in interpretation of gram stains

Other Comments:

Page 45

Elective Title: Infectious DiseasesFaculty in Charge: Lawrence Eron, MD

Site: Kaiser-Moanalua Hospital: 3288 Moanalua Road 96819; Telephone: 432-7848; [email protected]

Other Faculty: Philip Bruno, MD, Tarquin Collis, MD, , , , , , , , , , , , , , , ,

Prerequisites:



Ambulatory: 5 Ambulatory Site(s): Kaiser-Moanalua Hospitalhrs/wk

Inpatient: 10 hrs/wk Inpatient Site(s): Kaiser-Moanalua Hospital

Consultations: 20 hrs/wk Consult Site(s): Kaiser-Moanalua Hospital

Other Patient Care:

hrs/wk Other Patient Care Site(s): Antimicrobial Therapy & Disease Diagnostics



Kaiser weekly lunchtime conferences in Infectious Diseases

c) Required reading list: Relevant articles will be assigned on a daily basis.



Sample of a typical day's schedule: AM ConsultationsPM HIV, Hep C, Hepatitis B, OPAT, ID Clinics




Incredible range of pathology


Goals:

1) Proficiency in the diagnosis and management of CAP, SSTIs, and UTIs.2) Understanding the complexity of ART of HIV, Hep C, and Hep B.3) Familiarization with OPAT (Outpatient Parental Antibiotic Therapy).

Objectives:

1) An introduction to Infectious Diseases consultative practice.2) An enjoyable month seeing many patients with a variety of inflammatory conditions.

Other Comments: Not available: July, August, October, & November 2008; June 2009

Page 46

Elective Title: Infectious DiseaseFaculty in Charge: Tomas Ferguson, MD

Site: Tripler Army Medical Center (TAMC): ID Clinic Office Telephone 433-6513

Other Faculty: Joshua Hawley, MD, Gunther Hsue, MD, , , , , , , , , , , , , , , ,

Prerequisites: PGY-1, 2, 3, or 4






Other Patient Care:




TAMC AM ReportTAMC Department of Medicine ConferencesID case conferences at QMC

c) Required reading list: MKSAP, ID guidelines available at www.idsociety.org


e) Other Activities: ID rotation questions

Sample of a typical day's schedule: 0730 - 0810 AM Report0815 - 0900 Rounds0900 - 1200 Clinic1200 - 1300 Lunch/Conference1300 - 1600 Rounds/Lectures




Excellent mixture of travel, HIV, non-HIV, inpatient & outpatient exposures and TB issues.


Develop expertise in interpretation of gram stains and laboratory microbiology support

Other Comments:

Page 47

Elective Title: Infectious DiseaseFaculty in Charge: William Lau, MD

Site: QMC, KMC, Hawaii Medical Center: East & West, Pali-Momi Telephone 532-2955

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None






Other Patient Care:




ID Grand Rounds




Sample of a typical day's schedule: Rounds, consultations





Develop expertise in interpretation of gram stains

Other Comments:

Page 48

Elective Title: HIV MedicineFaculty in Charge: Cecilia Shikuma, MD

Site: Leahi Hospital 3675 Kilauea Avenue, Young Building 5th Floor Honolulu HI 96815 Office Telephone 737-2751

Other Faculty: Victor Valcour, MD, Dominic Chow, MD, Bruce Shiramizu, MD, Arron McMurtray, MD, , , , , , , , , , , ,

Prerequisites: Resident must be interested in completing research during the rotation.

Maximum Number of Residents: 3 per year


Ambulatory: 8 Ambulatory Site(s): Leahihrs/wk



Other Patient Care: Research Clinic 12 hours per week

hrs/wk Other Patient Care Site(s): Leahi



1. Clinic Spencer Clinic Patient Care meeting - 1 hour2. Friday Research patient care meeting - 2 hours3. Friday "HIV 101" lectures - 1 hour4. Wednesday afternoon research presentation/journal club - 1 hours5. UHDOM Medicine Grand Rounds via teleconferencing on Tuesday - 1 hour6. AIDS Education Project dinner for medical personnel occurring 1-2 times per month

c) Required reading list: 1. DHHS HIV Rx guidelines2. American Academy of HIV Medicine Care core curriculum text3. Other selected materials


e) Other Activities: One to one lectures on rudimentary care and Rx topics in HIV

Sample of a typical day's schedule: Clinic in AM; directed reading lectures in afternoon. Conferences as scheduled for that day.





Goals: Basic understanding of HIV care and management.

Objectives:1. Understand "When to Start" antiretroviral Rx and "What to Start".2. Understand general care of HIV infected patients including common complications seen in HIV subjects.3. Understand the use and toxicities of antiretroviral medications; understand sequencing of antiretroviral regimens and the use of genotyping and phenotyping resistance testing.

Other Comments: Co-Director: Dominic Chow, MDNot Available: August, December & April

Page 49

Elective Title: Infectious DiseasesFaculty in Charge: Russell D. Wong, MD

Site: Private Office: 321 North Kuakini St., Suite 811 Honolulu HI 96817; Office Telephone 531-2731; QMC, KMC, HMCE

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None





Consultations: 28 hrs/wk Consult Site(s): QMC, KMC, HMCE

Other Patient Care:







Sample of a typical day's schedule: 8:00 AM - 2:00 PM Consultations2:00 PM - 4:00 PM Rounds(1-hour lunch)





Teach practical ID hospital consultative practice with broad variety of infectious disease problems.Develop expertise in interpretation of gram stains

Other Comments:

Page 50

Elective Title: Infectious DiseasesFaculty in Charge: Royden Young, MD

Site: (1) Private office QMC POB 1, Suite 904 Telephone 599-8800; (2) QMC, KMC

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: At least one year of inpatient medicine (Level 2 and above)



Ambulatory: 3 Ambulatory Site(s): QMChrs/wk


Consultations: 40 hrs/wk Consult Site(s): QMC, KMC, HMCE

Other Patient Care:




Antibiotic lectures

c) Required reading list: Mandel's Principles and Practices of Infectious Disease


e) Other Activities: Lectures, handouts, discussion of cases

Sample of a typical day's schedule: 8:00 AM: See new and old consults12 Noon: Lunch12:30 PM: Conference1:30 PM: Finish rounds and discuss cases for teaching5:00 PM: Done


b) Other evaluation: `



Goals:1. Evaluate patient for signs and symptoms of infections2. Manage common infections3. Develop differential diagnosis for infectious diseases4. Understand antimicrobial pharmacotherapy principles5. Understand pathophysiology of various infections

Objectives:1. Diagnose/manage/treat pneumonia, meningitis, endocarditis, sepsis, epidural abscess, necrotizing fasciitis, osteomyelitis, septic arthritis, cellulitis, intra-abdominal infections2. Understand/manage antibiotic dosing and toxicity (B-lactam, quinolones, aminoglycosides)3. Understand diagnostic studies (blood cultures, viral cultures, serology, ELISA)4. Diagnose and manage noninfectious causes of fever (drug, DVT, PE, malignancy, connective tissue disease)

Other Comments:

Page 51

Elective Title: NephrologyFaculty in Charge: Rossini C. Botev, MD

Site: Kaiser Moanalua Medical Center Telephone 432-0000

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: Commitment for high quality patient care

Maximum Number of Residents: 1 - 2


Ambulatory: Ambulatory Site(s): Kaiser Moanalua Medical Centerhrs/wk

Inpatient: hrs/wk Inpatient Site(s): Kaiser Moanalua Medical Center

Consultations: hrs/wk Consult Site(s): Kaiser Moanalua Medical Center

Other Patient Care:

hrs/wk Other Patient Care Site(s): Kaiser Moanalua Medical Center



c) Required reading list: "Primer on Kidney Disease"


e) Other Activities: Case presentations and discussions, review articles discussed, access to Up-to-Date software.

