Department of Medicine Subspecialty Divisions

The divisions of the Department of Medicine provide a wide range of clinical services including primary, secondary, and tertiary care. All have active referral clinical practices in addition to inpatient University hospital-based consultation services. Referrals consist of consultations from the community as well as tertiary referrals from all over the world. Residents receive excellent subspecialty education from leaders in their respective fields. There is well-established collaboration between basic and clinical research throughout the Department. Fellows and residents participate in projects in nearly every division in addition to actively participating in inpatient and ambulatory consultation services.

Clinical Divisions of the Department of Medicine:

• Cardiology
• Clinical Pharmacology
• Dermatology
• Endocrinology and Metabolism
• Gastroenterology
• General Internal Medicine
• Hematology/Oncology
• Infectious Diseases
• Nephrology and Hypertension
• Pulmonary, Critical Care and Sleep Medicine
  
• Rheumatology, Immunology, & Allergy

Each of these clinical divisions are described below:

Division of Cardiology
Cardiology and all its subspecialties have a long tradition at Georgetown. The Medical Center, along with our partner institution at Washington Hospital Center, participates in all aspects of modern cardiology and acute cardiac care. Diagnostic angiography, Echocardiography, Cardiology consultation services and Cardiac Nuclear imaging are complemented by our interventional services, performed at WHC, with Georgetown fellows and residents as part of the educational mix at both sites. The Division conducts a comprehensive conference series, including conferences on core curriculum topics, ECG/arrhythmia, cardiac pathology, clinical auscultation, cardiac radiology, and echocardiography.

Division of Clinical Pharmacology
Georgetown is currently one of only ten NIH-sponsored clinical pharmacology training programs in the nation, offering a two-year training program for physicians who have completed board eligibility requirements in Internal Medicine and plan a career in academic medicine and/or research. Residents are exposed to the division through clinical pharmacology fellows who round regularly with the Cardiology and Hematology/Oncology inpatient services. In addition, division faculty members have organized a course in critical literature review and will initiate a quarterly new drug conference this year.

Clinical research projects are usually conducted in the Clinical Research Center and often involve drugs at the earliest stages of development. Ongoing collaborative research with investigators in Cardiology, Infectious Diseases, Nephrology, Hematology/Oncology, and Rheumatology/ Immunology make it possible to conduct research in specific patient populations. The fellowship training experience, tailored to the background and future needs of the fellow, generally consists of basic or clinical research conducted under the mentorship of division faculty. Graduate level courses in advanced pharmacology, drug metabolism, pharmacokinetics, receptor mechanisms, molecular pharmacology techniques, and biostatistics are available to supplement training.

The division maintains a close relationship with the FDA, including a jointly sponsored training program available to those specifically interested in clinical pharmacology and regulatory medicine.

Division of Dermatology
The Residents first meet with the Division of Dermatology during the ambulatory curriculum of the first year. The growing division provides a busy primary, secondary, and tertiary referral service for diseases of the skin. Residents are challenged to find patients with interesting skin lesions for weekly "Derm Rounds," which includes not only other residents on elective, but also interested house staff from other services as well. Teaching is enhanced by faculty with board certification in dermopathology as well as dermatology.

Division of Endocrinology and Metabolism
Residents interact with the Division of Endocrinology and Metabolism on the inpatient consultation service as well as in the ambulatory clinics. The programs two hospitals, Georgetown and Washington Hospital Center, boast national leaders in thyroidology and sodium metabolism as well as diabetes management and general endocrinology. Members of the division are closely involved with resident education throughout the program. The division treats a wide variety of endocrine and metabolic diseases, offering inpatient and outpatient services for diabetic patients through the Georgetown Diabetes Center as well as a busy outpatient consultation service. The Endocrinology Fellowship is a two year program with an optional third research year offering extensive exposure to all aspects of clinical endocrinology. In addition to the Georgetown inpatient and outpatient services and WHC, fellows rotate through the Endocrinology ward at the National Institutes of Health with optional rotations with the Pediatric Endocrinology services at Georgetown.

Division of Gastroenterology
Residents interact with the Division of Gastroenterology both at Georgetown and at the VAMC on the consultation services, in the emergency lecture series, and on a popular elective. The Division of Gastroenterology is specifically oriented towards consultative services ranging from diagnosis to interventional endoscopy. The faculty is internationally recognized for expertise in gastrointestinal malignancies and hepatitis C, as well as inflammatory bowel disease; most serve in editorial and leadership positions in national and international gastroenterology organizations. All recognized gastrointestinal procedures and techniques are offered by the division, and residents become proficient in the selection and interpretation of invasive and endoscopic procedures. The division, in conjunction with the VAMC, offers a three-year fellowship program that includes training in ERCP with papillotomy, advanced laser endoscopy, and EUS.

