Residents split their training between Wichita's three major hospitals: Ascension Via Christi St. Francis, Wesley Medical Center and the Robert J. Dole VA. These are the busiest hospitals in the state and collectively comprise around 1,200 staffed beds, with over 50,000 inpatient admissions a year. Med/Peds residents complete 24 months of Internal Medicine. Ten of these involve rounding on the general medicine service, with the rest being divided between subspecialty electives, critical care, emergency room and ambulatory rotations. Internship in Medicine is nine months, after which senior resident duties begin. Rounding teams typically consist of an attending physician, senior resident, one or two interns, a pharmacist, sub-intern, two medical students, and pharmacy residents and students as well. Daily census numbers typically vary from 15 to 25, averaging around 16-18 a day. Interns are responsible for the day-to-day management of their patients, while seniors have a supervisory and educational role, and are responsible for every patient on the service.

There are no sub-specialty wards, so general medical patients feature a wide variety of pathology, presentations, and levels of acuity. With the exception of the VA, all adult intensive care units are open, meaning residents continue to follow and manage their patients - with appropriate subspecialist assistance - from admission to discharge, regardless of where they are in the hospital. Residents also perform any common procedures their patients need. Call while on inpatient services usually averages every 5th to 6th night.

Nearly all Pediatric training takes place at Wesley Medical Center, the single busiest hospital in Kansas. The pediatric service includes a 43-bed general pediatric floor, and a 12-bed pediatric intensive care unit with plans to expand to a new 28-bed unit in the future. There is also pediatric sedation, pediatric ambulatory surgery, and the only pediatric emergency room in Kansas.  The total number of admissions to the general pediatric floor for 2006 was 3181. In 2007 there were 1044 PICU admissions, with an average daily census of 7 patients. As for neonatal care, approximately 6,000-7,000 babies are born at the medical center each year, the most in a 7-state area excluding Texas. The Perinatal Center is a referral base for 23,000 deliveries across Kansas and surrounding states. Wesley has 46 labor rooms and 5 OR's, and regularly handles high- and low-risk deliveries. The Level 3 Neonatal Intensive Care Unit and Special Care Nursery encompass 62 beds dedicated to premature and critically ill infants. NICU physicians respond to more than 750 admissions annually. Internship in Pediatrics lasts nine months, after which senior resident duties begin.

Five months on the general pediatrics service are required, four of which are completed at intern level. Four months of critical care, and two months of normal newborn - one as supervisor - are also required. Interns are responsible for the day-to-day management of their patients, while seniors have a supervisory and educational role, and are responsible for every patient on the service. On Pediatrics, as on medicine, there are no subspecialty wards, so residents are regularly responsible for a very wide range of pathology and presentations. In contrast to Medicine, however, the PICU and NICU are closed units; residents on the general service resume care when their patients return. Call while on inpatient services usually averages every 4th to 5th night. Two two-week periods a year on night float are required for senior residents.

Critical care experience for Medicine occurs in three settings:

1. Rotation in a closed ICU at the Robert J. Dole VA
2. Rotation with Pulmonary/Critical Care Specialists in the MICU and CCU at Ascension Via Christi St. Francis
3. Management from admission to discharge of all patients, including those admitted directly to the ICU, or who require intensive care at some point during their stay. This occurs at both Ascension Via Christi St. Francis and Wesley Medical Center.