Sample of a typical day's schedule: Inpatient service for 1 week (8 - 10 Hrs/Wk) + Outpatient service for 3 weeks (8 Hrs/Wk).

Consultation hours (6 - 10 Hrs/Wk) are part of the total hours for the Inpatient/Ambulatory services (new patients are seen in each setting on a weekly basis).

Non-patient teaching hours (10 - 15 Hrs/Wk) are part ot the total hours for Inpatient and Ambulatory services and includes medical records review, performing urinalysis, and review of radiology imagings and kidney biopsies.

4 - 5 hours direct patient care; 2 - 3 hours discussions, 30 minutes-one hour in evaluating laboratory and radiology results.





Goals: Initial evaluation and management of common kidney diseases in outpatient and inpatient settings.

Objectives: Acute and chronic renal failure, end-stage renal disease, hypertension, electrolyte disorders, kidney biopsy, radiology imaging of the kidneys, kidney transplant, patient follow up, management of dialysis patients, systemic diseases and kidney involvement.

Other Comments: Not available: Blocks 4-5

Page 52

Elective Title: Clinical NephrologyFaculty in Charge: Shiuh-Feng "Sherwin" Cheng, MD

Site: Private Office: 2228 Liliha Street, Suite 200 Honolulu HI 96817 Office Telephone 533-3130; HMCE; QMC, KMC

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None

Maximum Number of Residents: 1 per rotation



Inpatient: 10 hrs/wk Inpatient Site(s): HMCE, QMC, KMC

Consultations: 10 hrs/wk Consult Site(s): HMCE, QMC, KMC

Other Patient Care: Dialysis Center







Sample of a typical day's schedule: 8:00 - 10:00 AM Inpatient rounds10:00 AM - 11:00 AM Consultations11:00 AM - 12:00 NOON Dialysis rounds1:00 - 4:00 PM Clinic





Goals:

(1) Residents will be able to evaluate common acid-base and electrolyte problems(2) Residents will be able to initiate workup for common glomerular diseases(3) Residents will have an appreciation for common problems seen with dialysis patients

Objectives:

(1) Residents will be able to recognize and evaluate metabolic acidosis and alkalosis, respiratory acidosis and alkalosis(2) Residents will be able to evaluate hypernatremia and hyponatremia(3) Residents will be able to workup for nephrotic syndrome(4) Residents will be able to evaluate acute and chronic renal failure(5) Residents will be have exposure to dialysis and kidney transplant patients

Other Comments: Not available: Blocks 3, 7, 10, & 13

Page 53

Elective Title: Clinical NephrologyFaculty in Charge: David A. Na'ai, MD

Site: (1) 2226 Liliha Street, Suite 306 Honolulu HI 96817 Office Telephone 531-5711 and (2) HMCE, QMC, KMC, Castle, Wai

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 15 - 20 Ambulatory Site(s): HMCE, Castle, Waimanalohrs/wk

Inpatient: 10 hrs/wk Inpatient Site(s): HMCE, QMC, KMC

Consultations: 10 hrs/wk Consult Site(s): "

Other Patient Care:

hrs/wk Other Patient Care Site(s): Saint Francis Liliha



c) Required reading list: "Nephrology for the House Officer" or "Nephrology Secrets"


e) Other Activities: Didactic teaching, literature review, topic review

Sample of a typical day's schedule: AM: inpatient roundsAM or PM: Clinic 3-4 hoursConsults throughout the day




Special emphasis on native Hawaiian health issues as it relates to kidney disease


Goals: Exposure of resident to patients with kidney disease.

Objectives:1. Enable residents to recognize patients with renal disease and initiate diagnostic workup2. Familiarize residents with renal transplant management.3. Enable residents to comfortably manage acute and chronic renal failure, electrolyte abnormalities, hypertension and acid-base disorders.

Other Comments: Not available: Blocks 1, 2 & 13

Page 54

Elective Title: NephrologyFaculty in Charge: Aaron K. Nada, MD

Site: (1) Private office 1520 Liliha Street, Suite 601 Honolulu HI 96817 Office Telephone 523-0445 and (2) KMC

Other Faculty: David D. Ono, MD, Leilani Ka'anehe, MD, , , , , , , , , , , , , , , ,

Prerequisites: None




Inpatient: 30 hrs/wk Inpatient Site(s): KMC

Consultations: 10 hrs/wk Consult Site(s): KMC and Private Office

Other Patient Care:




c) Required reading list: Yes



Sample of a typical day's schedule: Hospital rounds, one-half day outpatient office, consults as they arise, lectures as time allows


b) Other evaluation: End of rotation exam



The major objective of this rotation is to promote a better pathophysiologic understanding of basic nephrologic problems in such areas as fluid and electrolyte imbalances, acid base disorders, acute renal failure, chronic renal failure and dialysis, glomerular disorders, nephrolithiasis and, hopefully, exposure to renal transplantation.

Other Comments:

Page 55

Elective Title: NephrologyFaculty in Charge: Roland Ng, MD

Site: KMC, HMCE, QMC Telephone 521-1818

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: PGY-2 or PGY-3



Ambulatory: 14 Ambulatory Site(s): KMC, QMChrs/wk

Inpatient: 8 hrs/wk Inpatient Site(s): HMCE, KMC

Consultations: 2 hrs/wk Consult Site(s): KMC, HMCE, QMC

Other Patient Care:




c) Required reading list: Nephrology lecture notes; reprints of articles


e) Other Activities: Resident required to give mini-lectures on topics.

Sample of a typical day's schedule: 06:30 - 09:30 Inpatient rounds09:30 - 10:30 Joint Med/Attending didactic/bedside rounds10:30 - 12:00 Office patients02:30 - 04:30 Office patients


b) Other evaluation: Weekly exams x 4 on reading materials; one comprehensive final exam



Resident will be able to manage general nephrology patients and perform diagnostic maneuvers and order appropriate tests to evaluate renal failure, acute or chronic. Resident will be able to treat acid-base disturbances as well as fluid/electrolyte problems. Resident will pass final comprehensive exam.

