The Internal Medicine Residency Program offers a variety of rotations and experiences to residents.
Inpatient Medical Experiences
MICU / CCU / Acute Renal Inpatient Consult
- These rotations are supervised by subspecialty internists on our clinical faculty. Each experience will allow residents to learn about the care of critically ill, complex patients from the subspecialist's perspective.
- The advantages of these rotations include exposure to excellent practicing internists, contact with a diverse patient base, and exposure to the real-life benefits and challenges of subspecialist internists in community practice. Residents spend a total of 3 1/2 months on these service.
General Medicine Ward ("B") Services
- Patients cared for by housestaff and faculty in the ambulatory care center and patients without a private physician who are admitted through the Emergency Department make up our two general inpatient services. The first-year resident, supervised by an upper-level medical resident, is responsible for the clinical decisions involving the care of these patients. The faculty, while ultimately responsible for patient care, believe that initiative in decision-making is a vital part of a resident's experience on the inpatient service. However, attendings are always quickly available for any questions and provide perspective and experience to patient care.
- The Internal Medicine Program maintains high standards for quality patient care on the inpatient service through close attending interaction and decision-making support with bedside informatics. Housestaff on these services admit every fourth day and are supported by a comprehensive night float system that routinely limits work hours to 70 per week while preserving a comprehensive educational experience.
- The Night Float system for housestaff coverage was implemented to alleviate stress and fatigue. Each upper-level resident spends one month and interns spend four to six weeks on the Night Float rotation per year. Night float teaching rounds to enhance the educational experience commence at 7 a.m. each morning.
Clinical staff, faculty, and residents share in the enthusiasm for ambulatory care as an important component of an internist's education. Ambulatory care teaching is primarily conducted in the Internal Medicine Ambulatory Care Center, located within Moses Cone Hospital. Each resident receives a small panel of patients and develops a personal practice by following patients initially encountered on the wards or in the acute care clinic. Proficiency in the use of an electronic health record is an integral component of the ambulatory curriculum. Electives in office-based practices are available with practicing faculty, both in urban and rural areas.
In addition to continuity in the clinic, each resident dedicates two months per year in the Ambulatory Care Center. This allows full development of rapport with the staff, ambulatory care skills and focused teaching. Faculty members serve as attending physicians for all clinic sessions. Teaching areas include interview skills (sometimes incorporating audio and video taping), and morning ambulatory conferences. Interns present each individual case and receive one-on-one faculty teaching. A behavioral medicine program, conducted by a faculty psychologist, focuses on patient interviewing techniques, principles of managing difficult social problems and the management of psychiatric illness in the primary care setting.
Since all medical subspecialties are represented among the full-time and part-time faculty, there is a wide choice of electives, including: cardiology, rheumatology, endocrinology, hematology/oncology, gastroenterology, neurology, pulmonary, infectious diseases, geriatrics, dermatology, rehabilitation medicine, radiology, palliative care, psychiatry, orthopedics, ENT, gynecology, occupational medicine, sports medicine, ophthalmology, hospital medicine, nephrology, invasive procedures and adolescent medicine, as well as economics, ethics and research rotations.
The emergency service is a Level II Trauma Center with 23 full-time ED staff members (spread over three campuses) who are Board-certified in emergency medicine. The Emergency Department has 100,000 annual visits and offers a broad and deep variety of clinical problems.
PGY-1 residents serve a one-month rotation to get exposure to the full range of emergencies, such as minor trauma, cardiovascular and pulmonary emergencies and toxicologic problems.
Since 1984, we have set aside part of the R-1 curriculum for a series of seminars in the areas of clinical reasoning and critical appreciation of the medical literature. The intent of this protected time is to teach an organized approach to these methods of evidence-based reading and thinking that are often short-changed in the press of patient care. The course provides a brief respite from clinical work, and serves as a bonding experience for the intern class.
We make the course time as undistracted as possible in order to promote learning and reading. The only patient care responsibility during the course is continuity clinic - one half-day per week. Otherwise, interns are expected to participate in the course 8 a.m.-5 p.m. each day. The schedule is constructed so that it does not conflict with any regular lectures, conferences or journal clubs. However, there is homework.
The course is presented twice in the month. Half of the R-1s attend each session. Typical seminars are based on assigned problems or guided reading of representative and recent journal articles. Topics explored in the course include the principal areas of medical knowledge: diagnosis, risk, prognosis, treatment and prevention. Methods of framing clinical questions and searching the medical literature will be covered as well.
Ambulatory Care Block
All second-year residents take the Ambulatory Care Block, which consists of outpatient gynecology, sports medicine, adolescent medicine, and ophthalmologic care. This rotation is structured to introduce PGY-2 residents to important aspects of outpatient care that they may not have experienced previously in their training.