VA Rotations
The West Roxbury VA (aka West Rox) is one of the strengths of our program. Rotating at the VA gives you the opportunity to care for an entirely different patient population and to work with other residents in the Boston area. We have several rotations at the VA including the general wards, medical ICU, cardiology, and nightfloat. At any given time, there are approximately 6 interns and 4 residents from BIDMC rotating at the VA. Most interns are at the VA for 1-2 rotations over the course of the year whereas residents generally have one rotation every year. Rotations at West Rox are shared between the housestaff from BIDMC, Boston Medical Center, and Brigham and Women's Hospital, which gives you the opportunity to learn different practice styles and meet new people.
The General Medicine rotation is full of bread and butter cases (COPD, renal failure, end-stage liver disease, GI bleeds) but also plenty of patients with alcohol withdrawal, psychiatric comorbidities, and spinal cord injuries. Generally, housestaff have much more autonomy at the VA. Interns and residents do more procedures, occasionally perform lab draws, and make more independent decisions regarding acute management given the structure of rotations at the VA. The volume of patients is generally higher than at BIDMC but the turnover is often slower. Long call is every fourth night until 9pm (cap of 6 patients per intern). Short call admits until noon (cap at 2 patients per intern). Conferences occur throughout the day and you even have weekly barbeques in the summertime.
One BI intern will have nightfloat at the VA for one to two weeks at a time. The nightfloat cross-covers patients from the medical and cardiology services with a senior resident there for assistance as necessary.
The Cardiology Service is quite popular. The West Rox is a cardiology referral center for most of New England. Most of the attendings are excellent teachers and are considered favorites among the housestaff. You feel like a full-fledged cardiologist when the attending asks you if you want to take someone to cardiac catheterization, perform a stress test, or discharge for outpatient workup. It is rewarding to make these initial assessments and you feel like an integral member of the team. The CCU is now an open ICU so this allows the team to participate in the care of a cardiology patient throughout their entire hospital course. This rotation involves overnight call every fourth night but the volume tends to be less than on the general wards.
The Medical ICU is a terrific learning experience. There is one BI intern working with interns and residents from BMC and BWH; call is overnight every third night. The volume and acuity are generally less than at the BIDMC but there is certainly more autonomy. Generally, the attending rounds with the team and teaches until the early afternoon. Thereafter, the resident and intern on-call perform all MICU evaluations and do all necessary procedures. You quickly learn how to acutely manage sick patients and have many opportunities to improve your procedural skills.
All together, the West Roxbury VA offers much to our training program. The patients are grateful for their care and the learning opportunities are abundant.
