Structure of the Med-Peds Program at Rush

How many Med-Peds-trained faculty are there at Rush?
Currently, there are eight Med-Peds-trained physicians on the Rush faculty. These include Drs. Stephanie Luther, Terry Lynch, Mona Mehrotra, Jeremy Pripstein, and Keith Boyd. Dr. Levy, an endocrinologist with a combined Med-Peds practice, Drs. Randy McConnie and Richard Sandler, gastroenterologist; and Dr. James McAuley, an infectious disease specialist.

How often do residents switch between departments?
Typically, our residents switch between the two parent departments every three months. Although there are advantages and disadvantages to longer periods between these switches, we feel the 3-month period keeps residents well-connected to the two parent departments. The first switch is always a bit tough, no matter when it occurs, so the program administration tries to provide additional support at this time. As residents progress in their training, these switches become more and more routine. It's important to remember that the division between pediatrics and internal medicine is artificial. Eventually, as a Med-Peds practitioner, you will "switch" from one moment to the next and the division between the two will disappear. You see this in your continuity sessions at Lifetime Medical Associates where you will care for patients of all ages in the same day, often seeing whole families.

How long is the Rush Med-Peds internship?
Our curriculum includes nine rotations at the intern level (two inpatient pediatrics, two inpatient medicine, one NICU, one general care nursery, one CCU, one MICU, and one at Lifetime Medical Associates). Most Rush Med-Peds interns do not complete all of these rotations until early in their second year of training; often one of the intensive care unit rotations is left for the second year. All Med-Peds rotations are in full compliance with the ACGME 80-hour work week requirement.

How much time do residents spend in the outpatient setting?
Much of the Rush curriculum is outpatient based. Many electives are entirely outpatient or include significant outpatient experiences. Most importantly, the curriculum includes seven full-time rotations at Lifetime Medical Associates. This allows our residents to focus on the development of their own patient practice, as well as other activities important to the practice of outpatient medicine and pediatrics.

Does Rush offer combined Med-Peds and international electives?
Rush offers a number of combined Med-Peds electives. Almost any elective can be combined although some fields are more amenable to combination than others. Although electives away from the institution are becoming harder to justify due to the federal government's reduction in Medicare funding for residency training, the Med-Peds program considers all resident requests for away electives and Rush allows each resident to take one elective at an unaffiliated site.

How often do residents take in-training examinations?
Rush Med-Peds residents take the Pediatric In-training Exam every year and the Medicine In-training Exam in years three and four of their residency.

Is there a board review course?
The Department of Medicine sponsors a board review course every spring on Friday afternoons. The Department of Pediatrics also has a monthly board review series. Board review packets are provided for residents to complete during the LMA rotation. In addition, the senior med-peds residents are encouraged to form a study group every year to prepare for the board exams. The best way to prepare for the board exams is to establish good reading habits early in your residency, driven by patient care and clinical questions.

Are there any meetings solely for Med-Peds residents?
The following meetings are unique to the Med-Peds program.

1. Med-peds Ambulatory Care Conference (MPACC)
   This conference occurs daily at LMA before continuity practice.
2. Med-peds monthly meeting
   This informal meeting is an opportunity for Med-Peds residents to gather for lunch with the program administration to problem-solve and exchange new ideas .
3. Rush Med-peds Steering Committee
   This committee meets quarterly to direct the residency program, from curriculum to educational activities, to the function of the outpatient practice.
4. Med-peds Dinner Club
   This is strictly a social gathering after work. Once a month a Med-Peds resident chooses his/her favorite inexpensive, ethnic restaurant for a group dinner; friends, family members, spouses, and significant others are always welcome, too.

What is MPACC?
Every weekday, before continuity sessions, residents who are seeing patients at LMA gather with their preceptor for the Med-Peds Ambulatory Care Conference (MPACC). This conference, led by a designated resident, is a case-based discussion of the most common problems encountered in ambulatory medicine and pediatrics.

Does the program pay for any conferences?
Rush pays the cost of all resident certifications and recertifications including BLS, ACLS, PALS, and NRP. Each year every Rush employee, including residents and attendings, is given an educational enhancement bank of $1000 towards the registration cost of conferences and classes offered at Rush and elsewhere.

Lifetime Medical Associates

Is Lifetime Medical Associates balanced between internal medicine and pediatrics?
Most combined Med-Peds practices have difficulty maintaining their pediatric populations for a variety of reasons. Lifetime Medical Associates (LMA) has not had this problem largely due to the relative abundance of pediatric patients in the Rush system. The patient population at Lifetime Medical Associates is well balanced between internal medicine and pediatrics.

