For Prospective Residents
Curriculum:
PGYIII Ambulatory VA-West Los Angeles
Goals:
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The resident rotates through the various ambulatory-focused specialties of neurology, ENT, GI, ophthalmology, rheumatology and urology gaining the necessary knowledge and skills to recognize common disorders of these specialties and know when to refer patients for consultation. |
Rotation Specific
Urology
Goals:
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The goals of the Urology Rotation are for the residents to learn to recognize those urologic problems that can be managed by the family physician as well as to recognize those that require direct referral to a consultant. |
Objectives:
Residents will:
Patient Care and Medical Knowledge
1. Be able to perform a history and physical examination with emphasis on the urinary system and male reproductive system.
2. Be able to recognize and/or manage common infectious abnormalities (e.g., pyelonephritis, cystitis, urethritis, orchitis, epididymitis, prostatitis) as well as urinary system calculi, incontinence, urinary obstruction, prostatic hypertrophy and nodules, urethral stricture, and venereal warts.
3. Have gained familiarity with congenital and acquired anomalies of the male genital organs (e.g. hydrocele, undescended/cryptic testicle, phimosis, balanitis, varicocele, spermatocele).
4. Be able to describe the management of the undescended testis.
5. Understand the diagnostic and therapeutic approaches to erectile dysfunction and male infertility.
6. Understand the indications for non-invasive examinations of the urogenital system and be able to interpret the results of these common procedures (e.g., x-ray, ultrasound, etc.).
7. Relate accepted indications for intravenous pyelogram, spiral CT, cytoscopy, PSA testing and ultrasound.
8. Be able to recognize testicular emergencies in young men and boys, such as testicular torsion.
9. Understand the proper evaluation of enuresis.
10. Be able to describe the treatment for erectile dysfunction.
Ophthalmology
Goals:
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The goals of the Ophthalmology rotation are to recognize those eye problems that may be managed by a Family Physician, and those that need referral to an Ophthalmologist, as well as the basics of the slit lamp exam and exposure to what a patient experiences when seeing an Ophthalmologist. |
Objectives:
Residents will:
Patient Care and Medical Knowledge
1. Attain core knowledge with respect to: normal and abnormal growth and development of the eye; eye problems associated with aging; the pathophysiology of common eye disorders (including congenital, infectious, immunologic, and traumatic disorders); neoplastic, degenerative and circulatory disorders; strabismus; glaucoma; papilledema; ophthalmologic manifestations of systemic diseases; and pharmacology of commonly used topical medications in ophthalmology
2. Be proficient in obtaining an adequate history of the eye
3. Be proficient in psychomotor skills requiree for performing a systematic examination of the eye, including the roles of adjunctive diagnostic procedures (i.e. fluorescein stain, slit lamp)
4. Be proficient in the diagnosis and management of common eye problems, such as the red eye, hordeolums, chalazions, uveitis, pterygiums, foreign bodies, diabetic retinopathy, and minor trauma
5. Be able to recognize what conditions require a referral to the ophthalmologist for consultation
6. Be able to demonstrate proficiency in basic ophthalmologic procedures
a. Safe removal of foreign bodies from the eye
b. Application of eye patch and shield
c. Performance of tonometry, when indicated
d. Performance of fluorescein staining of the cornea and interpretation of the results
e. Performance of tests designed to assess visual acuity, visual fields, and strabismus (cover/uncover test)
f. Use of the slit lamp
Neurology
Goals:
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The goals of the Neurology rotation are to learn to recognize neurologic problems that may be managed by a Family Physician and those that need referral to a Neurologist, as well as the basics of neurologic and mini – mental status examinations. |
Objectives:
Residents will:
Patient Care and Medical Knowledge
1. Be able to perform a basic neurologic examination
2. Be able to perform a mini – mental status examination
3. Be able to perform a dementia work - up
4. Be able to describe common neurologic diseases, their evaluation and treatment
a. Dementias (including Alzheimer’s Disease and vascular dementia)
b. Parkinson’s Disease
c. CVA
5. Be able to describe the risk factors for stroke
6. Be familiar with what neurologic conditions require referral to a Neurologist
ENT
Goals:
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The goals of the ENT rotation are to learn to recognize those medical problems that occur in the head and neck that may be managed by a Family Physician and those that need referral to an Head and Neck Surgeon, as well as the basics of the nasolaryngoscopic exam. |
Objectives:
Residents will:
Patient Care and Medical Knowledge
1. Be able to perform a details history and focused physical examination of the ears, nose, throat and neck
2. Be able to perform a basic nasolaryngoscopic examination
3. Be able to use a dissecting otoscope
4. Be able to describe the risk factors for cancers of the head and neck
5. Be able to describe the workup for a suspicious lymph node
6. Be familiar with various diseases of the head and neck
7. Be familiar with the diseases that require referral to an ENT Surgeon
Rheumatology
Goals:
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The goals of the Rheumatology rotation are to learn to recognize musculoskeletal and rheumatic problems that may be managed by a Family Physician, and those needing referral to a Rheumatologist, as well as the basics of joint and musculoskeletal examinations. |
Objectives:
Residents will:
Patient Care and Medical Knowledge
1. Be able to perform a basic joint examination
2. Be familiar with the common serologic markers of the various rheumatologic diseases