Other Comments: Not Available: Blocks 3 & 13

Page 56

Elective Title: SELECTIVE: NephrologyFaculty in Charge: Roland Ng, MD

Site: Hawaii Medical Center East, Kuakini Medical Center & Other Outpatient Clinic Sites

Other Faculty: James Musgrave, MD, Sherwin Cheng, MD, Ramona Wong, MD, Carmen Stanko, MD, Thomas Tasaki, MD, , , , , , , , , ,

Prerequisites: Upper-Level Only



Ambulatory: 9 Ambulatory Site(s): Drs. Sherwin Cheng's or Roland Ng's officeshrs/wk

Inpatient: 18 hrs/wk Inpatient Site(s): HMCE, KMC

Consultations: 5 hrs/wk Consult Site(s): HMCE, KMC

Other Patient Care: Transplant Clinic: x2/week; dialysis patients

6 hrs/wk Other Patient Care Site(s): HMCE, Liberty Dialysis Unit



ICU/Nephrology combined conference & HMCE Thursday medical conferences

c) Required reading list: Nephrology Notes, selected review papers


e) Other Activities: Daily didactic sessions; resident will review urinalyses for 2 hours every other week at Dr. Musgrave's office; kidney biopsy; cases will be reviewed weekly

Sample of a typical day's schedule: 7-10 AM: Inpatient Hospital/Dialysis rounds at HMCE (KMC); 1-2 PM: Didactic session with Dr. Ng; 3-5 PM: Ambulatory experience with Dr. Cheng; every other Wed. 9-11 AM review U/A at Dr. Musgrave's office; every Thurs. 10-12: Chronic Disease Clinic with Dr. Wong; Dr. Tasaki will do bedside rounds weekly with resident focusing on physical diagnosis & assessment time at Dr. Tasaki's discretion; every Mon. 1-2 PM: Dr. Stanko will cover glomerulonephritis as didactic session; resident is on call for admit/consults M-Sat noon; Sunday day off





Goals:1-Nephrology curriculum, as detailed in UHIMRP's standards, will be covered.2-MKSAP questions will be covered to review current up-to-date standards.

Objectives:1-Resident will be able to pass Nephrology section of ABIM.2-Resident will be able to assess and treat chronic kidney disease patients and refer in a timely fashion to Nephrology consultants.3-Resident will be competent to take care of ESRD and transplant patients.

Other Comments:

Page 57

Elective Title: Sleep MedicineFaculty in Charge: Gabriele M. Barthlen, MD

Site: Hawaii Center for Sleep Medicine: 98-1238 Kaahumanu St., #300 Pearl City / Phone: 487-1235, Fax: 487-1236, Email: b

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites:





Consultations: 8 hrs/wk Consult Site(s): Hawaii Center for Sleep Medicine

Other Patient Care: Performing sleep studies on patients

16 hrs/wk Other Patient Care Site(s): Hilo Sleep Center & Hawaii Center for Sleep Med



Monthly Sleep Case Conference: 2 hours

c) Required reading list: Principles & Practice of Sleep Medicine R & K Scoring Manual



Sample of a typical day's schedule: 8:00 AM - 12:00 PM reading sleeping studies1:00 PM - 5:00 PM patient consultations, OR

7:00 PM - 7:00 AM running sleep studies on patients





Goals:

1-Differentiate common sleep disorders2-Evaluate patients with sleep disorders3-Learn methodology of sleep studies (PSG & MSLT)

Objective: Familiarize with treatment options for sleep disorders (e.g. apnea, PLMS, narcolepsy)

Other Comments: Not available: Blocks 1, 6 & 7

Page 58

Elective Title: Neuroscience Intensive Care UnitFaculty in Charge: Cherylee Chang, MD

Site: Queen's Medical Center Neuroscience ICU (QET-4D) Telephone 537-7152

Other Faculty: Kristine O'Phelan, MD, , , , , , , , , , , , , , , , , ,

Prerequisites: Background knowledge of neuroanatomy

Maximum Number of Residents: One per month




Consultations: 10 hrs/wk Consult Site(s): ICUs, ER and other hospital floors

Other Patient Care:

30 hrs/wk Other Patient Care Site(s): Neuro ICU rounds/patient care



Neuroradiology; Case conference; Journal Club

c) Required reading list: 1. Neurological and Neurosurgical Intensive Care 4th Edition, Ropper, Allan MD, et al. 2. Journal articles included in NSICU elective packet.


e) Other Activities: Didactic one-on-one sessions; reading relevant texts and journal articles

Sample of a typical day's schedule: 7:30 AM: Neuro ICU patient exams/review of imaging studies8:30 AM: Rounds with SICU/MICU residents, nurses11:00 AM - 5:00 PM: Consults, follow ups, didactic one-on-one sessions of important topics in neurocritical care, reading literature


b) Other evaluation: Daily verbal evaluation


Opportunity to observe and participate in stroke codes and understand the decision-making process involved in determining whether a patients is a candidate for thrombolysis.


Goals:(1) Residents will be able to perform a thorough neurologic examination.(2) Residents will demonstrate knowledge of the diagnosis and management of common critical neurologic conditions.

Objectives:(1) The resident will be able to initiate the evaluation and management of a patient presenting with coma or altered mental status; acute or subacute onset of weakness or numbness; acute loss or change in vision; sudden change in speech or language. (2) The resident will be able to initiate the evaluation and management of critical neurologic problems such as ischemic stroke; intracerebral hemorrhage; subarachnoid hemorrhage; seizure/status epilepticus; spinal cord injury; traumatic brain injury; meningitis; Guillain-Barre syndrome; myasthenia gravis crisis.

Other Comments: Resident to pick up NSICU elective packet prior to rotation at the Neuroscience Institute office at the QET 5th floor - contact Jackie Leonard 537-7152.

Residents must have received Care*Link training.

Page 59

Elective Title: SELECTIVE: Clinical NeurologyFaculty in Charge: Melvin Yee, MD

Site: Kuakini Medical Center, The Queen's Medical Center, Hawaii Medical Center East & West

Other Faculty: Kevin Kimata, MD, Terry Shimamoto, MD, Ray Romero, MD, Jeffrey Liu, MD, Stuart Pang, MD, Michael Watters, MD, , , , , , , ,

Prerequisites: None

Maximum Number of Residents: 1 per site





Other Patient Care:




HMCE CME conference: 3rd Thursday/week, 8-9 AM

c) Required reading list: Clinical Neurology (Greenbers, Arninoff, Simon)


e) Other Activities: Case review and presentation to preceptor.

Sample of a typical day's schedule: 7:30-9:00 AM Morning inpatient rounds and consultations9:00-12:00 PM Morning Clinic1:30-4:30 PM Afternoon Clinic4:30-5:30PM Afternoon Hospital Rounds





Goals:1-Resident should be able to perform a complete neurologiocal examination.2-Resident should have an outline for a systematic approach to diseases of the nervous system.