When do residents go to LMA?
Med-Peds residents have office hours at LMA every week. Each resident is assigned to a specific session so that each afternoon at LMA includes one resident at each level of training. Beginning the first week of internship and continuing through the four years of residency, each resident has office hours the same day of the week regardless of rotation.

What do residents do for the LMA rotation?
Residents assigned to the LMA rotation spend the entire rotation in our office involved in a variety of activities including expansion of their continuity practice, urgent care for their colleagues' patients, ambulatory care quality management, telephone triage, completion of board review packets, chart audits, preparation of MPACC material, and general office operations.

How are patients recruited to LMA?
LMA sees large numbers of new patients. These patients come to us from a variety of sources. Many of our new patients are referred by our current patients. Others come to us through the Rush PHO (Physician Hospital Organization) Rush sub-specialists, our residents, and other sources. In addition, the Rush Graduate Medical Education office often refers incoming residents and fellows in need of a physician to LMA. LMA is the medical provider for Rush medical students. The Student Health Program at Lifetime Medical Associates gives Rush Med-Peds residents the opportunity to care for Rush medical students in a variety of capacities including primary care.

Who covers LMA night call?
The two residents doing the LMA rotation split coverage of the LMA night call. A member of the Med-Peds faculty always provides supervision. Management of after-hours calls is a very important skill to learn during residency.

Will I do procedures at LMA?
The outpatient procedures commonly done at LMA include joint aspirations and injections, removal of minor skin lesions, pelvic exams, incision and drainage of abscesses, suturing lacerations, wart removal and others.

Are there options to do flexible sigmoidoscopy?
Dr. McConnie, a Med-Peds-trained gastroenterologist who sees patients at LMA, has flex-sig sessions in the endoscopy suite. Through this experience, residents have the opportunity to be certified in flexible sigmoidoscopy.

Do residents get experience in practice management?
Because LMA is a fundamental feature of the Rush Med-Peds training, residents receive extensive experience in medical office management. LMA is a small group practice in which the residents are treated as partners. Residents attend and participate in quality improvement, staff meetings and other work groups integral to the operation of a medical practice.

Residency at Rush

What are the social, cultural, economic and racial make-ups of patients at Rush?
Like Chicago, our patient population is a diverse mix of individuals and families. Rush is located just west of downtown Chicago. Our patients are from downtown, our local community and the suburbs, as well as from around the state.

What is the payer mix at Rush?
Rush has a diverse payer mix. Residents care for patients from various backgrounds in both the outpatient and inpatient settings. At Lifetime Medical Associates, residents see the entire spectrum of insurance plans including commercial insurance, HMO and PPO plans, government-supported plans and self-paying patients.

Does Rush have an advisor system?
Every incoming intern is assigned a resident "big brother" or "big sister." In addition, Rush Med-Peds residents select a faculty advisor.

Outstanding Pediatric Intern 2006-2007 Temitope Oyedele

How are residents evaluated?
After every rotation, residents are evaluated by students, peers and faculty supervisors. In addition, the Med-Peds faculty completes an annual summary evaluation. Each Med-Peds resident also experiences an annual 360° evaluation where peers, LMA staff, students, and patients are part of a written evaluation process.

Can residents participate in research?
Although resident participation in research is not a requirement of the Rush med-peds program, many opportunities exist for the interested resident to become involved in research -- either in a block of concentrated experience in a faculty project or by developing original research that may continue over months or years.

Inpatient Rotations at Rush

Who admits patients to Rush?
Every patient admitted to Rush has an assigned attending physician who is ultimately responsible for the patient's medical care. An intern will have contact with a mixture of physicians who are responsible for the care of their patients. Residents benefit from exposure to different management styles of the attending physicians responsible for the care of their patients.

What is Rush Children's Hospital?
The State of Illinois has designated Rush as an officially recognized Children’s Hospital. Rush pediatricians, surgeons, nurses, and other health professionals address the full range of pediatric diseases and congenital problems from the common to the complex. Physicians from more than 30 specialties provide care that aims to fulfill community needs, empower parents, and patients, and advance medical science.

Do residents follow their own patients when they are hospitalized?
Residents follow their patients who are hospitalized if their schedules allow it. As the primary physician for the patient, the resident has the opportunity to direct inpatient care when an LMA patient is hospitalized (although one of our Med-Peds faculty is always the attending of record).

Rush and the Illinois Medical District

What is the relationship between John H. Stroger Jr. Hospital of Cook County and Rush?
Ten years ago, Rush and Stroger Hospital signed an affiliation agreement, which has been a great success. Programs at the two institutions have benefited from the relationship. Some sections are fully integrated between the two institutions. Rush residents spend some time at Stroger Hospital as part of their training. A handful of rotations are based at Stroger Hospital and some elective rotations with integrated departments include time spent in Stroger Hospital subspecialty clinics. The residency program at the two institutions remain independent.