Denver Health offers two different settings for providing urgent care services. In both settings, there is awide variety of cases in medicine, surgery, gynecology, orthopedics and other fields. This elective offers aunique experience that most internal medicine residents don’t get elsewhere in their training. The Adult Urgent Care Clinic (AUCC) is a busy urgent care center that works in conjunction with the Emergency Department to provide urgent care to adult patients. AUCC has the resources of the hospital including advanced imaging and specialist consultations. The Southwest Family Health Center Urgent Care Clinic is an urgent care clinic in a new Denver Health Primary Care Clinic which treats patients of all ages. The resources at Southwest are more limited but include x-ray radiology and labs. You may have the opportunity to work with the dental department, podiatry and sports medicine in this setting. Residentautonomy and independent decision-making are stressed. In both settings, you will see a broad spectrum ofacute and sub-acute conditions that will present to your office as a practicing general internist, often requiringentirely different management skills than you have acquired on the wards. You will suture lacerations,perform incision and drainage of abscesses, diagnose acute appendicitis, tap a hot joint, manage acomplication of early pregnancy or treat a straightforward case of strep pharyngitis. Residents tell us ourbiggest strengths are our great staff, tremendously varied patient population and wide variety of medical conditions treated.
We may hold off this elective in AY2016-017; however, please contact Akemi Iwanabe if you are interesed.
This course focuses on the development of advocacy and leadership skills to better serve the needs of the underserved and vulnerable populations. This elective is designed to provide participants with a basic understanding of our current healthcare system and training on specific strategies that can be used to advocate on behalf of patients—through legislation, written pieces, media, coalitions, and community organizing.
Residents can elect to take a 1-4 month block of rotations at the Denver Veteran’s Affairs Hospital in their 3rd year. Several different clinics are available to rotate through on a regular basis including, but not limited to, urology, rheumatology, dermatology, ENT, ortho, pulmonary, renal, and more.
This elective is designed to help residents develop a broad understanding of complementary and alternative therapies. Residents work with the University, Kaiser and community providers who specialize in various alternative healing disciplines, including acupuncture, naturopathy, yoga therapy, hypnosis, meditation, and shamanism.
Clinical Nutrition: With the majority of chronic diseases having a lifestyle component, residents have the option to spend two weeks learning more about clinical nutrition. Experiences may include spending time with dietitians and physicians in nutrition specialty clinics such as obesity, type II diabetes, eating disorders, nutrition and oncology, and general nutrition counseling. The majority of the experiences are ambulatory, though inpatient nutrition training can be arranged with advance notice.
This one month of out-patient dermatology clinic in a multi-specialty group setting is one of our most popular! Residents achieve independence with basic dermatology diagnosis, treatment and biopsy procedures. We also offer dermatology clinics at VA and UCH in combination with podiatry. Private practice - Open to primary care 2nd and 3rd year residents.
“The dermatology rotation at Kaiser gave me a great introduction to the diagnostic and therapeutic approaches to common skin complaints. Additionally, because Kaiser has a mix of Medicare, Medicaid, low-deductible, & high-deductible plans, I was also exposed to the costs associated with varying treatments which is important to keep in mind with the ever-changing insurance landscape. I rotated with different physicians primarily in Lafayette & Centennial (with a few other clinics such as downtown or Aurora mixed in). Each physician did a great job of teaching me their biopsy techniques & tailoring their teaching points toward my future career as a PCP.” Rebecca Petersen, MD, Class of 2016
This elective focuses on cardiac stress testing: picking the right stress test, testing protocol, reasons for testing, interpretation of data and safety considerations. At the end of the course, you should be able to conduct exercise testing independently and we will certify you as ready to do this if you have proctored at least 50 stress tests and taken the pre and post tests. Many physicians who have completed this rotation are now performing treadmills in their practice settings!