Objectives:1-Resident have a basic understanding of: ischemic stroke, celebral hemorhage, coma, metabolic encephalopathy, dementia, acute weakness, neuropathy, myopathy, migraine seizures, Parkinsons Disease, trauma

Other Comments:

Page 60

Elective Title: Nuclear Medicine and PETFaculty in Charge: Marc Coel, MD

Site: Queen's Medical Center: Nuclear Medicine Department and PET Imaging Center Telephone 547-4544/4309

Other Faculty: Sandi Kwee, MD, Roy Behjati, MD, , , , , , , , , , , , , , , ,

Prerequisites: 3rd and 4th year medical students, residents






Other Patient Care:

40 hrs/wk Other Patient Care Site(s): QMC Nuclear Medicine Department



Tumor Conference

c) Required reading list: Fundamentals of Nuclear Medicine (will be provided)



Sample of a typical day's schedule: Perform cardiac stress tests from 7:30 AM - 3:00 PMPerform other interventional studies, i.e., nuclear venograms 8:00 AM - 6:00 PMInterpret nuclear medicine scans from 8:00 AM - 6:00 PMInterpret PET scans from 8:00 AM to 6:00 PMCounsel and treat thyroid cancer, hyperthyroidism, lymphoma




Nuclear imaging with emphasis on correlative studies with other diagnostic modalities. All areas of nuclear medicine will be available for the residents to participate in. MRI, CT and PET will be integrated into the program.


Other Comments: Not available: July, August, December, & June

Page 61

Elective Title: Pulmonary DiseaseFaculty in Charge: Vincent Grbach, MD, FCCP

Site: Tripler Army Medical Center (TAMC): Pulmonary Disease Clinic Telephone 433-6792

Other Faculty: Eric Crawley, MD, Joseph Pina, MD, Pedro Lucero, MD, , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 25 Ambulatory Site(s): TAMC Pulmonary Clinichrs/wk

Inpatient: 10 hrs/wk Inpatient Site(s): TAMC Wards


Other Patient Care:

5 hrs/wk Other Patient Care Site(s): TAMC Pulmonary Function Lab



TAMC Medicine Morning ReportUH/TAMC Pulmonary Conference

c) Required reading list: Yes



Sample of a typical day's schedule: 0730 - 0815 Morning Report0900 - 1200 Outpatient Clinic1200 - 1300 Lecture1300 - 1500 Outpatient Clinic1500 - 1630 Inpatient Rounds




Exposure to common outpatient pulmonary problems (asthma, dyspnea, cough, SPN, lung cancer, COPD).


Other Comments: Availability dependent on TAMC residents' scheduled

To be provided at start of rotation:

1. Checklist for pulmonary service rotation2. Resident pulmonary pretest3. Resident pulmonary post-test4. PFT examination for certification in PFT interpretation

Page 62

Elective Title: PulmonaryFaculty in Charge: Roger Yim, MD

Site: QMC, 1329 Lusitana Street, Suite 704, Honolulu HI 96813 Office Telephone 524-1200

Other Faculty: George Druger, MD, , , , , , , , , , , , , , , , , ,




Ambulatory: 8 Ambulatory Site(s): Officehrs/wk


Consultations: 10 hrs/wk Consult Site(s): QMC

Other Patient Care:

hrs/wk Other Patient Care Site(s): QMC






Sample of a typical day's schedule: 0700 - 1000 Inpatient1000 - 1300 Outpatient1300 - 1700 Inpatient





Goals:

1-To learn basic pulmonology2-To learn sleep medicine

Objectives:1-Learn how to read pulmonary function tests2-Assess patients with obesity-hypoventilation syndrome3-Learn the indication of bronchoscopy and its procedure

Other Comments: Not available: Block 4

Page 63

Elective Title: Physical Medicine & RehabilitationFaculty in Charge: Cedric K. Akau, MD

Site: Straub Clinic & Hospital, 888 South King Street, Honolulu HI 96813 Office Telephone 522-4000

Other Faculty: Timothy F. Olderr, MD, Montemayor Andrew, MD, , , , , , , , , , , , , , , ,

Prerequisites: Level 3 residents only

Maximum Number of Residents: 1 per block


Ambulatory: 40 - 45 Ambulatory Site(s): Straub, also Punahou School during school yearhrs/wk

Inpatient: 1 - 2 hrs/wk Inpatient Site(s): Straub


Other Patient Care:




c) Required reading list: Recommend "Ortho Physical Assessment" by Magee & "Illustrated Manual of Ortho Med" by Cyriax


e) Other Activities: Patient centered - experienced teaching

Sample of a typical day's schedule: 8:00 AM - 5:00 PM, Monday thru Friday, with half-day off and every other Saturday AM


b) Other evaluation: Will expect good understanding of basic exam and differential diagnosis of musculoskeletal and peripheral nerve problems.


Outpatient evaluation and treatment of common musculoskeletal and peripheral neurologic problems - non-surgical approach.


By the end of this elective, the medical resident should be comfortable in evaluating and treating common musculoskeletal and peripheral neurologic problems.

Other Comments:

Page 64

Elective Title: RheumatologyFaculty in Charge: Ken Arakawa, MD


Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: Be a resident in good standing at UHIMRP





Consultations: 8 hrs/wk Consult Site(s): QMC

Other Patient Care:




c) Required reading list: "Primer in Rheumatology"



Sample of a typical day's schedule: Rounds at hospital for inpatients, seeing patients in office, end of day inpatient consults, admissions in the hospital.





Other Comments:

Page 65

Elective Title: RheumatologyFaculty in Charge: David Finger, MD, FACP, FACR

Site: Tripler Army Medical Center (TAMC): Rheumatology Clinic Office Telephone 433-6513

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: Upper-level resident

Maximum Number of Residents: 1 resident & 1 students


Ambulatory: 15 - 20 Ambulatory Site(s): TAMC Rheumatology Clinichrs/wk

Inpatient: 1 hrs/wk Inpatient Site(s): TAMC Wards

Consultations: 15 - 20 hrs/wk Consult Site(s): TAMC Rheumatology Clinic

Other Patient Care:




TAMC Medicine morning report

c) Required reading list: "Primer on Rheumatologic Diseases"


e) Other Activities: Procedural Skills: (1) Diagnostic and therapeutic arthrocentesis of joints and bursae(2) Diagnostic and therapeutic injection of corticosteroids into joints and periarticular structures such as bursae and tendon sheaths

Ordering and Interpreting Tests:(1) Interpretation of synovial fluid for cell count and crystal identification(2) Interpretation of plain radiographs of the joints and spine(3) Acute phase reactants (C-reactive protein, erythrocyte sedimentation rate)(4) Autoantibodies (rheumatoid factor, antinuclear antibodies, extractable nuclear antigens, double-stranded DNA, CCP, ANCA, Jo-1, Scl-70)(5) Complement(6) Creatine kinase and aldolase

Sample of a typical day's schedule: 0730-0800 Morning report0815-0900 Lecture0900-1200 Outpatient clinic1300-1500 Outpatient clinic1500-1600 Rounds/lecture


b) Other evaluation: (1) Resident mini-lecture to staff(2) End-of-rotation written exam


Overview

Rheumatology encompasses diseases and conditions involving the musculoskeletal system. The primary goal in rheumatology is early diagnosis and treatment to prevent disability and premature death. Residents in internal medicine will be expected to learn about the various conditions seen in rheumatology and nonoperative orthopedics, and to be competent in the application and performance of specific rheumatologic procedures and tests. They must also be proficient in the use of corticosteroids, nonsteroidal anti-inflammatory agents, and immunosuppressive medications used in rheumatology.

