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

"During my time on the Denver Health addiction consult service, I was able to see a wide range of presentations of substance use including acute overdose, withdrawal, and chronic use impacting other medical comorbidities and psychiatric diagnoses. I was given the autonomy to see multiple new consults per day if I wished as well as follow up and build rapport with existing patients. I was able to work with incarcerated individuals and see the barriers to care that they face, particularly in transitioning out of the hospital. I also received didactics and chalk talks in a variety of topics taught by internal medicine and psychiatry attendings as well as the addiction medicine fellows. My favorite part of the rotation was hearing from the patients’ lived experiences with substances and receiving their advice – to listen nonjudgmentally and advocate for them whenever possible. This 2-week experience was so impactful that it changed my career path and led me to shadow outpatient addiction medicine providers at various Denver Health clinics, attend addiction-related national conferences, and apply for fellowship training." Nat deQuillfeldt, MD, MA class of 2024

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.

"The Denver Health endocrine elective is an amazing opportunity to explore the intersection of hormones with primary care. I enjoyed learning about managing diabetes technologies, hyperthyroidism, thyroid nodules, osteoporosis, resistant hypertension, adrenal nodules, hypogonadism, and more. You can customize your schedule to learn about diabetes technologies with the diabetes educator. I utilized my self-directed research time to spearhead quantitative and qualitative studies examining the benefits of continuous glucose monitors to tackle disparities in diabetes outcomes." (doi.org/10.1210/jendso/bvae125 and doi.org/10.2337/dc22-1287). Kevin Ni, MD, PhD, class of 2024

Residents will rotate through the Denver Health safety net specialty practice as well as at a private practice cardiology center (South Denver Cardiology). Work with general cardiologists to improve knowledge and treatment on hypertension, hyperlipidemia, coronary artery disease, and more. There is emphasis on CAD prevention (primary/secondary) and understanding evaluation and referral to cardiology. During this rotation you may spend time interpreting echocardiograms, treadmill and nuclear stress tests, seeing inpatient consults as they prepare to discharge, or with cardiac rehab. Only available to PC residents

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 do not 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 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.

Improve your assessment, differential, diagnosis and treatment plan for skin lesions, rashes, and wounds. Understand when dermatologic referral is necessary and recognize dermatologic emergencies. Residents will rotate at multiple Kaiser dermatology sites and work 1:1 with a board-certified dermatologist. Gain knowledge of common dermatologic conditions and how to diagnose and treat them. Residents will perform minor dermatologic procedures and become familiar with techniques for shave, punch, suture, and simple excisional biopsies. 

 

 

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 elective was a pivotal part of my residency experience. It epitomized what it means to meet patients where they are at while providing evidence based, excellent care. I worked in a primary-care based HIV clinic with multiple doctors who specialize in both general internal medicine and HIV, and witnessed what it looks like to build relationships with patients living with HIV while providing the full spectrum of primary care. I also saw patients in the infectious disease clinic, the STI clinic, and in the county jail. The elective motivated me to become an HIV specialist in my future role as a primary care attending, and I am carrying its lessons with me in New York City!" Nathan Rockey, MD, class of 2024

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.

"The Indian Health elective was unique because you were able to really see what it was like to live on a reservation and serve the Navajo Nation Native American population. Living close to the clinic/hospital where most of the attendings lived was very special and allowed us to socialize and find out more information of what it is like working there long term for the attendings. At Chinle specifically, there are other residents from University of Pittsburgh who I ended up becoming great friends with and still keep in touch with, which was an added bonus! This elective was very flexible in allowing you to do whatever you enjoyed the most. Clinic, ER or hospital medicine etc. Another great part of Chinle was the proximity to the National Parks and beautiful nature. This elective was helpful for my future career because it allowed me to work with attendings who told me the ups and downs of working with Indian Health and how it was overall completely worth it. Additionally, I got a little practice working with medical conditions that were common at Chinle Indian Health, which turns out to be common where I work today (Cherokee Nation). I'm so glad I did the elective, it ended up being one of my favorite experiences in residency." Anna Samuel, MD, class of 2023

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.

"I really enjoyed the broad exposure and experience in orthopedics, PMR, neurosurgery and even physical therapy. Really helpful to be in these clinics where we often refer our patients to and see what the next step in the process is. Lots of procedural training. Some of the best parts of this elective were learning ultrasound guided shoulder and hip injections and learning about the variety of treatments that are offered by physical therapy. By the end of the elective I felt comfortable with MSK joint exams and improved my procedural skills. I would like procedures to be a significant part of my future career/practice and after this month, I feel much more comfortable with knee and shoulder injections." Sanjna Vinze, MD, class of 2026

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

"I spent 4 weeks rotating with the Inpatient Palliative Care team. While we interact with the Palliative care team frequently on the inpatient side, this elective gave me the chance to see how it works "from the inside". Our palliative care team has a robust interdisciplinary team including physicians, NPs, social workers, chaplains, art therapy who have tons of experience working together. This teamwork is impressive to see in action, observing their nonverbal cues and how they explore difficult situations with patients. While much of inpatient consults revolve around goals of care discussions, you will also learn plenty about management of cancer-related pain and symptomatic treatments at the end of life. Every palliative care program is different, so being able to see their practiced style is helpful to learning how a well-functioning palliative care team can work. This elective has helped me feel more comfortable with each of the aspects mentioned, and has helped set the basis for my upcoming fellowship year in palliative care." Troy Sterling, MD, class of 2025

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.