The rotating residents will be in the Family planning clinic at TCH,and will focus on adolescent contraceptive counseling, including indications, contraindications, side effects and management. There will be emphases on 1) Adolescent psychosocial development and its’ influence on adolescent contraceptive and reproductive decision making and 2) Motivational interviewing for contraception and sexual health in the adolescent. Skills of IUD and implant insertion/removal will be taught and well practiced during this rotation. The Children’s e-Pic training is required. 100% Ambulatory
“Family Planning takes place at Children’s Adolescent clinic and was by far my favorite elective during residency. The physicians and nurse practitioners were very engaging and focused on refining my contraceptive counseling and procedural technique. I am now very adept at not only wet preps and gynecologic exams but also am comfortable counseling & inserting various types of birth control. In the course of my 3 week rotation, I placed over 30 Nexplanon & 30 IUDs (including both Mirena and Paragard). This is a fantastic rotation for anyone hoping to integrate contraceptive management into their future practice.” Rebecca Petersen, MD, Class of 2016
During this unique rotation, residents will learn pedigree construction and interpretation, become familiar with available genetic tests, develop genetic counseling skills, and become familiar with the ethics and legal implications of genetic testing. Several clinic sites will be used to capture an array of diseases and styles of practice, and there are curricular offerings throughout the month to enhance learning built into the schedule. The main thrust of the month is to help Internal Medicine residents develop the skillset to understand and how medical genetics relates to Internal Medicine and to prepare for the continued evolution of clinical genomic medicine as applied to adults.
During this elective, residents will learn chronic care of HIV-infected individuals with a focus on the primary care of this population. Residents will gain the knowledge and skills to provide guideline-based preventive care specific to HIV patients, initiate anti-retrovirals, manage complications of treatment including viral resistance, and manage chronic co-morbidities. This is a required rotation for PC residents who wish to enter the HIV program, but is open to all interested residents.
“I chose to take the HIV primary care elective in my 2nd year after having a long interest in HIV and the underserved population it disproportionately affects. It was an excellent experience combining diverse didactic sessions, getting to know community and public health resources, and clinical experience with experienced and passionate faculty with backgrounds in both general internal medicine and infectious disease. I had one of the more unique experiences in my residency when I spent an afternoon in the Denver Health Tuberculosis Clinic with an ID attending. Since the elective, I have done an HIV primary care continuity clinic and been able to see many patients multiple times, counsel patient on starting antiretroviral therapy, and see the strong relationships that Dr. Adams has forged with her HIV patients over the years. I will be able to sit for the HIV provider exam when I complete residency and hope to incorporate that into my future primary care practice. I would highly recommend the HIV elective to anyone interested in learning more about caring for patients with HIV in the primary care setting - it has been an awesome experience and an opportunity that is quite unique to our residency program.” Kelly Evans-Hullinger, M.D. Class of 2015
"This elective provides a comprehensive overview for caring for patients with HIV. During this month, residents gain exposure to providing care for patients with HIV, including general healthcare maintenance, management of medications, identifying and managing common infections, and so much more! In addition, residents have the opportunity to participate STI-screening and counseling, as well as, substance abuse counseling and treatment in the inner-city. After completing this elective, I was motivated to continue learning HIV-medicine and complete the HIV-track. Truly, the best elective of my residency training!" Tierney Sparks, M.D., Class of 2013
Residents can take advantage of wonderful opportunities in Arizona and New Mexico with the Indian Health Service. Several CU graduates serve as preceptors. Residents will practice the full spectrum of internal medicine including outpatient clinics and inpatient rounding in this unique practice setting. During this rotation, residents live on the reservation affording them an opportunity to become fully immersed in the unique culture and community found on the reservations.
"Rotating at the Northern Navajo Medical Center in Shiprock, NM was a fantastic opportunity to see how high quality, academic-oriented primary care clinicians can continue to provide outstanding evidence-based care in a community setting. The hospital in Shiprock serves a VERY large geographic area, encompassing most of the Navajo reservation. It was an amazing opportunity to learn about the Navajo culture and meet the wonderful people who live in the Four Corners area. I loved having the opportunity to care for patients in the outpatient clinic, the walk-in clinic, the general medicine ward, and the ICU. They also have some unique clinics to serve the unique needs of the patient population, such as a Uranium Miner Clinic, TB clinic (common on the reservation), group diabetes clinic, and very busy rheumatology clinic (a lot of rheumatologic diseases run in Navajo families). The internal medicine physicians in Shiprock were a blast to work with and exceptional clinical educators. On the weekends (yes, you do get weekends off) you have the chance to explore amazing places such as Canyon of the Ancients, Hovenweep, Chaco Canyon, Mesa Verde, Moab, the Grand Canyon, Taos, Santa Fe, Durango, and more! This rotation had a huge and positive impact on my career decisions." Kathryn McCaffrey, MD, class of 2013
Kaiser Permanente is a non-profit integrated health system (primarily HMO with some PPO and high-deductible plans) caring for more than 450,000 members in 17 clinics throughout Denver and Boulder. Primary care internists host residents at their clinic site where the resident will work with 2-3 internists seeing patients, performing clinic-based procedures, attending CMEs and business-related meetings of interest.