Division of General Internal Medicine
The Division of General Internal Medicine (GIM) was established in 1979 to meet the expanding interest in generalist education and the need for training in ambulatory care. The division includes a general internal medicine practice, an active consultation service (including inpatient consultation to all specialties as well as a busy outpatient pre-operative service) , a geriatrics section which provides care at area nursing homes, a clinical bioethics service, and several faculty hospitalists. Most medical residents have continuity clinic in GIM, which averages 24,000 outpatient visits per year. Residents develop a personal practice during block rotations and weekly afternoon continuity practice sessions. During block rotations, there is a core curriculum for management of common ambulatory care problems, and in consultative medicine, which includes an active inpatient consultation service and outpatient peri-operative consultations.

Division of Hematology/Oncology
The Division of Hematology/Oncology offers training in malignant disorders and hematologic diseases to students, residents, and fellows. Oncology patients are are staffed by the general medical teams, with the exception of chemotherapy patients, who are staffed specifically by a Hematology fellow or a separate Oncology fellow along with the attending. The Oncology inpatient service provides comprehensive training in the management of solid tumors including chemotherapy. In similar fashion, the Hematology service provides comprehensive training in the management of hematologic malignancies. In addition, an elective month on the Hematology consultation service provides exposure to the spectrum of non-malignant hematologic disorders.

In addition, there is an outstanding elective rotation in the outpatient department of the Lombardi Cancer Center.

The Hematology/Oncology Division is an integral component of the Lombardi Cancer Center and offers fellowship training in Medical Oncology, in Hematology, as well as dual certification after a joint three year program. The fellowship provides comprehensive training in clinical care and in clinical/basic research. During the second year, fellows have elective time and initiate a comprehensive research project in either the lab or the Developmental Therapeutics Program.

Residents interested in basic science research can choose the clinical investigator track or reserve time in their senior year for work in one of Lombardi's laboratories. The Lombardi Cancer Center is one of the National Cancer Institute's designated Comprehensive Cancer Centers. An internationally recognized research center for breast cancer, the Center is nationally known for its trans-national investigators, whose research focuses on tumor cell and molecular biology, anti-angiogenesis, drug development, tumor metastasis, and molecular genetics.

Division of Infectious Diseases
The Division of Infectious Diseases includes faculty with a broad range of interests and an active clinical investigation program at both Georgetown and the Veterans Affairs Medical Center. Residents frequently interact with faculty and fellows from this division in a busy consultation service. Didactic sessions include lectures on infectious disease emergencies and a weekly lunch conference. The division offers a fellowship training program in the clinical management of infectious diseases. Fellows have been integrated into the program's research activities in the AIDS Clinical Trial Unit (ACTU). The Division has initiated an ambulatory curriculum for Medicine residents in the management of HIV-related disease, including a core curriculum of lectures, the management of ambulatory HIV patients within General Internal Medicine, involvement in enrolling patients in clinical trials, and participation in a large, multi-disciplinary evening clinic within the Department.

Division of Nephrology and Hypertension
Faculty from this division are involved with the residency program at all levels. Residents receive core lectures in renal diseases and interact frequently with the busy inpatient consultation service. Post-transplant patients are seen regularly as are patients suffering from renal failure, metabolic disorders, renal calculi, and urinary tract infections. The clinical management of hypertension is emphasized along with acute/chronic hemodialysis and continuous ambulatory peritoneal dialysis. The nephrology fellowship is oriented toward training in all aspects of clinical and investigative nephrology, including developed proficiency in the interpretation of radiologic studies, biochemical parameters, and renal biopsies.

Division of Pulmonary, Critical Care and Sleep Medicine
Residents work closely with faculty and fellows in the division throughout all three years of the program. The division runs a busy consultation service as well as the Medical Intensive Care Unit (MICU) and manages medical issues in the surgical intensive care unit (SICU). A well organized core curriculum covering the procedures of critical care medicine is provided to residents while rotating through the MICU. Residents are also able to perform bedside pulmonary procedures under the supervision of the division while on the medical wards. Numerous teaching conferences for housestaff are sponsored by the division, covering topics which include chest radiology, pulmonary physiology, thoracic surgery, lung cancer, and pneumonia. Opportunities are available for both resident and fellow involvement in clinical and basic research in sleep disorders, respiratory therapy, COPD, tuberculosis, lung immunology, lung injury, control of respiration, and septic shock.

Division of Rheumatology, Immunology And Allergy
This division has been one of the most active in resident and fellow education, with several members having won teaching awards from medical students and residents. Residents may elect to spend time in either the second or third year in Rheumatology at Georgetown and the Veterans Affairs Medical Center. The VA program currently employs an innovative computer-interactive teaching program that incorporates a self-directed learning program with a very busy outpatient experience. The division is comprised of eight full-time faculty at the University who have clinical and investigative interests in Rheumatology, Immunology, and Allergy. Areas of research include the molecular biology of B-lymphocytes, neurotransmitter receptors in nasal mucosa, the eosinophilia myalgia syndrome, fibromyalgia, scleroderma, childhood rheumatic diseases, and the vasculitides. All faculty participate in the inpatient and outpatient care of patients with immunologically-mediated disease. Additional faculty at the Washington VA Medical Center, National Institutes of Health, and D.C. General Hospital participate in clinical, teaching, and research programs of the division. The two-year fellowship program includes training in the clinical and research aspects of rheumatology and immunology with ample opportunity for participation in investigation.