Curriculum
Ambulatory General Medicine (All Years)Our educational program includes three complementary components: Continuity practice, urgent care, and ambulatory block rotations. Continuity Practice: From the beginning of residency, each resident serves as the primary care physician for a panel of patients and provides continuous care for these patients over the three years of residency. Residents are divided into "firms," each of which sees patients one afternoon a week. Residents attend their firm sessions each week, except when they are on critical care rotations, doing out-of-town electives, or on vacation. Each firm has a faculty firm director, aided by two other members of the general medicine faculty. During firm sessions, they are available to review and discuss patients with residents. Faculty has no other patient care responsibilities at these times and devote their full attention to teaching and assisting the residents. One PGY-2 resident and one PGY-3 resident are chosen each year to serve as "firm chiefs." They help organize the curriculum and weekly case conferences and assist in business management. To support the residents, each firm has nurse-practice partners, a social worker, a pharmacist, a community health nurse liaison, and a secretary. A Firm Advisory Board of residents, faculty, and practice staff meets monthly to develop plans to improve education and patient care. Urgent Care: Each morning and afternoon, interns on ambulatory block rotation (and senior residents during some of their elective rotations) see firm patients with urgent care needs. They are supervised by the ambulatory chief resident and by a general medicine faculty member. Ambulatory Block Rotations: Each PGY-1 has five two-week ambulatory general medicine block rotations. Three of these blocks involve the resident's own continuity practice and urgent care cases. The other two blocks are spent working in the office of a community-based general internist. There are no required ambulatory block rotations for upper-level residents. But many use elective time for additional ambulatory general medicine experience. Ambulatory Subspecialty Blocks (PGY-1)For two weeks at a time, each PGY-1 chooses two clinical rotations in internal medicine subspecialties. For the most part, these rotations are in ambulatory settings. They're designed explicitly for PGY-1s, and are closely mentored by experienced clinical subspecialists. These rotations give residents the basic skills for future rotations and provide early positive experience in clinical subspecialty practices. The PGY-1 subspecialty rotations complement elective subspecialty experiences in the PGY-2 and PGY-3 years. Inpatient General and Subspecialty Medicine (All Years)
Every inpatient at both hospitals has an attending physician of record, either a full-time general medicine hospitalist, a full-time subspecialist, or a community-based general internist. The attending physician of record sees the patient every day and discusses plans for diagnosis and therapy with the house staff. Critical Care (All Years)All residents have rotations in Strong's Coronary Care Unit (CCU) and the Respiratory/Medical Intensive Care Unit (MICU). There are daily teaching rounds with faculty members from either the cardiology division or the pulmonary/critical care division. The call schedule in both units is either short (until around 2 p.m.) or long (overnight). Emergency Medicine (PGY-1 and PGY-3)Medical residents evaluate patients in our emergency department and our observation/short stay unit under the supervision of emergency medicine faculty. Residents work in rotating 10-hour shifts, five days a week. They see patients with both acute and sub-acute medical problems. They make the first diagnoses of challenging medical disorders and learn to function confidently, decisively, and efficiently under pressure. Residents assess patients on arrival, gather necessary data, and then present each patient to a faculty member. The resident and faculty member, usually in consultation with the patient's personal physician, decide on management and disposition. Residents also participate in the ongoing didactic educational program for emergency medicine residents. Neurology (PGY-1)Each first-year resident does two two-week blocks on the neurology service. Residents evaluate and manage patients with diverse neurological problems under the supervision of residents and faculty from the Department of Neurology. They acquire the skills and knowledge in neurology that are needed by the general internist. They also become proficient in taking a neurological history and performing a complete, yet efficient, neurological examination. Residents also learn how to select and interpret commonly used neurologic tests and procedures. Geriatrics and Palliative Care (PGY-1 and PGY-2)Each first-year resident gets two weeks of geriatrics training. Second-year residents get two additional weeks of geriatrics, and two weeks with Strong's Palliative Care Consultation Service. In both years, residents work with geriatrics faculty in a wide variety of largely ambulatory settings, learning to promote health and to assess and manage common problems in older adults. Experiences include geriatrics primary care practice, geriatrics assessment clinics, hospice programs, home care programs, and home visits. During the two weeks on the Palliative Care Consultation Service, residents work with palliative care faculty and nurse practitioners. General Medicine Consultation (PGY-3)One of the three PGY-3 residents on the inpatient teaching practice at Strong works with a member of the full-time general medicine faculty to provide consultation for patients on non-medical services. Residents learn the role of the general internist as a consultant. The focus is on pre- and post-operative evaluation of patients with complex medical problems. Research Mentorship (PGY-1)All residents get experience in medical scholarship. Each PGY-1 chooses a research mentor from among 80-plus faculty volunteers, and spends two weeks working on a scholarly activity. That might include designing a research project to be carried out over the remainder of residency; preparing a case report; or performing a critical-topic review. Additional research experience is offered as an elective option in PGY-2 and PGY-3. |
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Our core curriculum includes experiences in ambulatory general and subspecialty medicine; inpatient general and subspecialty medicine; and in critical care, emergency medicine, neurology, geriatrics, palliative care, general medicine consultation, and research/scholarship.
Inpatient experience includes rotations on two inpatient teaching practices at Strong: general medicine and hematology/oncology. Add to that a general medicine