PC Immersive is an individualized 2 week experience for R3s, planned in collaboration with the resident and PC Program Director. Using resident preferences and goals, a schedule is built with focus on career preparation, additional general and specialty clinic experiences, scholarly works in progress, and more. Aim is for these experiences to best prepare our primary care residents for their post-residency next steps and anchor primary care core foundations for a sustainable career in primary care or primary care specialties. These 2 weeks of PC Immersive  are accompanied by 1 week of Physical Medicine and Rehabilitation as well as 1 week of Home Based Care Visits with a VA Geriatrician and interdisciplinary team.

An excellent opportunity to participate actively in a busy 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 become accustomed to private practice care and management.

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

 

This elective is focused for residents who wish to develop experience working with patients whose health is greatly affected by their refugee status including but not limited to: unique cultures, personal histories, social circumstances, and legal circumstances. Residents will learn to effectively use an interpreter, how to culturally negotiate clinical encounters, how to incorporate the patient’s unique life circumstance into their clinical encounters, and how to utilize local resources, organizations, and clinics to advocate for refugee patients’ medical care. Residents will spend time doing evaluations at the Denver Health Lowry Refugee Clinic, working with a community organization the Spring Institute, observing at the Human Rights Clinic and/or spending time with the Rocky Mountain Immigrant Advocacy network team.

 

In this elective, residents will be able to care for patients in a rural community and may choose from inpatient, outpatient, and emergency/urgent care experiences, as available at each site. Emphasis is placed on the rural physician’s roles and responsibilities to diagnose, treat, and manage most health problems on a continuing basis while utilizing the health care resources of the community. We have established Colorado rural clinic sites for resident opportunities through our CU Primary Care Track Alumni network. Out-of-state rural clinic settings may also be considered, as long as meeting elective and program requirements. Overall, additional aims of experiencing the gratification of being a rural physician in the hopes to further advance the rural physician workforce are also targeted. We also have funding sources for coverage of travel/housing at in-state practices, as available.

"I rotated in a rural primary care clinic in Montrose, CO at the end of my 2^nd year of residency. In many academic training programs, we practice in tertiary care centers with nearby subspecialists which is a wonderful resource, but this rural experience highlights the wonderful aspects of community medicine: practicing a broader scope of outpatient medicine, building tight-knit community relationships, and spanning multiple care settings from clinic, acute care, to critical care (sometimes all in the same day). The community of Montrose offered incredible outdoor opportunities (running along the river trail, mountain biking, hiking in Telluride and Ouray) as well as homey restaurants and breweries. I could go on..." Cara Saxon, MD, class of 2022

The intricacies of the health care system are important for any physician to learn, particularly those who are interested in leadership and innovative solutions to improve health care delivery. In this elective, residents will aim to understand different health care systems, participate in high level medical decision meetings, and meet many of the people around Denver/Aurora who make policy decisions. Designed to give residents a glimpse “behind the curtain” of how the health systems around us are driven, financed, operated, and managed, this didactic and networking heavy elective will help residents in understanding many of the healthcare systems in which they train.

"I think this was one of the most valuable experiences in my medical education because it allowed me to not only learn about hospital systems, insurances, policies, etc. but also to have very valuable 1:1 mentoring time with executive officers and other leaders in the field locally. The resources put together by Dr. Elwell were high yield and interesting and I enjoyed the time with COPIC, the FM residency, infection prevention team, etc. Each experience felt specifically curated for our education and well worth the time. I also found it valuable to do this rotation with a prelim who was more business-minded and had a different background and goals from myself because we each asked unique questions that allowed each of us to learn from our variable perspectives." Nat deQuillfeldt, MD, MPH, class of 2024

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 was a great learning experience overall with good exposure to a variety of conditions. The majority of visits are post-hospital follow-ups and PCP visits for patients with complex medical and social needs. You also get a couple of sessions with the wound care NP, which is a great opportunity to learn hands-on skills we rarely get to learn, including practicing wound debridement (if desired - you can also just observe). The visits are a bit longer than many clinics we work in, so you have more time with patients and less patients you're expected to see per session (at least this was true for me early in intern year). You'll walk away with practical tips including ways to help patients without insurance, patients who recently immigrated here, and patients experiencing homelessness." Keren Blackman, MD, class of 2027

During this elective, residents will gain experience of care of patients in the urban underserved setting found in and around Denver, Colorado. Residents will have the choice of clinical setting (as available) to learn care of patients in a resource limited, diverse setting.  Site choices include: Colorado Coalition for the Homeless, Spring Institute (Refugee care), or Denver Health Internal Medicine Clinics (Federally Qualified Health Centers).

Colorado Coalition for the Homeless: "One of the many reasons I loved the primary care track is that we had the flexibility and support to adapt our educational experiences to meet our specific career goals. I wanted to do healthcare for the homeless and even though an elective in this didn't exist (and it was in the midst of the COVID pandemic), our program created one for me (and residents after) with Colorado Coalition for the Homeless. Further, I had the ability to choose to work in diverse settings from traditional clinic environments doing primary care and substance use disorder treatment to urgent care in shelters to the "COVID hotels" where people experiencing homelessness with COVID illness isolated and received outpatient treatment. It was an exceptional experience that exposed me to broad scope of what primary care can look like and was pivotal in developing my current clinical work with patients experience homelessness and community health research around homelessness." Emily Scott, MD, MPH, class of 2022

 

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