The rheumatologic curriculum will be divided into three parts to facilitate learning these objectives. Part I covers basic concepts that pertain to the practice of rheumatology. Part II lists the various rheumatic clinical syndromes and specific disorders that the medicine resident will be expected to understand. Part III lists diagnostic tests and procedures the resident should be able to both perform and interpret.

Physical Examination

The resident will be expected to perform a complete general internal medicine and rheumatologic history and physical examination.


Page 66

The Curriculum (Rheumatology - David Finger, MD, FACP, FACR)

Part 1: Basic Concepts

Epidemiology of rheumatic disordersHistory and physical examination of the musculoskeletal systemDifferential diagnosis of the various rheumatic signs and symptomsOrdering and interpreting diagnostic tests used in rheumatologyUnderstanding the indications, risks, and benefits of various rheumatologic proceduresKnowing the indications, recommended monitoring, and possible side effects of the medications used in rheumatology

Part 2: Clinical Syndromes & Specific Disorders

Clinical Syndromes:Joint pain (arthralgias): acute vs. chronic inflammatory vs. noninflammatory monoarticular vs. oligoarticular vs. polyarticular distribution patternsMuscle pain (myalgias): localized vs. diffuse neurogenic vs. myopathic patterns inflammatory vs. metabolicNonarticular signs of rheumatic diseases: cutaneous manifestations (Gottron's papules, malar rash, palpable purpura, alopecia, nodules, keratoderma blenorrhagica, etc.) Raynaud's phenomenon oral/nasal/genital ulcerations pleuritis/pericarditis,carditis ocular findings (conjunctivitis, uveitis, hypopyon)Regional rheumatic pain syndromes: fibromyalgia syndrome bursitis tendonitis entrapment neuropathies (carpal tunnel)

Specific Disorders:Degenerative arthritisSystemic inflammatory connective tissue disorders: systemic lupus erythematosus rheumatoid arthritis polymyositis/dermatomyosis Sjogren's syndrome scleroderma psoriatic arthritis colitic arthritis polymyalgia rheumatica crystalline arthritis inflammatory myopathies metabolic bone disease systemic vasculitides reactive arthritis ankylosing spondylitisInfectious arthritisMetabolic bone disorders (Paget's, osteoporosis)

Part 3: Procedures and Tests

Diagnostic and therapeutic arthrocentesis of joints and bursaeDiagnostic and therapeutic injection of corticosteroids into joints and bursaeInterpreting radiographic images of bones and jointsSynovial fluid analysis for cell count and crystal identificationOrdering and interpreting laboratory tests: Autoantibodies Muscle enzymes Acute phase reactants Complement

Other Comments: Availability based upon TAMC residents' and UH Medical Students assigned

Page 67

Page 68

Elective Title: RheumatologyFaculty in Charge: David John, MD

Site: 1329 Lusitana Street, Suite 804 Honolulu HI 96813 Telephone 531-7111; QMC, various hospitals

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 40 Ambulatory Site(s): Private officehrs/wk



Other Patient Care:




c) Required reading list: "Primer on Rheumatology"



Sample of a typical day's schedule: Office 8:00 AM to 4:30 PM; Hospital consults/rounds Monday thru Friday





Other Comments: Not available: Block 4

Page 69

Elective Title: Hospitalist ServiceFaculty in Charge: Randy Yates, MD

Site: Straub Hospital, 888 South King Street, Honolulu HI 96813, 222-5210, [email protected]

Other Faculty: Wen-Yu Lee, MD, Edwin Yanami, MD, Ronald Schaefer, MD, , , , , , , , , , , , , ,

Prerequisites: Internal Medicine Resident PGY2 or PGY3



Ambulatory: None Ambulatory Site(s):hrs/wk

Inpatient: 60* hrs/wk Inpatient Site(s): Straub Hospital


Other Patient Care: Multidisciplinary rounds, committee participation, clinical research


a) Nonpatient focused teaching sessions that address the breadth of the subspecialty: Few hrs/wk


c) Required reading list: "Hospital Medicine", Editors Robert Wachter, Lee Goldman, Harry Hollander



Sample of a typical day's schedule: 7:30 AM - 8:00 AM: Arrive at Straub; round on patients; committee meetings one hour/day4:00 PM - 6:00 PM: Leave Straub





Goals: Achieve a better understanding of the multidisciplinary (team) approach to hospital patient care and the current financial constraints surrounding the practice of hospital medicine.

Objectives: Develop skills in four major areas:1. Inpatient medical consultative service for surgical patients. Preoperative medical clearance for surgery. Medical management of patients with primary surgical problems, e.g., orthopedics, neurosurgical, burns.2. Integrated team approach to patient care; participate in multidisciplinary rounds, work with case managers, referral facilities.3. Quality and patient safety: Applying current criteria that dictate whether a hospital admission is "appropriate" or not (UR Committee); participating in reviewing practices and developing policies for appropriate drug utilization (P&T Committee); understanding current concepts regarding futility and the ethical principles surrounding patient care (Ethics Committee); understanding what are some of the quality benchmarks that are recommended by the Center for Medicare and Medicaid Services and integrating them into everyday practice (Quality Committee); understanding what are some of the JCAHO policies for patient safety, e.g., restraint policies, medication errors, sentinel and near miss events and patient rights (I.e., Advanced Directives, privacy); reviewing and updating of protocols that guide management of most common medical admissions - CHF, CVA, chest pain, urosepsis, syncope, community acquired pneumonia, GI bleed; clinical research - develop and participate in the evaluation of hospital practice, e.g., costs, utilization and appropriateness of medications, diagnostic tests.4. Financial constraints: working with case managers, coding specialists to understand how to get paid in the current era of declining reimbursement.

Other Comments: * Note: Inpatient wards and consultations: 60 hrs/week (based on seven days rotation alternating with three and four days off). On call during the day for medical admissions and consults every other day; not required to see all patients. May also follow patients into the ICU.

The hospital environment presents a unique opportunity to coordinate patient care in an efficient manner and to direct care of the highest standards that is most appropriate to the patient's personal and social needs. The physicians and staff of Straub Hospital are committed to these goals.

Page 70

Page 71

Elective Title: Pain and Palliative CareFaculty in Charge: Daniel Fischberg, MD, PhD

Site: QMC 1301 Punchbowl Street, Honolulu HI 96813 Office Telephone 537-7524

Other Faculty: , , , , , , , , , , , , , , , , , , ,

Prerequisites: None



Ambulatory: 0 - 5 Ambulatory Site(s): Cancer Research Centerhrs/wk


Consultations: 40 - 45 hrs/wk Consult Site(s): QMC

Other Patient Care:




QEC Pain Conference, Pain & Palliatve Care Journal Club

c) Required reading list: Assigned reading from journal articles, book chapters, handbook


e) Other Activities: Case conferences, small group teaching

Sample of a typical day's schedule: Team rounds 7:30 AM - 8:30 AM; Ward rounds 8:30 AM - 5:30 PM





Goals:1. Enhance knowledge and skill in the management of pain and other symptoms.2. Broaden understanding and appreciation of psychosocial and spiritual issues related to serious illness.3. Enhance communication skills with patients, families and colleagues.