“The University of Colorado does an excellent job at providing its residents the opportunity to work in several different hospital settings: academic, county, private, and the VA. However, the ambulatory experience is usually in the setting of an academic center with providers who are involved in research, administration, etc. Personally, this seemed somewhat daunting to undertake and I was interested in what primary care looked like in a non-academic setting. The Kaiser Preceptorship provided me this opportunity and it was wonderful. I was able to work with several different providers from a variety of backgrounds: some previously worked in an academic center while others were from a traditional private practice. It was a great opportunity to hear them compare and contrast the different settings while experiencing life as a Kaiser provider. The Kaiser Preceptorship allowed me to see and feel what the day-to-day life was like for a full-time non-academic primary care provider. I was able to work on my time efficiency and towards seeing the number of patients expected of an attending. The Kaiser rotation also reassured me that interesting patient pathology exists outside of an academic center. Overall, this was a great rotation and exposed me to yet manner in which to practice primary care.” Allison Wolfe, M.D., Class of 2015
This popular rotation has been rated as one of the most valuable outpatient experiences offered at CU. Practical experience with a personable, superb clinician-educator. Residents will master joint exam skills and injection techniques. Available to primary care residents only.
“The opportunity to rotate with an orthopedic surgeon during residency is a very unique option but proved to be invaluable. Dr. Parks is invested in teaching primary care providers appropriate strategies for managing orthopedic issues. He focuses on teaching the essential physical exam skills and how to perform them properly. He also wants us to give the training to do joint injections in our own clinics with confidence. Part of this training happens in the OR. As a medicine resident I never thought I would be back in the OR but it proved to be a beneficial experience. After the patient is prepped for the surgery, Dr Parks allows you to insert a needle into the joint space and he opens the joint so you can see if you were in the right location. Also, seeing what is involved with many orthopedic procedures allows me to have more meaningful conversations with my patient regarding what they can expect from the surgery. I now feel much more confident in when to refer, how to perform the relevant physical exam maneuvers and how to do therapeutic injections of the knee and shoulder.” Joel Jorgenson, M.D., Class of 2015
This month is designed to provide the resident with exposure to both palliative care and hospice experiences, including inpatient hospice care centers (Lutheran Hospice), hospital palliative care consultative services (University Hospital with options for ambulatory care) and Denver Health (ambulatory or inpatient). The focus of the rotation is on care for the seriously ill and their loved ones. Skills covered include acute pain and non-pain symptom management, advanced communication/complex family meetings, goals of care clarification, advance care planning and end-of-life transitions. Residents will integrate into the interdisciplinary team approach for the care of patients. Didactic education sessions occur at least weekly, in addition to weekly palliative medicine conferences. There are no weekend or evening call responsibilities. 25% Ambulatory
“This elective was a fantastic opportunity to improve my communication skills surrounding serious illness and the dying process, and to learn what resources are available to patients in these difficult situations. I appreciated the chance to work with team-based palliative care and hospice in three different settings. Moreover, the palliative focus provided me with practical tools to manage common and debilitating symptoms like pain, nausea, and constipation. I now feel well prepared to support patients and families as they make important decisions surrounding illness, end-of-life, comfort, and quality of life.” Laura Macke, M.D., Class of 2018
PC Selective is a new rotation for our third year residents. During this rotation, residents will learn and experience in community health at different clinics, hospitals and community centers. For example, transitional care experience will allow residents to receive handoff from inpatient colleague on a patient who will then have a home visit by the “community resident.” This will include feedback to inpatient resident on how it is going at home, use of a standard med rec form. Other sites and activities include; Care team, Palliative care clinic, Telehealth clinic, InnovAge (day care for seniors), Homeless and refugee clinics.
Internal Medicine Clinic (Main office in Centennial) An excellent opportunity to participate actively in a busy 3 internist community-based practice with a variety of managed care plans (HMOs, PPOs, POS, and indemnity insurance). Learn to code, refer, pre-authorize, use superbills and understand the myriad variations of insurance reimbursement. Residents will also be exposed to overhead and traditional office expenses. Opportunities to attend peer review, medical staff leadership and quality management meetings. A terrific opportunity to get accustomed to practicing in the real world.
