Curriculum
The curriculum for the internal medicine resident is designed to cover all areas of internal medicine and its subspecialties. The curriculum addresses all of the requirements of the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education.
The schedule is divided into 12 months (28-32 days) for each year. The typical schedule for each year of training is listed below. Over night continuity of care is provided by a night float team, with in-house overnight call limited to the MICU.
PGY-1
| PGY-1 Rotations | |
| Inpatient General Medicine | 3 months |
| Inpatient Specialty Medicine (Cardiology, Nephrology or Oncology) |
2-3 month |
| MICU | 1 month |
| Night Float | .5-1 month |
| Emergency Medicine | 1 month |
| Ambulatory Care* | 1-1.5 months |
| Neurology | 0-1 month |
| Subspecialty Consults | 1-2 months |
| * Required for categorical only | |
The PGY-1 supplies fundamental clinical skills for the future internist. This is accomplished through the provision of supervised care for acutely ill patients in both the inpatient and outpatient settings. The trainee develops confidence in the care of patients with many and varied, complex clinical problems. Integrative problem-solving skills, and a broad range of clinical tools are thus acquired by the intern, all of which are supplemented by exposure to a structured didactic curriculum.
PGY-2
| PGY-2 Rotations | |
| Inpatient General Medicine | 2-3 months |
| Inpatient Specialty Medicine (Cardiology, Nephrology or Oncology) |
1-2 month |
| MICU | 1-2 months |
| Junior Cardiology Night Float | 1 month |
| Ambulatory Medicine | 1 month |
| Geriatrics | 1 month |
| Subspecialty Consults | 2 months |
| Research Electives | 0-1 month |
During the PGY-2, junior residents become team leaders on inpatient general medicine, inpatient specialty medicine, and in the intensive care units, where they learn to direct a health care team in the management and care of patients. This system facilitates the integration of the cognitive and organizational skills necessary for clinical independence, the development of accurate differential diagnoses and the synthesis of effective therapeutic plans. The number of ward rotations decreases to foster development of fluency in the sub-specialties of internal medicine. Ambulatory clinical development is also emphasized through a two month ambulatory clinic block rotation.
PGY-3
| PGY-3 Rotations | |
| Inpatient General Medicine | 1-2 months |
| Inpatient Specialty Medicine (Cardiology, Nephrology or Oncology |
1-2 months |
| MICU | 1 month |
| Sr. General Night Float | 1 month |
| Medical Consultant | 1 month |
| Ambulatory Medicine | 2 months |
| Subspecialty Consults | 2-3 months |
| Research Elective | 0-1 month |
PGY-3 training is designed to fine tune leadership, decision-making and teaching skills, through increased autonomy. Rotations in the sub-specialties of medicine and supervisory roles on all services, facilitate development of the skill-set necessary to transit into the practice of internal medicine or pursue additional training in a sub-specialty fellowship program.
Ambulatory medicine is a crucial component of any internal medicine residency program. We prepare our residents for the care of patients in the outpatient arena in a variety of platforms, including urgent care clinic, subspecialty outpatient medicine rotations and the resident physician's continuity care practice. The latter averages one half day per week over the 36 month residency and allows the resident to provide care to his/her own panel of patients under the guidance of the internal medicine faculty. Residents do not see patients in their outpatient practice during their MICU or night float rotations.
The night float rotation is an effective solution to meeting the duty hour requirements mandated by the ACGME, as well as providing trainees with after hours decision-making opportunities. The duties of the night float intern provide the trainee with the experience necessary to make acute, inpatient care decisions, of a broad range of severity. The senior night float resident supervises and supports the night float intern. The cardiology night float resident provides after hours management experience with potentially unstable cardiac patients, as well as cross cover decision-making in more stable cardiology patients. Night float teaching rounds with the program leadership keep the educational spirit of the rotation viable, and provide continuous feedback between the night float team and the residency leadership group.
Faculty balance teaching and management while respecting the growth of the residents. Attending availability is not limited to attending rounds. Frequent contact with the faculty attending ensures in-depth discussion of patients and their illnesses. During PGY-2 and PGY-3, residents assume increasing responsibility and autonomy in diagnosing and managing patients. Our residents become efficient and experienced practitioners in the inpatient and ambulatory settings.
Mega teams on inpatient general medicine is a program that uses a mega team concept for structuring ward teams on inpatient general medicine. Mega teams facilitate the conduction of effective work rounds and allow for easy cross coverage for days off, clinic, etc. By increasing the number of senior residents per team from one to two, every intern has a designated senior resident partner for the month (as opposed to one senior for every two interns). Mega teams are used at the beginning of each academic year and greatly facilitate work rounds and bedside teaching by senior residents, allow interns a gradual adjustment to decision making in acute patient management, and facilitate patient care and a team concept by simplifying necessary absences from the service.
Resident self-governance through the House Staff Council for Education (HSCE) is an elected body consisting of 3 to 4 representatives from each residency class. The HSCE meets with the program leadership on a regular and as needed basis, and serves as a critical advisory body to the program leadership when important changes in educational curriculum or policy are contemplated. In addition, the HSCE functions as a clearinghouse for trainee concerns and is a viable pathway for bringing issues to the attention of the leadership, and providing for effective dialog and problem solving. Recommendations by the HSCE are presented to the entire residency cohort at monthly town meetings, allowing for further feedback and refinement. This system was used to effectively develop programs such as mega teams.