3. Be familiar with the indications for the serologic testing of rheumatologic disease
4. Be familiar with common rheumatologic diseases, including the presentation, workup and basic treatment
a. Osteoartiritis
b. Inflammatory arthritis
i. Rheumatoid arthritis
ii. Psoriatic arthritis
c. Vasculitis
d. Enthesopathies
e. Systemic Lupus Erythamotosis
7. Be familiar with the use of medications, including DMARD’s in the treatment of rheumatic disease
8. Be familiar with diseases that require referral to a Rheumatologist
Gastroenterology
Goals:
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The goal of the Gastroenterology rotation is to learn to recognize gastroenterolgic problems that may be managed by a Family Physician and those which need referral to a Gastroenterolgist. |
Objectives:
Residents will:
Patient Care and Medical Knowledge
1. Be able to perform a focused history and physical examination of the GI system
2. Be able to describe alarm symptoms in gastroenterology
3. Be familiar with common GI problems including inflammatory bowel disease, colon cancer, rectal bleeding, dysphagia, GERD and peptic ulcer disease
4. Be familiar with the indications for endoscopy
5. Be familiar with the guidelines for GI cancer screening
6. Be familiar with the basic workup of common GI problems
7. Be familiar with medications commonly used in the treatment of GI problems, including the role of H2 blockers and Proton Pump Inhibitors
8. Be familiar with the diseases that require referral to a Gastroenterologist
For all subspecialty clinics the resident will:
Practiced Based Learning and Improvement
- Be able to use the internet to access current literature about various problems seen in subspecialty clinics
- Be able to critically evaluate literature about subspecialty medical care
- Be able to work well in the context of various subspecialty clinics
- Be able to implement changes in patient care based on new information obtained from the physicians subspecialist, clinical experience, review of the literature and other sources
Interpersonal Communication Skills
- Communicate effectively with patients
- Able to communicate in a manner in which the patient with a medical or surgical condition can understand the underlying disease, treatment plan and prognosis
- Able to listen to and address the concerns of patients and their families
- Communicate effectively with colleagues
- Able to work efficiently in the context of the ambulatory clinics in a Veteran’s Administration facility
- Able to work efficiently with the support staff in the care of the ambulatory clinic patient
Professionalism
- Demonstrate cultural competency
- Demonstrate the ability to act in the best interests of the patients
- Respect for confidentiality
- Respect for patient autonomy
- Be professional in all aspects of patient care
- Accepts personal responsibility for patients
- Accepts feedback in all aspects of care, including the six Core Competencies
- Timeliness
- Appropriate attire
Systems – Based Practice
- Demonstrate understanding of the care of the patient with outpatient medical and/ or surgical conditions in the context of the current health care system in a Veteran’s Administration facility
- Coordinate care with ancillary services to improve the healthcare of the patient
- Assist patients and their families in dealing with the medical or surgical condition of the patient
Logistics:
(The clinics you will be attending are various outpatient clinics at the VA)
Contacts:
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Lisa Altman, MD, Lead Physician for Primary and Ambulatory Care Calvin Payne, Assistant West Los Angeles VAMC 11301 Wilshire Blvd. Los Angeles, CA 90073 (310) 268-3526 (Dr. Altman) |
Location and Contacts for specific clinics:
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Urology (Uro) and Erectile Dysfunction (ED) - West Los Angeles VAMC 11301 Wilshire Blvd. Room 0093 (Uro) and Room 0100 (ED) Los Angeles, CA 90073 Contact – Carol Bennett, M.D. (310) 478-3711 x44047 (310) 268-3744 (clinic) |
Ophthalmology - West Los Angeles VAMC 11301 Wilshire Blvd. Room 0105 Los Angeles, CA 90073 Contact – Lynn Gordon, M.D., Chief of Ophthalmology (310) 268-4363 (310) 268-3396 (clinic) |
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Neurology (Neuro) - West Los Angeles VAMC 11301 Wilshire Blvd. Room 1647 Los Angeles, CA 90073 Contact – Claude Wasterlain, M.D., Chief of Neurology (310) 268-3399 (310) 268-3116 (clinic) |
Ears, Nose, and Throat (ENT) West Los Angeles VAMC 11301 Wilshire Blvd. Room - 0209 Los Angeles, CA 90073 Edward Livingston, M.D., Chief of ENT (310) 268-3525 (310)268-3122 (clinic) |
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Rheumatology (Rheum) - West Los Angeles VAMC 11301 Wilshire Blvd. Room - 1647 Los Angeles, CA 90073 Contact – Jay Persselin, M.D., Chief of Rheumatology (310) 268-3663 (310) 478-3711 x83116 |
Gastroenterology (GI) - West Los Angeles VAMC 11301 Wilshire Blvd. Room – 4 West Los Angeles, CA 90073 Joseph Pisegna, M.D., Chief of Gastroenterology (310) 268-3578 (310) 268-3754 (clinic) |
Continuity Clinics – You will have 5 continuity clinics a week. There may be more or less continuity clinics based on clinic availability.
Educational Half – Day – Attendance is required.
Additional Information:
Attendance must be documented for each half-day clinic; see Marlene Abbott in Room 1601. Report to the assigned Ambulatory Clinic and introduce yourself to the Attending or Chief Resident. Clinic Contact and Location information is listed above.
ED clinic – please present yourself to Tina Keller, N.P.
PARKING at the VA: Because there is adequate parking at the VA, it is not necessary for residents to get parking permits. However, you MUST park in areas designated for employees. Lot 6 is west of the Wadsworth Building; Lot 2 is south of the Wadsworth Building. Do NOT park in Lot 42 or Lot 43 (which are north and east of the Wadsworth Building, respectively), as these are Patient, Volunteer and Visitor Parking Areas – and monitored closely by the VA police.