ROSE - Busy private practice with former CU grads at Rose with the possibility of doing some treadmills during the month as well.
Kaiser - See Kaier Rotatons
CU-Denver Internal Medicine Group (Cherry Creek) - An terrific opportunity to participate actively in a busy 6 internist, 1 NP community-based practice located in Cherry Creek. The clinic is uniquely positioned as a CU School of Medicine clinic that is not located on the hospital campus. This clinic was in private practice until November 2015 when it joined CU. They have the benefit of running like a private practice, yet having the backing and resources of the University, including running Epic. They also have a case manager on site as part of the practice. Multiple opportunities to learn outpatient management, joint injections, skin biopsies, etc. Learn to code, refer, schedule testing, pre-authorize, use superbills, and understand the business of outpatient practice. Opportunity to participate in ongoing process improvement/PCMH meetings while at the clinic.
IM Clinic: "Engaging clinic with 3 providers who have been established in their area for over 20 years. Tremendous opportunity to practice clinic based procedures such as arthrocentesis, skin biopsies, joint injections, cryotherapy etc... The preceptors here are also especially helpful for anyone interested in the business aspect of medicine. They have experience running a for profit organization/small business that is also a part of a much larger ACO in the Denver area." Alejandr Mora, M.D., Class of 2017
Outpatinet Cariology at South Denver Cardiology - Only available to PC residents. This large general cardiology group allows you to tailor your time with them to your needs. You will spend time with the senior partners (many of whom are former UH faculty) seeing patients with them, but their first question to you is, "What do you want to get out of this time"? They are happy to let you spend time interpreting ECHOs, nuclear stress tests, seeing inpatient consults, or doing more treadmill tests. The partners are excellent general cardiologists who place an emphasis on CAD prevention (primary/secondary) and have a thriving cardiac rehab program.
We will make every attempt to accommodate educational requests and individualized learning objective during this elective. Clinic experiences can include: intake evaluations, common psychiatric diagnoses such as anxiety and mood disorders, addiction and substance abuse clinics, women’s health clinics, eating disorders clinics, geriatric clinics, and motivational interviewing. Internal medicine residents will get experience in diagnostic formulation, assessing for suicidality and violence, pharmacotherapy, and some basic principles of psychotherapy.
"In the primary care psychiatry rotation, I was able to spend time seeing patients with senior psychiatry residents and faculty, observing firsthand the types of patients who are referred to and followed by psychiatrists as well as learning management pearls directly from them. This was a valuable experience that improved my management of psychiatric patients in several specific ways, and was enjoyable as well. I highly recommend it!" Mark Learned, MD, class of 2012
The objective of participating in primary care research is to allow residents exposure to the process of conducting research while exploring issues that are relevant to them. As a secondary objective, we encourage presentation of research results at regional or national meetings as well as publication in a peer-reviewed journal.
See PC Research
Suggested objectives for the initial research month include: 1) Conduct complete literature review, 2) Develop research protocol study plan, 3) Confirm data sources, availability and reliability, 4) Develop study timeline. Objectives for subsequent research months are: 1) Conduct proposed study, 2) Data analysis (can include working with a statistical analyst) and interpretation, 3) Preparation of abstract/manuscript, 4) Preparation for abstract presentation at a meeting. Other objectives, including work on existing projects, will be reviewed on a case-by-case basis. Prior to beginning the research month, residents must identify a research mentor who will be able to work closely with them to achieve the above goals. Drs. Frank and Nicklas provide oversight to the research program and can assist in identifying research mentors, defining projects and obtaining research funding. They will also be available to provide study design and analytic advice. Once a research elective is scheduled, the resident must complete a short research elective application form that is signed by their mentor for review and approved by Dr. Frank or Dr. Nicklas at least 60 days prior to the rotation. This step is to ensure your research project is appropriate for a resident, including feasibility within the length of time available. We also want to ensure that any necessary regulatory requirements for the research are in place. It is always a good idea to also speak to other residents who have been involved in research about their experiences. Non-clinical
Residents may choose from a large number of rural clinical sites that incorporate both inpatient and outpatient medicine. Most of these sites qualify for loan repayment and are looking for new internists to join their group.