Following the rotation, the resident will:1. Demonstrate improved knowledge and skill in the management of pain and other symptoms2. Describe and define the scope of modern palliative care including its integration with disease-modifying treatments3. Demonstrate the ability to coordinate family conferences related to goals and plan of care and work effectively with colleagues to implement palliative aspects of a care plan.

Other Comments: If resident attends QMC's Ethic Committee meetings, must submit Self Reflection form to the Program office.

Page 72

IV. INTERNAL MEDICINE RESIDENTS’ HANDBOOK 2008 - 2009 ACADEMIC PROGRAM

3

Preliminary Inpatient Medicine Wards 7 blocks Critical Care 1 block Queen Emma Clinics Ambulatory Block 1 block VA Ambulatory Care Clinics 1 block Emergency Medicine 1 block Elective 1 block Vacation 3 weeks Study/Reading Week 1 week *In some instances, residents’ schedules may be changed such that rotations may be moved to a different year.

B. ELECTIVE GUIDELINES

1. Please refer to your “Electives for Medical Residents – July 2008” booklet for further information about the selection of electives, copies of various forms and detailed descriptions of individual electives.

A written request for all electives should have been submitted and reviewed by your firm director for the current academic year.

All electives must be arranged through the program office. Residents are not to contact individual elective supervisors without prior approval from the program unless they trying to arrange an elective that is not offered in the booklet.

Cancellations or changes of electives must be made by completing the “Request for Change in Rotation Schedule” form at least EIGHT weeks prior to the commencement of the elective rotation.

Electives are meant to provide a rigorous educational experience, which ensures the resident will master specific educational material to achieve the goals and objectives determined by the appropriate division and the curriculum committee. These may include patient encounters, interactive sessions with attending physicians, directed reading and other activities as determined by the elective supervisor.

The purpose of each elective is educational. Firm Directors and the Program Director have oversight on residents’ elective choices.

Electives are offered according to the following schedule:

Level 1 Resident 1 elective Level 2 Resident 1 or 2 elective(s) Level 3 Resident 3 electives


4

2. Guidelines for Off-Island Electives

Please see memo below from Mr. Richard Philpott, Chief Executive Officer of HRP, which is applicable to the first half of the 2008-09 academic year (until December 31, 2008).

“REQUIREMENTS FOR REVIEW AND APPROVAL OF MAINLAND ELECTIVE ROTATIONS

During the first half of the 2008-2009 academic year, i.e., until December 31, 2008, I will apply the following requirements. Thereafter, I will review these requirements in light of then current budget issues and risk management considerations. This does not imply that I will change these restrictions, only that I will engage in a review once our budget picture is clearer. Mainland Electives requests must be accompanied by the required HRP request and approval forms. Your PA has those forms. I will not approve international rotations except in most exceptional situations (with particular emphasis on Requirements 4, 5 and 7 below). Note that approval by the Program Director, HRP Legal Counsel, and CEO are all required. 1) The request must reach my desk not later than 3 months prior to the

rotation. Reason: even if otherwise acceptable, we still must negotiate the PLA which includes the issue of malpractice and risk management.

2) When submitted to me, there must be a proposed PLA, together with

goals & objectives, information on the prospective supervising physician, and hopefully some indication of prospective commitment by that supervisor of this resident.

3) Residents should not purchase tickets or make any other non-

refundable travel arrangements until they have received final approval of the request.

4) Residents should be encouraged to select electives from an approved

program list, or at least a location where our residents have already rotated. In this way, we can avoid having to “reinvent the wheel” for every request.

5) All requests must be consistent with the HRP Mission: “To improve the

health care of the people of Hawai‘i” – or to have a significant potential to do so.

6) For residents who are serving or will serve with the U.S. Armed

Forces, that definition may be expanded to “improve the health care of


5

members of the Armed Forces and their dependants”.

7) One way to demonstrate this value is to show that the elective is prestigious, competitive or highly sought after, such that attendance by our resident will enhance the prestige of the Program and/or other HRP programs by being accepted there.

8) The receiving program MUST agree to use the pre-approved HRP

generic template PLA. No significant changes are permitted. As DIO, I hold delegated authority only to sign this form. Any other form must be submitted to UH counsel and then the Dean.

9) The resident must pay all expenses associated with the rotation,

including travel, accommodations, license fees, etc. HRP will pay only the salary & benefits for the resident.

10) HRP MAY under some circumstances provide malpractice coverage.

That is the exception, not the rule. Coverage will be provided only when the risk is determined by our outside legal counsel and consultant to be acceptable. I simply cannot accept a substantial risk that I must pay for the defense of a malpractice claim in another state.

Here are some of the kinds of electives rotations that I simply won’t approve: Rotations that enable the resident to spend time with, or close to, home/family/significant others. Rotations that will assist the resident in transitioning to an anticipated practice after graduation. Rotations that will permit a resident to “try out” an area. Rotations that will help the resident get to a fellowship early in order to get settled. Rotations that require an Affiliation Agreement or equivalent, i.e., something more than a simple generic PLA.”

Only upper-level Medicine residents are eligible for off-island elective rotations. These include: 1. rotations to Accreditation Council for Graduate Medical Education Program (ACGME) - accredited programs; 2. rotations with a faculty member at an accredited School of Medicine; 3. other rotations arranged by the resident and approved by UHIMRP.


6

Residents may be permitted to take a maximum of TWO (2) off-island electives, one of which may be taken in the second year. No stipend is provided for off-island electives.

Residents who have received a borderline or unsatisfactory rating in the overall evaluation for any rotation may be denied the opportunity for an off-island elective. Off-island electives must be approved by the elective supervisor, firm director, the program director, and HRP. Documents for U.S. electives must be submitted to Hawaii Residency Programs, Inc. not less than THREE (3) months prior to the beginning of the rotation. Documents for INTERNATIONAL electives must be submitted to Hawaii Residency Programs, Inc. not less than SIX (6) months prior to the beginning of the rotation.

Residents should not purchase tickets or make any other non-refundable travel

arrangements until they have received final approval of the request.

Residents must pay all expenses associated with the rotation, including travel, accommodations, license fees, etc. HRP will pay only the salary and benefits for the residents.

U. S. Electives

The following must be submitted to HRP:

a. A proposed Program Letter of Agreement,

• The receiving program MUST agree to use the pre-approved HRP generic PLA template. No significant changes are permitted. HRP’s CEO/DIO holds the delegated authority to sign only this form. Any other form must be submitted to UH counsel and then the Dean of JABSOM.

b. Resident Request for U.S. Off-Island Elective form

• Supervising physician’s CV (information on the prospective supervising physician)

c. Request for Workman’s Compensation & Medical Malpractice Coverage for

Residents on U.S. Rotation Outside of Hawaii Residency Program’s Affiliated Medical Centers form. The resident will need to provide at a minimum the following [not applicable to international electives]: • name of host institution • name of elective supervisor • position of elective supervisor at host institution and his/her contact

information • an assessment of the level of exposure to risks in patient care activities • name of contact person at host institution for questions regarding professional

liability insurance. • The resident should inquire about whether the host institution provides

liability insurance.


