Outpatient 4 week elective focused on learning the spectrum of care for patients with addiction. Based at Denver Health working with Methadone clinic, Outpatient Behavioral Health Services, primary care buprenorphine prescribing, certified addiction counselors, psychiatry and others. Protected time will be provided for 8 hour online X-waiver training, such that resident will be licensed to prescribe buprenorphine along with their DEA license upon graduation.  Skills that will be a focus of this rotation include

1) Identify risky substance use,

2) Recognizing and treating opioid addiction in patients with chronic pain,

3) Motivational interviewing as a tool for helping patients achieve healthy changes,

4) Harm reduction for all risk taking behaviors,

5) Prescribing for opioid addiction,

6) Prescribing for alcohol addiction,

7) Prescribing for nicotine addiction. 

100% Ambulatory.  Location: Denver Health (Main) and other community sites. Primary care residents will get priority

“In the addiction medicine elective I was able to work with providers at the leading edge of medicine to address one of our countries most significant new health problems. I was able to reflect on the medical and behavioral interventions that can take place in a primary care setting and to discover and observe the community resources available for the treatment of addiction. Finally, I was provided with the opportunity to deeply explore a clinical problem in the area of addiction, which allowed me to provide novel insights to the addiction providers in the Denver Health system. I appreciate that chance to master the tools and resources available to help our patients.” Joseph Boyle, MD, Class of 2019

Residents will work in a variety of outpatient endocrinology settings based in Denver Health’s urban safety net ambulatory care. Ability to work with faculty and interprofessional teams with a focus on endocrine/metabolic disorders ranging from diabetes, thyroid and parathyroid disorders, pituitary and adrenal disorders, bone mineral disease, and obesity. There will be significant focus on metabolic disorders, specifically, assessment, investigation, and management of diabetes. Residents will spend time in endocrinology consult clinic at the main Denver Health hospital as well as satellite community clinics within 20 minute drive of Denver Health campus (ability for own transportation recommended).  Residents will work closely with faculty as well as nurses/nutritionists to learn and be able to counsel patients in glucometer teaching, nutritional guidance, carbohydrate counting, and insulin pump management. They will have opportunity to spend time with the Denver Health Diabetes Prevention Program.  Great elective opportunity for residents with particular interest in managing chronic metabolic diseases in underserved populations and investigating resource access for vulnerable patients. Primary care residents will get priority.

PC Community Health month is a required rotation for our third year PC residents. Focus on the transitional care experience will allow residents to receive handoff from inpatient colleague on a patient who will then have a home visit by the PC Community Health Resident. This will include medicine reconciliation and feedback to inpatient resident on how patient's health is doing post discharge. Other rotational experiences will include subspecialty clinics (resident preferences for urology, ENT, ophthalmology, rheumatology, etc are considered when scheduling), DAWN student run free clinic, Physical therapy, and any other clinical experiences that will be of help to resident prior to residency completion.

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.

Focused clinical practice of orthopedic and sports medicine skills for primary care. Rotate through sports medicine, podiatry, and orthopedics to learn and practice advanced joint exams, joint injections as available, and approaches to common musculoskeletal problems. The rotation will focus on practicing initial diagnostic steps and determining when to refer to PT/OT, pain psychology when available, and/or surgical specialists. Additional half day experiences include learning stretches and exercises from PT clinic to better treat chronic MSK related issues. Primary care residents will get priority. Denver Health based rotation

Denver Health now offers two different settings for providing urgent care services. In both settings, there is a wide variety of cases in medicine, surgery, gynecology, orthopedics and other fields. This elective offers a unique experience that most internal medicine residents don’t get elsewhere in their training. The Adult Urgent Care Clinic is a busy urgent care center that works in conjunction with the Emergency Department to provide urgent care to adult patients. The Adult Urgent Care Clinic 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. Resident autonomy and independent decision-making are stressed. In both settings, you will see a broad spectrum of acute and sub-acute conditions that will present to your office as a practicing general internist, often requiring entirely 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 a complication of early pregnancy or treat a straightforward case of strep pharyngitis. Residents tell us our biggest strengths are our great staff, tremendously varied patient population and wide variety of medical conditions treated. The schedule of 40-45 hours per week will be primarily Monday through Friday business hours, but may include occasional evening or weekend shifts to ensure there are only one or two residents in the clinic at a time. Location: Denver Health Adult Urgent Care Clinic & The Southwest Family Health Center Urgent Care Clinic

