Internal Medicine Residency Program: Program Structure

Training Tracks 

The Department of Medicine at St. Elizabeth's Medical Center offers ACGME accredited training in two categories: Internal Medicine Categorical and Internal Medicine Preliminary.

The Internship year is similar for both Categorical and Preliminary interns. Preliminary Interns do not have a half-day per week outpatient continuity clinic. They may also use their Elective and Ambulatory time to pursue rotations relevant to the field they will enter in the PGY-2 year (e.g. Anesthesia, Dermatology, Neurology, etc). During the last 3 years Preliminary Interns have continued on in Residencies in Anesthesia, Dermatology, Emergency Medicine, Neurology, Ophthalmology, Radiology, and Rehabilitation Medicine.

The academic year at St. Elizabeth's Medical Center is divided into thirteen, four-week, blocks.

Ward Rotations

The ward teams are set up geographically. There are three medical teams covering the three major medical/cardiology floors. Each team consists of one third year, 2 second year, 4 first year residents and one or two medical students from Tufts University School of Medicine. Each team is assigned to a particular medical floor. The average number of patients carried by each of the three major floor teams is 15-20. One team is involved in the care of inpatients on the General Medicine service, the second in the care of predominantly patients on the Cardiology service and Cardiology Step-Down Unit and the third, the care of patients on the Medical Step-Down unit, Hematology-Oncology service and general medical patients on outlying floors. . Interns and residents on the wards are ensured at least one full day off every week (either Friday, Saturday, Sunday or Monday).

The geographical distribution of care involves a drip system of admission with each team admitting patients every day. One resident and one intern on each team are required to remain in the hospital till 7 pm every third day, considered the long call. There is no overnight call for interns or residents on the ward rotations. There is a night float system in place for the interns where one of the four interns on each team work 6 nights at a stretch in a month, from 7pm to 7am. Intern night floats provide cross coverage for patients on the medical ward services. For all Ward Teams the number of admissions and transfers are strictly capped.

While on the wards house staff work closely with Faculty from the Hospital Medicine Service, Pulmonary Division (Medical Step Down Unit), Cardiology Division (Telemetry floors and Intermediate Cardiac Care Unit), and a dedicated group of Primary Care Physicians (most located on campus or nearby).

ICU and CCU Rotations

There are 14 ICU beds on the medical service (physically connected 7-bed MICU and 7-bed CCU). The MICU/CCU team is a combined team consisting of a 2 third year residents, 2 second year residents and four interns. Call is taken every fourth night by the second year and third year residents leaving by 11 am the next day. There is a night float system in place for the interns where one of the four interns work either 3 or 4 nights at a stretch from 7pm to 7am. Interns and residents on the intensive care unit services are ensured at least one full day off every week (either Friday, Saturday, Sunday or Monday). The CCU patients are rounded on by an Attending Cardiologist and a Cardiology Fellow, while the MICU patients are rounded on by a Pulmonary and Critical Care Attending and a Pulmonary Fellow. Fellows serve as active back up and come in at night to assist with difficult cases.

PGY-2 Night Float Rotation

The PGY-2 Night Float Rotation provides an opportunity for residents to admit and manage a broad variety of medical cases, while reducing the work and hours of floor teams. Each night, two PGY-2 night floats admit new patients and provide back up for float interns. Intern night floats provide cross coverage for patients on the medical ward services. The night float shift starts at 7:00 PM and ends at 7:00 am. Second year residents on the Night Float Rotation work six days per week for a total of two weeks. The remaining two weeks are usually assigned for vacation, elective, or ambulatory rotations.

Electives

The table below shows the elective rotations available to house officers. For subspecialty rotations, residents divide their time between outpatient clinics and inpatient consultation services. When rotating on the Cardiology, Hematology-Oncology, Nephrology, Infectious Diseases, Pulmonary, and Gastroenterology Services, interns and residents work closely with Subspecialty Attendings, Fellows and fourth year medical students. On average, 33-50% of the elective is devoted to outpatient subspecialty work and the remainder to inpatient (consultation) work. Additional Elective Rotations are available in Anesthesia, Endocrinology, Geriatrics, Pathology, Patient Safety, Radiology, Rehabilitation Medicine, Rheumatology, and Women’s Health. Residents with a well-conceived plan can perform one Elective off site. Residents on the elective rotation get weekends and holidays off. PGY-2 and PGY-3 residents with a well-conceived research plan and a designated faculty mentor can use one elective block to pursue a research project.

Emergency Medicine

House officers rotate for a total of two, 4-week blocks in the Emergency Room (once as an intern and once during the PGY-3 year). The Emergency Room is staffed by one or two board certified Emergency Physicians 24 hours a day. Each emergency medicine rotation consists of approximately 18 shifts over the course of 4 weeks. During the Emergency Medicine rotation, Medical House Officers play an active role in the triage and management of a diverse number of patients with different levels of acuity.

Neurology

PGY-3 Residents spend 4-weeks rotating on the Neurology Service working closely with Neurology Residents and Attendings.  Mornings are spent seeing patients on the inpatient Neurology Service while afternoons are devoted to work on the Neurology Consultation Service. During this period they are encouraged to attend all Neurology noon conferences and morning reports.

Ambulatory Care Rotation 

During each of the PGY-1, PGY-2, and PGY-3 years, house officers perform two to three 4-week Ambulatory Care Rotations. While on the Ambulatory Rotation, House Officers are still able to attend weekly didactic sessions such as morning report, Morbidity & Mortality Conference, Journal Club, and the noontime lecture series. Rotations covered during the Ambulatory Block include Dermatology, Office Gynecology, Non-operative Orthopedics and Sports Medicine, Medical Ophthalmology, Non-Operative Otorhinolaryngology, Rheumatology, Endocrinology, Occupational Medicine, Travel Medicine, Walk-In Clinic, and the Center for Weight Control. There are additional rotations available in Home Care, Rehabilitation Medicine, and Women’s Health.

Continuity Clinic

The Continuity Clinic and Ambulatory experience is under the leadership of Dr. Abbas Zaidi, Associate Program Director. Dr. Zaidi, a former Chief Medical Resident and dedicated General Internist, has received teaching awards from both Medical Students and Medical House Staff. Categorical residents spend one-half day per week in a continuity clinic conducted in a general medicine setting. All continuity clinics are on campus or within easy walking distance. Each resident is assigned to one General Internist and works closely with that Attending Physician for three years. The focus is on managing a panel of patients with a broad array of illnesses over time. The Ambulatory program utilizes the Yale University Primary Care Curriculum (a comprehensive set of cases) to supplement the outpatient experience.

Research

There is a long and rich tradition of resident participation in research projects (see Resident Research). Numerous opportunities exist for residents to engage in either clinical or basic science research. PGY-3 residents can use some of their elective time to participate in research projects. Research opportunities in each Division of the Department of Medicine are actively publicized on the Intranet page, “Research for Residents.”

Summary of Rotations by Year	PGY-1	PGY-2	PGY-3
Medical Wards	Yes	Yes	Yes
Medical ICU/CCU	Yes	Yes	Yes
Night Float		Yes
Emergency Medicine	Yes		Yes
Neurology			Yes
Electives	Yes	Yes	Yes
Ambulatory Blocks	Yes	Yes	Yes
Continuity Clinic	Yes*	Yes	Yes
Research Elective		Yes	Yes
*Categorical interns only