7

International Electives The resident must complete: 1) Resident Request for Travel Permission & Medical Malpractice Coverage for Resident Seeking International or Non-U.S. Rotations form (some indication of prospective commitment by the prospective supervising resident) and 2) HRP’s International Rotation Acknowledgement, Consent and Release form.

Allowing the Needed Travel Time The appropriate amount of travel time necessary to reach the site of the off-island elective will be granted. This will be taken at the beginning and at the end of the rotation, not during the end of the previous rotation or the beginning of the next rotation.

Notification of Continuity Clinic Residents who are approved for an off-island elective must notify their continuity clinic site coordinator of their planned absence from continuity clinic. Such notification should be given as early as possible, and not less than two months prior to the beginning of the elective rotation.

Notification of Jeopardy Call Chief The resident must notify the chief medical resident in charge of the jeopardy call schedule (for 2008, Katsufumi Nishida, MD) and notify the program and schedule coordinator of the changes not less than two months prior to the beginning of the off-island elective rotation.

C. ACADEMIC-HALF DAY Starting July 1, 2008, a pilot Academic Half-Day will be held every Tuesday from 12:30–4:30 pm at The Queen’s Conference Center. The implementation of this pilot activity is the result of years of discussion at past Program retreats, efforts of the Academic Half-Day task force and willingness of faculty and residents to work together toward common goals. The potential benefits include: dedicated learning time, improved conference attendance, improved morale from bringing residents together from multiple sites, and program-wide common educational experiences. The challenges include preserving continuity and quality of patient care especially on high volume inpatient services, preventing “brain freeze” in our residents after the first two hours of the afternoon and maintaining our outstanding pool of OIM speakers with the time change. During the first two Tuesdays, Department of Medicine Grand Rounds will be geared toward faculty and residents will have their own separate didactic lecture during the 12:30–1:30 pm time slot. During the third and fourth Tuesdays, residents will be required to join the faculty at Grand Rounds for topics appropriate for both groups. The second session of the Half-Day will be Board Review given by our two chiefs (for 2008-2009, Drs. Katsufumi Nishida and Prashant Verma). The third session and potentially fourth sessions will be either didactic lectures or additional educational experiences including M and M, CPC, Journal Club, and resident-driven sessions.




1-800-55-UHMED • 1-800-558-4633

RESIDENT REQUEST FOR U.S. OFF-ISLAND ELECTIVE

Residents interested in doing an off-island U.S. elective not offered by the program must complete this form a minimum of three (3) months prior to the beginning of the rotation, six (6) months for an international elective. The elective supervisor of this off-island elective, your firm director, continuity clinic coordinator or preceptor, and the program director must approve the request. The elective supervisor must also complete and sign an Elective for Residents form. 1. Name of resident: ________________________________________________________________ 2. Elective requested: ________________________________________________________________ 3. Block / dates of rotation: ___________________________________________________________ 4. Name of program: ________________________________________________________________ 5. Name and title of individual responsible for the elective and evaluation of the resident (attach CV).

_______________________________________________________________________________

_______________________________________________________________________________

6. Program / individual address:

_______________________________________________________________________________

_______________________________________________________________________________

7. Why do you want to do a rotation at this institution and/or with this individual?

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

I have reviewed the resident’s objectives and agree to assume responsibility for this elective and to evaluate the resident at the completion of the rotation.

APPROVED BY: ________________________________________________________________ Elective Supervisor Date ________________________________________________________________

UHIMRP Firm Director Date ________________________________________________________________ UHIMRP Continuity Clinic Coordinator or Preceptor Date

________________________________________________________________ UHIMRP Program Director Date

Rev 10/07




1-800-55-UHMED • 1-800-558-4633

ELECTIVE FOR RESIDENTS Name of Resident: _______________________________________________________Block: _________________________________ (Include dates) Elective title: __________________________________________________________________________________________________

Faculty in Charge of Elective: ____________________________________________________________________________________

Address: ______________________________________________________________________________________________________

Phone/FAX/E-mail: ____________________________________________________________________________________________

Site(s) of Elective: ______________________________________________________________________________________________

Other faculty members involved in the Elective: _____________________________________________________________________

Prerequisites for the Elective: ____________________________________________________________________________________

Instructional Methods

1. Meaningful patient responsibility/direct clinical experience Ambulatory: hrs/wk _________________________ site(s) _________________________________________________ Inpatient: hrs/wk _________________________ site(s) _________________________________________________ Consultations: hrs/wk _________________________ site(s) _________________________________________________ Other patient care (describe): ______________________________________________________________________________

hrs/wk _________________________ site(s) _________________________________________________ 2. Non-patient focused reading sessions (describe): ___________________________________________________________________

hrs/wk _________________________ site(s) _________________________________________________ 3. List required conferences: _____________________________________________________________________________________ 4. Required reading: ___________________________________________________________________________________________ 5. Are MKSAP questions used in this Elective? Yes _____ No _____ 6. Other instructional methods: ___________________________________________________________________________________

__________________________________________________________________________________________________________ 7. Sample of typical day’s schedule: ______________________________________________________________________________

__________________________________________________________________________________________________________

Evaluation Methods

1. UHIMRP “Attending Evaluation of Resident Performance” (to be completed and reviewed with the resident) 2. Other: ____________________________________________________________________________________________________

Curricular Goals (also see Curriculum Handbook)

1. __________________________________________________________________________________________________________ 2. __________________________________________________________________________________________________________ 3. __________________________________________________________________________________________________________

Curricular Objectives (also see Curriculum Handbook)

1. __________________________________________________________________________________________________________ 2. __________________________________________________________________________________________________________ 3. __________________________________________________________________________________________________________

Other comments: ______________________________________________________________________________________________ ______________________________________________________________________________________________________________

_______________________________________________ ______________________________________________________ Name of Elective Supervisor (print) Signature of Elective Supervisor Date

Approved / Disapproved: _________________________________________________________________________________________ Signature of UHIMRP Division Chief (if applicable) Date

______________________________________________________________________________________ Signature of UHIMRP Program Director Date




1-800-55-UHMED • 1-800-558-4633

Request for Workers Compensation & Medical Malpractice Coverage for Residents on U.S. Rotation Outside of Hawaii Residency Program’s Affiliated Medical Centers

