Curriculum and Rotations
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 10-12 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.
Medical Intensive Care Unit (MICU)
The MICU provides an educational forum to support the following general learning goals:
- Diagnosis of severe, life-threatening derangements spanning multiple physiologic systems
- Ability to triage, organize and prioritize between multiple problems and patients
- The ability to recognize and rapidly correct urgent, life-threatening disorders
- Expertise with the technology and procedures of modern critical care
- Use of a multidisciplinary team approach to care, encompassing numerous disciplines and professions
- Enhancement of communication skills with patients and families, particularly in sensitive areas such as end-of-life care
- Use of protocols and policies as quality assurance and improvement tools
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).
The Ambulatory Block
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:
- Primary Care – Four half- day sessions per week in the Adult Health Center providing primary care to the residents’ own panel of patients, as well as emergency care to patients of other residents (not on the Ambulatory Block) from their color coded clinic team. (Color coded clinic teams provide continuity of care to patients when their own physicians are not on the Ambulatory Block and facilitate communication between residents when cross covering in the outpatient setting.
- Hopkins Modules – For every Ambulatory Block, residents will be assigned two or three Hopkins modules. The Hopkins modules are completed online and cover the gamut of topics in Ambulatory Medicine. Each module is comprehensive and residents are offered the opportunity to monitor their knowledge improvement using a pre-test and post-test. By the end of the third year, residents will have completed the majority of the Hopkins modules to ensure up-to-date knowledge of outpatient Internal Medicine.
- Ambulatory Didactics – A half-day per week will be protected time for Ambulatory Didactics. A comprehensive three-year curriculum has been developed based upon the Yale Office-Based Curriculum which is synchronized with the Hopkins modules. In addition, there will be opportunities for learning in Joint Conferences with the Family Practice residents, particularly in the Business of Medicine curriculum, Law and Ethics Conferences and the Research Curriculum.
- Simulation Lab – Protected time in the Simulation Lab will ensure that all residents achieve competency in Procedural, Behavioral and Clinical skills (medical code training, central line placement, etc). By placing the Simulation Curriculum into the Ambulatory block, all residents are afforded the opportunity to learn and develop skills in the Simulation Laboratory in a standardized fashion.
- Quality Improvement – All residents on the Ambulatory Block will be given protected time to engage in quality improvement work – multiple projects are ongoing in both the inpatient and outpatient setting some related to Medical Reconciliation, Transitions of Care, and High-Value Care. Residents will participate in group projects with other members on the Ambulatory Block and will also complete individual performance audits on their own panel of patients.
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.
Resident Admitting Officer (RAO)
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:
- Inpatient Floors – 9-10 blocks
- ICU – 4 blocks
- Night float – 3-4 blocks
- Ambulatory Medicine – 6 blocks
- Elective (Neuro and Geriatrics) – 2 blocks
- Vacation – 2 blocks
- Inpatient Floors – 6-7 blocks
- ICU/ICU Night float – 4/3 (total 7 blocks)
- Night float- 1-2 blocks
- Ambulatory Medicine – 6 blocks
- Elective – 3 blocks
- Resident Admitting Officer – 1 block
- Vacation – 2 blocks
- Inpatient Floors – 3-4 blocks
- ICU/ICU Night float 2-3/1 (total 3-4 blocks)
- Night float – 1-2 blocks
- Ambulatory Medicine – 6-7 blocks
- Elective – 6-7 blocks
- Resident Admitting Officer – 2-3 blocks
- Vacation – 2 blocks