Curriculum

A typical day during inpatient service at Memorial Health University Medical Center looks like this:

Inpatient Teaching Services

There are 4 general ward services comprised of an attending, a resident, one or two interns, 1-3 medical students, and a pharmacist.

The ward teams take call every 4^th day from 7:00am to 7:00pm.

Night teams arrive at 7:00pm and continue admissions until morning the following day.

We fully comply with all ACGME requirements for residency training programs with particular attention to the number of weekly hours and the number of patients each intern or resident can admit and manage.

All members of the house staff are given a minimum of one day off per week averaged over four weeks.

Duty Hours

All caps and ACGME work-hour requirements are strictly enforced. A web-based program allows residents to log their hours.

Night Team

The department of internal medicine has developed a night team system. Sunday through Saturday from 7:00pm to 7:00am are covered by an upper-level resident and two interns. This system is strongly supported by the house staff. Residents are off every Sunday and Interns are off every Saturday.

Intern PGY1, Residents PGY2, and Residents PGY3

Sample Schedule

ICU

Each ICU team typically has two interns and three residents. Call and night float is divided among the team members.

Outpatient Internal Medicine Clinic

Our Center for Internal Medicine clinic allows residents to practice medicine in a real-life private-practice setting to a diverse panel of patients. Additionally, as part of the outpatient experience, students learn core concepts in outpatient medicine through the Yale Office-Based Curriculum.

All interns and residents follow the "ABC" Block schedule, in which residents spend 4 weeks uninterrupted in continuity clinic, followed by 2 additional 4-week blocks on other core rotations. This ensures that residents spend 4 out of every 12 weeks in ambulatory clinic. This also ensures 4 weekends off out of every 12. Interns spend half-day sessions in the clinic when on the rotation (either morning or afternoon) and the other half of the day is for independent study, research, administrative tasks, etc. Residents also spend half-day sessions in continuity clinic, and the other half-day is spent in subspecialty clinics in order to broaden the scope of management in ambulatory care. Some of these experiences include core internal medicine specialties, but also orthopedics, dermatology, and otolaryngology. Senior residents also have the opportunity to practice urgent care skills through a week of same-day visits in the center for internal medicine.

Subspecialty and Elective Rotations

Residents on subspecialty services do not take in-house call. Generally, the resident will take call with the respective subspecialist and in the morning pick up any new patients admitted overnight.

Selective rotations for PGY-2s include ID, Neurology, Nephrology, and Endocrinology. PGY-2s generally complete 3 of these during the year but may complete 2 or 4, depending on the rest of their individual schedules. Any remaining selectives are completed during the PGY-3 year. PGY-2s may also complete an away rotation at another institution if they wish. This is highly encouraged for those seeking fellowship.

Selective rotations for PGY-3s include any not completed during the PGY-2 year (ID, Neurology, Nephrology, or Endocrinology), Rheumatology, Geriatrics, Palliative Care, Hematology/Oncology,ER, and Addiction Medicine (listed separately). Once these selectives are scheduled, PGY-3s choose from a list of electives which includes Dermatology, ENT, Allergy/Immunology, Sleep Medicine, Orthopedics, Women's Health/Gynecology, Physical Medicine & Rehab, Hospital Medicine, Psychiatry, Community Medicine, Radiology, and Pulmonology. PGY-3s also have the option of completing an extra 2-4 weeks of ID, Neurology, Nephrology, or Endocrinology, or an extra 4-week rotation of continuity clinic. Finally, PGY-3s may complete an away rotation at another institution if they wish (if not already taken in the second year).

Conference and Board Review

Educational conferences have varying formats and are a large part of our program. Our conferences complement our curriculum and include team-based learning, case presentations, journal clubs, and much more. These conferences are highly rated and well attended.

Morning Report

Morning report is every Monday, Tuesday, Wednesday and Thursday, from 9:15am – 10:00am for all house staff, students, and faculty on medical wards. This is a resident-driven conference in which one to two cases recently admitted are presented for an in-depth interactive teaching session focusing on differential diagnoses, treatment modalities, and interpretation of laboratory and radiographic data.

Noon Conferences

These daily meetings are held Monday through Thursday, 12:30pm – 1:30pm, for all house staff and teaching faculty. There is a three-year revolving curriculum addressing all aspects of internal medicine in preparation for the American Board of Internal Medicine Examination given by subspecialist and general medicine faculty.

Evidence-Base Medicine

Each resident is responsible for two EBM conferences per year, in which the resident articulates a clinical question in PICO format and presents appropriate evidence to support or refute clinical decisions. These conferences provide comprehensive coverage of emerging evidence and the format ensures that the content is current with the medical literature.

Grand Rounds

Conferences are held on Fridays in the state-of-the-art Medical Education Auditorium at Memorial Health University Medical Center. Distinguished and renowned guest lecturers present a broad spectrum of topics. Each 3rd year resident presents a grand rounds in the spring as part of their graduation requirements.

Performance Improvement Conference

Residents are guided by faculty to design, implement, and study various practice improvement and quality improvement initiatives. Each PGY year is responsible for its own project and meets monthly to discuss progress.

Monthly Board Tests

Once a month, the residents take an internally prepared test based on specific areas of internal medicine.

Resident Forum

Residents meet with faculty on a monthly basis to provide feedback on educational and clinical experiences. Through the feedback, both small and major program initiatives have been implemented to better resident experience.

Mentorship

Residents are assigned a core faculty as their mentor or “academic advisor”. There is a rigorous advising program that entails individualized learning plans and focuses on helping each resident set appropriate educational and career goals.

Resident Career Enhancement

The program integrates a career-enhancement curriculum that covers areas such as obtaining a job, contracts, overhead, healthcare financing, bank loans, disability insurance, setting up an office, promoting a practice, how to get a fellowship, and opportunities in clinical research.

Med Study Board Review Course

All PGY3 residents are required to participate in a week long internal medicine board review course in May. The course is an excellent way to solidify clinical knowledge at the end of training and is paid for by the program.

Vacation

All residents take four, one week-long vacations a year: 1) one week during blocks 1-6; 2) one week during blocks 8-13; and 3) one week during block 7 (holidays/Mega Rounds). The fourth week may be taken anytime with the exception of block 7.

Performance Improvement and Research

All residents are required to participate in a Performance Improvement (PI) project which is facilitated through the PI curriculum lead by Dr. Patel. No rotation is dedicated to this, however elective time can be used as appropriate. Research is continuous throughout each year.