 

*PC Selective (Required)

 

Improve your assessment, differential, diagnosis and treatment plan for skin lesions, rashes, and wounds. Residents will rotate in busy Dermatology clinics at VA and UCH. Rotation also aims to include experience at the Wound Clinic and Podiatry and Foot & Ankle Center at UCH for exposure to wounds and lower extremity skin conditions. Residents will attend dermatology program didactics as appropriate.

 

This elective is focused on teaching Internal Medicine residents the knowledge and skills to manage out-patient women’s health, family planning, and sexual health conditions. Residents will rotate at a variety of out-patient clinics where care is focused on family planning counseling and procedures (including IUDs and contraceptive implant placement and removal), vasectomy counseling and procedures, STD testing and treatment, preventive women’s health, and pre-pregnancy counseling. This rotation will also include didactics in topics related to women’s health. Available to PC only.

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.

 

This rotation will need to be taken in combination with another elective to complete block scheduling needs.

Outpatient 4 week elective offered for those who wish to learn chronic care of HIV-infected individuals and the significant issues of underserved populations that can affect HIV care. Elective content will be based on the areas of HIV, substance abuse, hepatitis C and the social determinants that shape their health outcomes. Clinical sites will include HIV and infectious disease clinics across Denver, substance abuse clinics (with education with medication-assisted treatment such as methadone and suboxone), HIV testing community sites, correctional care facilities, and harm reduction enter to name a few. Didactics, case discussions, and journal clubs will also be incorporated into this diverse clinical experience. With completion of the elective, residents will have 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 longitudinal program. Priority will be given to second year primary care residents. Location: Denver Health (Main) and other community sites.

“​The HIV and Underserved Care rotation is a unique experience available to primary care residents. While there is still plenty of clinic to attend during the month, the rotation is special in that it takes a more holistic approach to barriers to health care. As a resident, you are able to see what life is like on a day to day basis for many of our patients through working at a Harm Reduction Action Center or doing free STI checking at one of the local clinics. Having already wanted to do the HIV track prior to this elective, I was only more sold after the rotation. In addition to some of the more unique experiences above, the HIV providers that are paired with residents on the elective are fantastic, dedicating plenty of their time to teaching. There are also scheduled didactic sessions that added plenty of useful information. If you think you might be at all interested in HIV medicine, I would highly recommend this elective. Even if HIV medicine turns out to not be for you, this rotation gives a different perspective to the people we see every day, and ultimately was a very special experience for me.” Matt Welzenbach, MD, Class of 2019

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

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

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. Dr Nicklas provides 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. 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.

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, Dr. Ted Parks, frequent presenter at Annual College of Physicians and guest expert on podcast The Curbsiders. Residents will master joint exam skills and injection techniques. A half to one day Sports Medicine Clinic will be included. Available to primary care residents only.

"Working with Dr. Parks in orthopedics was an incredibly valuable experience! Heading into geriatric primary care following residency, one the techniques I’d hoped to master was joint injections. During this rotation, you get plenty of exposure to various knee, hip, and shoulder injections. One of the unique aspects of working with Dr. Parks is you actually go into the OR with him on some days. As a medicine resident, I never expected to see the inside of an OR again, but was surprised at how beneficial these days were in helping me to improve my joint injection skills! Dr. Parks allows you to perform a knee joint injection immediately prior to starting the surgery; this gives you the opportunity to see exactly where the needle is going in relation to the specific anatomy and is an experience you won’t get on any other rotation. Dr. Parks is also incredibly open to teaching and letting you practice your skills, even on his busiest days. I’ve performed numerous injections on my own since doing this rotation and would recommend it to anyone hoping to master the joint exam and joint injections, especially those headed into primary care." Rebecca Kant, D.O. Class of 2018

Outpatient Cardiology at South Denver Cardiology - 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. Only available to PC residents

Internal Medicine Clinic (Private practice)- 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 super bills 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. Main office in Centennial

Rose - Busy private practice with former CU grads at Rose with the possibility of doing some treadmills during the month as well.