Med/Peds residents are required to complete two formal ICU rotations, and regularly manage patients in the MICU, CCU, CTICU, Neuro ICU, and periodically the SICU as well. Critical Care experience for Pediatrics occurs in three possible settings:

1. Rotation in the Pediatric Intensive Care Unit
2. Rotation in the Neonatal Intensive Care Unit (level 3)
3. Available supervised moonlighting experience in the Neonatal Intensive Care Unit

Med/Peds residents are required to complete one month of PICU, and two months of NICU. Moonlighting in the NICU is also available. A few extra notes about ICU training in Wichita:

• Wichita is the referral center for the majority of Kansas, as well as parts of Northern Oklahoma, so the ICUs are usually very busy.
• There are no fellows. Residents work directly with attending physicians to achieve patient management goals.
• Just as on the regular floor, residents are expected to develop and implement a management plan for their patients.
• Residents are expected to learn to manage ventilation on most patients, and to perform necessary procedures on all their patients. Supervision for procedures is provided until residents demonstrate ability to complete the procedure independently, with attending or senior resident backup

Acute Care training is accomplished through a combination of acute ambulatory care months in both Medicine and Pediatrics clinic, and Emergency Department rotations at Wesley Medical Center, a Level I Trauma Center that features over 70,000 visits a year. Wesley also features Kansas' only Pediatric ED. Med/Peds residents do one month as Acute Care Resident for Medicine, and another for Pediatrics.

Residents also periodically see overflow acute care visits as part of the normally scheduled clinic visits. Emergency Department rotations consist of one month of full ED, and two months of Pediatric ED. Moonlighting opportunities in both the adult and pediatric emergency room and ambulatory acute care settings in the community also exist for interested residents.

Both Medicine and Pediatrics feature a wide array of scheduled didactic activities, including noon conferences, board review sessions, journal clubs, morbidity/mortality, case conferences and grand rounds. Residents are expected to participate actively in many of these sessions, and are required to give a certain number of presentations before graduation. There is a Med/Peds Combined Grand Rounds once a month, which covers a topic applicable to both disciplines.

Computerized didactics involve modules covering everything from radiology exams to communication skills and topics in ambulatory medicine. Both the Peds and Med/Peds programs have also recently started building an electronic case-file.

Informal didactics include daily bedside teaching rounds on inpatient services, and resident and med student presentations on various topics, as well as senior resident teaching sessions. Most sub-specialists also have a series of fundamental topics which they cover through a combination of lectures and articles. The ultimate goal of all the above, however, is to spark residents to be self-motivated, life-long learners, dedicated to the constant expansion of their knowledge base.

Evaluation of clinical competence occurs at regular intervals throughout the program so that admission to the certifying examinations of the American Board of Internal Medicine and American Board of Pediatrics can be recommended at the end of the fourth year. Residents may choose a mentor in each department, and meet with them quarterly.

The faculty for each specialty meets on a semi-annual basis to review each resident's progress, and confer together on Med/Peds residents. Residents receive an electronic evaluation after each month, and also have the opportunity to evaluate their attending physicians, fellow residents, and the program in general without fear of repercussions. Resident comments are taken seriously, and changes are made in response to them. 

Internal Medicine/Pediatric residents are expected to be familiar with the following procedures. Required procedures are specified by the American Board of Internal Medicine (ABIM) and American Board of Pediatrics (ABP) respectively. Please note that some procedures double-count for both specialties; these are indicated in the Pediatrics section (see notes for details).

Internal Medicine

REQUIRED SKILLS

The resident will demonstrate the following during the procedure:

• Effective consent discussion, including risks/benefits and alternatives
• Use of standard or universal precautions
• Establishment of a sterile field
• Application of local anesthetic

Pediatrics

REQUIRED COMPETENCY

• Bag & mask ventilation
• Bladder catheterization
• Immunizations
• Incision & drainage of an abscess
• Lumbar puncture (signed off by peds supervisor)
• Neonatal endotracheal intubation
• Placing peripheral venous line
• Reduction of simple joint dislocations
• Simple laceration repair (simple suturing)
• Simple removal of foreign body
• Temporary splinting of a fractures
• Umbilical catheter placement
• Venipuncture
  

Must be familiar with the following procedures:

• Arterial line placement
• Arterial puncture of non-neonates
• Chest tube placement
• Circumcision resuscitation
• Endotracheal intubation of
• Neonatal delivery room
• Thoracentesis