For rural in Colorado, we have funds to support traveling to the site, housing service is available thru the Colorado AHEC (area health center) Office.
"My elective with Montrose was one of the best months of my residency. I was able to practice the full scope of internal medicine from the clinic to the internal medicine wards and ICU. I also did stress tests, medicine consults, and procedures important for internists. The providers in Montrose are some of the best around. Not only are they excellent clinicians, but they are leaders in the community. I was impressed with the high quality of care provided as well as the the seamless transitions between the hospital, clinics, and specialty providers. The Montrose medical community provides exceptionally patient-centered care and teamwork between other providers, nurses, and ancillary staff is the norm. Additionally, they are focused on improving health outcomes for the entire region which they do through a robust data infrastructure and their involvement in hospital and public health leadership. It was a great opportunity to work with and learn from the physicians in Montrose." Branden Comfort, MD, class of 2016
Residents learn about the health care system, participate in quality improvement projects and meet many of the people around town who make policy decisions. It will change the way you read the newspaper, watch the news, and interact with patients and multidisciplinary health care teams. This elective is well-suited for those who like topics such as understanding healthcare systems, what’s Medicare/Medicaid, who pays, how do you define “quality”, what is a quality improvement plan? The month is largely non-clinical in nature.
Available at Stout Street Clinic, Denver Health and Hospitals Clinics, Refugee Clinic, MCPN, Wheat Ridge Regional Center and others. Having the opportunity to spend a month at a single site will allow residents to experience the rewards of providing primary care to underserved populations. NOTE: Stout Street Clinic takes only 2nd and 3rd year residents. These sites will meet your preceptorship requirement in second year.
Refugee Health Preceptorship Dr. Jamaluddin Moloo: Global health - locally. The month is spent working at the Colorado Refugee Wellness Center and with a number of their partners. Refugees are a diverse group of patients with highly variable needs and customs. The rotation provides an opportunity to learn about refugees and refugee health; you will also have the opportunity to engage in a number of community based outreach activities.
“Rotating at Eastside Clinic was a fantastic opportunity that solidified my interest in primary care for the underserved. I met many patients who were obtaining medical care for the first time in several years and feel very grateful to have been involved in their care. The attendings were outstanding clinician-educators who are clearly passionate about their work and very committed to providing evidence-based care in a community setting. They also allowed me to tailor the rotation to reflect my interest in women's health. Throughout the month, I was able to participate in a Pap Clinic and Title X Family Planning Clinic. I was also able to refine my skills in several office-based procedures. I was very lucky to have had this rotation early on in intern year and look forward to working at Eastside Clinic in the future!” Andrea Ma, M.D., Class of 2017
"I was lucky to spend a complete month during my second year at Westside, the Denver Health community clinic where my continuity clinic is based. I really enjoyed building my patient panel, working closely with multiple attendings who love their careers and teaching residents, and getting a better sense of what a primary care career for an underserved population would entail. Additionally, I was able to spend time with the nurses at the clinic doing weight loss visits, a psychiatrist who treats difficult mental health cases within an integrated model, and an endocrinologist who assists with specialty care which gave me a broader sense of the clinic's activities." Mim Ari, M.D., Class of 2013
Iora: “Interesting take on the delivery of healthcare which will be interesting to anyone trying to see a different model of how primary care can be established. Very fast growing national business with a local feel inside each of their clinics. Small patient volume which gives you ample time to spend with each patient.” Alejandro Mora, M.D., Class of 2017
This elective provides residents exposure to several diverse outpatient clinical experiences including gestational diabetes, metabolic bone disease, breast and thyroid clinics, high risk OB, and pelvic pain clinics. Each schedule is crafted according to individual interest. All residents will gain exposure in the diagnosis and treatment of sexually transmitted infections, performance of well-woman examinations, contraception, treatment and management of abnormal pap smears, workup of abnormal and dysfunctional uterine bleeding, diagnosis and work-up of incontinence, including urodynamics, and hormone therapy counseling.
"This outstanding elective is individually designed to meet the educational goals of residents. After completing this elective, I am able to perform many gynecological procedures independently, including endometrial biopsies, IUD insertions, and biopsies. I am prepared to offer these services as a future primary care provider." Tierney Sparks, M.D., Class of 2013