Kaiser - See Kaiser Rotations. See what care is like in Kaiser Health System.

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

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 had the opportunity to work with senior psychiatry residents and faculty in a variety of settings: Integrated Behavioral Health, Adult Outpatient Behavioral Health, Inpatient Psychiatry Consults, Psychiatric ED, and the Women's Health Care clinic. I spent the rotation observing and practicing my skills with experienced clinicians in the management of both common and uncommon psychiatric disorders that I will encounter in any medical setting. Through this rotation, I gained valuable experience and expanded my abilities and confidence to provide mental health care for patients in my future role as a Primary Care physician. I would highly recommend this rotation!" Michael Pham, MD, class of 2021

 

Refugee Health Preceptorship: Dr. Jamaluddin Moloo: Global health - locally. 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.

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 through 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.

Priority to upper level PC and HTT residents. Transitions of care are vulnerable times for our patients due to changes in location of care as well as the corresponding care providers. This elective is designed for residents interested in careers in general internal medicine, hospital medicine, primary care as well as subspecialties that have a large inpatient practice such as cardiology, pulmonology, oncology, GI and nephrology. This elective provides a mixture of clinical and didactic learning. The focus will be on the care for medically complex “super utilizers” in the Intensive Outpatient Clinic and on patients being discharged from Denver Health in a newly created DH post-discharge clinic. There will be options to tailor additional experiences to the resident’s interests (e.g. home visits, medical respite and Healthy Hearts Clinic). Given this rotation is based at Denver Health, there will also be an education component that focuses on transitions of care for the underserved. The didactic components will include topics such as readmission risk assessment, interventions and bundles aimed at reducing readmissions, disease states that have been targeted, optimal communication around discharge, how to improve hospital-primary care relationship and physician satisfaction, as well as optimal opioid prescribing during the transitions period. Residents interested in procedures will also have the opportunity to perform procedures in the post-discharge clinic and IOC. Residents will have ample time for self-directed learning as well as opportunities for career mentorship in general internal medicine. There is no weekend or evening call on this rotation.

“The TOC elective is an awesome mix of experiences that allowed me to take a larger view of how the Denver Health system operates, specifically hospital transitions and where patients might fall through the gaps. The hospital discharge clinic provides plenty of experience with acute hospital follow up, while the intensive outpatient clinic offers a view into the model of ambulatory ICU care for our highest utilization patients. The elective’s focus on quality improvement provides ample opportunity to find mentors and to make a difference in how our system functions." Conor Grogan, M.D., Class of 2021

Available at Stout Street Clinic, Denver Health and Hospitals Clinics, Iora-Aurora, Refugee Health, MCPN, 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.

Denver Health Eastside Clinic: "I was very fortunate to rotate at Eastside during the early part of intern year. While the socioeconomic status of the patients provided its own set of unique challenges - it was accompanied by patient's strong sense of gratitude for the care I was providing them. Prior to rotating at Eastside, I often found myself wondering how much of a difference I was really making in patients' lives, since I was "just" an intern. After rotating there, it is clear to see that even as an intern you have a tremendous opportunity to positively impact lives. It was extremely rewarding working with a patient population who had such a clear need, and were so grateful for the care they received. Additionally, the faculty are tremendous as they are very thoughtful, friendly, and knowledgeable clinicians." Scott Kirkpatrick, MD, class of 2021

Iora (Medicare Advantage): “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.

 

*PC Selective (required) in combination with Neurology requirement