Our program has been designed to prepare our trainees for the full scope of practice in Internal Medicine and advance their professional development for careers as hospitalists, primary care providers or subspecialists.
The inpatient floors provide a broad exposure to common and uncommon presentations of conditions in both Hospitalist Medicine and subspecialty medicine, as well as the atypical presentations of common and uncommon conditions (“the zebras”).
There are three inpatient teams, each consisting of one PGY1 and a supervising PGY2 or PGY3. In addition, there may be a medical or PA student assigned to each team.
Each team is responsible for up to 10-14 patients (depending on the time of year) on the medical floors. All teams care for patients with both general medical and subspecialty problems. A core faculty member (“teaching attending”) oversees each team, serving as both the service attending and a resource person. The teaching attending conducts didactic and bedside rounds daily and is available for consultation at any time.
The MICU provides an educational forum to support the following general learning goals:
The Intensive Care Unit is staffed 24 hours a day, seven days a week
by a board-certified intensivist who is available for house staff teaching
and supervision in the care of critically ill patients. There are two ICU
teams composed of one intern and one supervising resident
(PGY2 or PGY3).
Our program has adopted an Ambulatory Block Structure known as “6+2” – there will be a two-week protected Ambulatory Block after six weeks of inpatient/other rotations. The Ambulatory Block allows residents to develop the necessary knowledge and skills to recognize, diagnose and treat a variety of illnesses that present in the outpatient setting. The components of the Ambulatory Block include the following:
Residents are afforded the opportunity to rotate through all of the subspecialties of Internal Medicine (Cardiology, Pulmonary, Gastroenterology, Infectious Diseases, Hematology/Oncology, Endocrinology, and Nephrology) and must complete electives in Geriatrics and Neurology to fulfill ACGME requirements. Residents may perform one “away” elective during their PGY2 and PGY3 years to obtain different exposures or to experience learning in a different environment. In addition, residents are afforded the opportunity to perform electives in non-medical subspecialties, such as Radiology and Anesthesia, to hone their clinical skills.
A universal night float system is in place for the inpatient floors and ICU to absolutely minimize any 24-hour calls. We recognize that resident fatigue is a major contributor to medical errors and “on the job injuries” and we have established relief systems to mitigate it as a factor. Night float rotations are scheduled for six nights a week, with one night off in every seven. ICU night float has the support of a night-time intensivist, and the floor night float team has the back-up of both the service, private and in-house intensivist attendings. Due to our night float system, we emphasize seamless transitions of care with standardized sign-outs.
All second-year residents will have the opportunity to rotate through the Emergency Department for one or two blocks. This rotation allows residents to work up patients immediately from the moment they walk in the door serving as “first eyes” on these patients. In addition, working in the ED fosters an understanding of the scope of Emergency Medicine, as well as the challenges faced by ED physicians and nurses.
The Resident Admitting Officer (RAO) is the major gatekeeper to the teaching service of the Department of Medicine. All admissions coming to the teaching service are presented to the RAO, who performs a quick review and triage of the patient and assigns the patient to the appropriate team based upon Geography. In addition, the RAO provides consultation services to other departments in the hospital such as Psychiatry, Ob/Gyn and Surgery.
The academic year is divided into 26 two-week blocks per year. Below are the current curricula for the residency:
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