When a resident plans a rotation outside of Hawaii, the issues of medical malpractice and Workers Compensation coverage must be addressed prior to the granting of permission for the rotation. Workers Compensation insurance is provided by HRP for approved outside rotations. Malpractice coverage is different: The program should first request that the host institution provide medical malpractice coverage for the resident during that rotation. In the event a host institution does not provide medical malpractice coverage for our resident, the risk of liability exposure must be assessed well in advance of the program granting the resident permission for the rotation. The program director is responsible for providing the following information to HRP for all outside rotations, whether or not medical malpractice is provided by the host institution. Please complete and submit the following information to HRP as early as possible to ensure a timely response regarding coverage: 1. Name of host institution, city and state:____________________________________________ 2. Full name of preceptor/attending physician:_________________________________________ 3. Academic connection of preceptor/attending to host institution:__________________________ _____________________________________________________________________________ 4. Does this elective rotation present any risk that would not be encountered if the resident remained here in Hawaii? No Yes If yes, please explain: ___________________________________________________________ _____________________________________________________________________________ 5. Will the host institution provide malpractice coverage? No Yes 6. Contact person at host institution:________________________________________________

Phone Number: __________________________________________________________

7. Is this a one-time-only or recurring rotation? _______________________________________

If one-time-only rotation, name of resident: _____________________________________ 8. Please attach UHIMRP Elective for Residents form. Information submitted by: ___________________________________ Date: ________________ Approved by: _____________________________________________ Date: _______________ UHIMRP Program Director Reviewed by HRP and approved:_____________________________ Date: ________________ Program Letter of Agreement: _____________________________________________________

University of Hawai‘i Internal Medicine Residency Program John A. Burns School of Medicine • VA Pacific Islands Health Care System

Kuakini Medical Center • The Queen’s Medical Center • Hawaii Medical Center East


Revised 6/07 1-800-55-UHMED • 1-800-558-4633

RESEARCH ELECTIVE FOR RESIDENTS Name of Resident: __________________________________________________Block (include dates): _______________________________ Elective title: _________________________________________________________________________________________________________ Faculty in Charge of Elective: __________________________________________________________________________________________ Address: ____________________________________________________________________________________________________________ Phone/FAX/E-mail: ___________________________________________________________________________________________________ Site(s) of Elective: ____________________________________________________________________________________________________ Other faculty members involved in the Elective: ___________________________________________________________________________ Prerequisites for the Elective: ___________________________________________________________________________________________ Maximum number of residents that can be accommodated: _________________________________________________________________


1. Complete thorough review of the literature (background) – Resident to discuss the magnitude of a medical problem and its potential biological mechanisms

2. Generating hypotheses – Resident with the guidance of his/her mentor will develop one or more hypotheses Hypotheses should be focused, achievable within the context of resources and sample size, and potentially adds to the current body of literature

3. Methodology – Resident should develop and write out the methods section before any data is collected. An apriori analysis plan should be devised with the mentor.

Data collection – Resident and mentor will discuss what data will be collected and how it will be collected. What type of data management will be required. Data analysis – Resident and mentor will discuss a data analysis plan. What variables (continuous, ordinal, or dichotomous) will be analyzed and what statistical methods will be employed.

4. Results – Resident with the help of the mentor will strive to present the results in a clear and orderly sequence 5. Conclusions – Resident with the help of the mentor will produce a conclusion that is supported by the research results 6. Presentation format (slides, poster, or manuscript) – Resident will learn to either create a poster, slide presentation and/or manuscript. The

final product will be submitted by the resident to the residency program. 7. Reference list – learn appropriate reference format 8. Human Subject Protection – All residents participating in a research elective MUST complete a Human Subject Protection course

A recommended course offered by the National Cancer Institute is located at http://cme.cancer.gov/clinicaltrials/learning/humanparticipant-protections.asp

9. Non-patient focused reading sessions (describe): _________________________________________________________________________ hrs/wk _________________________ site(s) ____________________________________________________

10. List required conferences: ___________________________________________________________________________________________ 11. Required reading: _________________________________________________________________________________________________ 12. Other instructional methods: _________________________________________________________________________________________

________________________________________________________________________________________________________________ 7. Sample of typical day’s schedule: _____________________________________________________________________________________

________________________________________________________________________________________________________________

Evaluation Methods

1. UHIMRP “Research Elective Rotation Attending Evaluation of Resident Performance” (to be completed and reviewed with the resident) 2. Other: (i.e. conference presentation or submission for journal review)_________________________________________________________


1. ________________________________________________________________________________________________________________ 2. ________________________________________________________________________________________________________________ 3. ________________________________________________________________________________________________________________


1. ________________________________________________________________________________________________________________ 2. ________________________________________________________________________________________________________________ 3. ________________________________________________________________________________________________________________

4. Other comments: _________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ _________________________________________________ _________________________________________________________ Name of Elective Supervisor (print) Signature of Elective Supervisor Date

Approved / Disapproved: ____________________________________ Approved / Disapproved: ____________________________________ Signature of Division Chief (if applicable) / Date Signature of Program Director / Date

University of Hawai‘i Internal Medicine Residency Program John A. Burns School of Medicine • VA Pacific Islands Health Care System

Kuakini Medical Center • The Queen’s Medical Center • Hawaii Medical Center East


1-800-55-UHMED • 1-800-558-4633

ELECTIVE FOR RESIDENTS (One-time, not offered in Elective Handbook)

Name of Resident: __________________________________________________Block: __________________________________ (Include dates) Elective title: ________________________________________________________________________________________________

Faculty in Charge of Elective: _________________________________________________________________________________

Address: ___________________________________________________________________________________________________

Phone/FAX/E-mail: __________________________________________________________________________________________

Site(s) of Elective: ____________________________________________________________________________________________

Other faculty members involved in the Elective: __________________________________________________________________

Prerequisites for the Elective: __________________________________________________________________________________

Maximum number of residents that can be accommodated: _________________________________________________________


1. Meaningful patient responsibility/direct clinical experience Ambulatory: hrs/wk _________________________ site(s) _____________________________________________ Inpatient: hrs/wk _________________________ site(s) _____________________________________________ Consultations: hrs/wk _________________________ site(s) _____________________________________________ Other patient care (describe):

_________________________________________________________________________________ hrs/wk _________________________ site(s) _____________________________________________

2. Non-patient focused reading sessions (describe): _________________________________________________________________ hrs/wk _________________________ site(s) _____________________________________________

3. List required conferences: ________________________________________________________________________________________

4. Required reading: _______________________________________________________________________________________________

5. Are MKSAP questions used in this Elective? Yes _____ No _____ 6. Other instructional methods:___________________________________________________________________________________

__________________________________________________________________________________________________________ 7. Sample of typical day’s schedule: ______________________________________________________________________________

__________________________________________________________________________________________________________

Evaluation Methods

1. UHIMRP “Attending Evaluation of Resident Performance” (to be completed and reviewed with the resident) 2. Other: __________________________________________________________________________________________________


1. ________________________________________________________________________________________________________ 2. ________________________________________________________________________________________________________ 3. ________________________________________________________________________________________________________


1. ________________________________________________________________________________________________________ 2. ________________________________________________________________________________________________________ 3. ________________________________________________________________________________________________________

Other comments: ____________________________________________________________________________________________ ____________________________________________________________________________________________________________

___________________________________________________ __________________________________________________ Name of Elective Supervisor (print) Signature of Elective Supervisor Date

Approved / Disapproved: _______________________________________________________________________________________ Signature of Division Chief (if applicable) Date

______________________________________________________________________________________ Signature of Program Director Date