Overview:
Medical genetics clinical training is accomplished through resident’s active participation at a variety of general and subspecialty clinics, coverage of the consultation service, exposure to the clinical laboratories, and completion of readings for each rotation. These experiences occur during the first 18 months of the 2-year genetics residency training program, with the final 6 months dedicated to research activities. Through participation in these rotations the resident will be exposed to the spectrum of genetic evaluation, testing, diagnosis, counseling, and management of genetic diseases; gain an appreciation for the natural history of genetic disorders and the value of multidisciplinary clinics in the management of genetic disease.
The UAB Medical Genetics Residency Training Program’s clinical rotations are carried out in designated 1-3 month blocks. In Year 1 there are two 3-month blocks designated as “Inpatient/Consultation”, and 6 one month blocks designated as “Outpatient”. The first 6 months of Year 2 consists of three clinical laboratory rotations (cytogenetics, molecular genomics, and biochemical genetics), with the second half consisting of a 6-month block for research activities. While patient care responsibilities are the focus of Year 1, the resident will continue to be engaged in patient care activities in Year 2 by maintaining a regular 2 ½ days per month resident’s clinic; clinical elective rotations; participating in the metabolism service during the biochemical genetics laboratory rotation; regular on-call responsibilities.
A sample rotation schedule is provided below
Year One |
Jul - Sep |
Oct - Dec |
Jan - Mar |
Apr- Jun |
| Out Patient I |
Inpatient/Consults I |
Out Patient II |
Inpatient/Consults II |
- General Genetics
- Prenatal Genetics
- General Genetics
|
- TCH clinics (Cleft/Craniofacial; Bone)
|
- Cancer Genetics
- General Genetics
- Prenatal/Cancer Genetics
|
- TCH clinics (Cleft/Craniofacial; Bone)
|
Resident's genetics clinic (two 1/2 days per month) |
Year Two |
Jul |
Aug |
Sept |
Oct - Nov |
Nov - Dec |
Jan - Jun |
| Cytogenetics Lab |
Medical Genomics Lab |
Elective |
Biochemical Lab |
Elective |
Research |
Resident's Genetics Clinic (two 1/2 days per month) |
Working Hours, Vacation and Leave
Elective
Two months are designated as clinical elective time. These can be used for a variety pursuits, but they must be clinical, not research, activities. The resident must discuss the proposed use of elective time with the Program Director at least 2 months in advance of the rotation.
Appropriate use of elective time:
Elective time can be used in a variety of ways. It can be used to supplement areas in which the resident feels less confident . For example, the resident could chose to spend an additional month in pediatric, cancer, metabolism, or prenatal genetics, or some combination thereof. (Note: a resident may be asked to do this if the program director feels that the resident needs the additional educational time in a specific clinical discipline to reach a high level of competence.
Other examples of the use of elective time include:
The resident can design a time during which they attend a variety of clinics to which they may have limited or no exposure during their scheduled rotations. Other examples include prenatal pathology, adult genetics (cardiovascular, lipid, and adult cystic fibrosis), and neurogenetics (muscular dystrophy, cerebral palsy, Huntington disease clinics).
The resident can spend additional time in any of the clinical laboratories. This must be done with the permission of the laboratory director.
Away electives (rotations at other institutions) are permitted. The Program Director must be notified in advance (~6 months) of the start of the proposed elective, and permission must be granted in writing for this rotation to count towards the resident’s required clinical training. The rotation must satisfy a clinical interest that is either not represented at UAB or there must be another compelling reason to do this. The resident must make all the necessary arrangements for this elective, and is responsible for the cost (travel, housing, etc.).
On-Call Duty Hours And Responsibilities
During the 1st year regular working hours are generally ~8:00 a.m. to 5:00 p.m., Monday through Friday. However, it is expected that the resident will spend time outside these hours reading, reviewing patient records, and working on clinic notes. Later in the year, other activities, such as writing manuscripts, preparing presentations and research are expected as well. Each resident is on-call 6 months of year 1 of genetics training, in two 3-month blocks (see above). Responsibilities of the on-call resident include: staffing all requests for inpatient consultation, including the clinical genetics and metabolism services*; answering phone consultations; attending the specialty clinics at The Children’s Hospital of Alabama (TCH) (Cleft, Craniofacial, and Bone Disorders). The responsibilities of the inpatient service take precedence to attending these clinics. In addition, while on the consultation rotation the resident should attend pediatric morning report, which is held each weekday at 7:45AM in the physician’s dining room on the first floor of TCH.
(*Note: during the months when there is a 2nd year resident on biochemical genetics rotation, the 2nd year resident will take first call on metabolism consults in the hospital and by phone. The 1st year resident should make every effort to participate in these consults, however.)
The on-call resident will take call from home during evenings and weekends for inpatient consultations or to answer questions from referring physicians, and is required to be available by pager 24 hours/day, 7 days/week (respond to a page within 15 minutes and get to TCH or UAB Hospital within 1 hour). There is an on-call attending available for both clinical genetics and metabolism services 24/7 as well, and all after-hours calls must be discussed with the on-call attending. An attending physician will typically accompany the resident to consultations. A resident may switch on-call responsibilities (e.g., weekend coverage) with other residents with approval and notification of the on-call attending. While on the consultation service, the resident is guaranteed every other weekend and one night per week off duty. That time will be covered by other residents in Year 1 and 2, or the on-call attending (if there is no second resident or they are not available).
On-call responsibilities when not on consult rotation:
During the 18 months when not on the consultation service, a resident will take call one weekend night (2 per month in Year 1, 1 per month in Year 2), and one weekend per month.
Patient log:
During their clinical months, the resident is required to maintain a log of their patients that includes the information required by the ABMG in their application for certification. The format for the patient log book can be found at the American Board of Medical Genetics’ web page – www.abmg.org
