Internal Medicine Residency Curriculum

Curriculum

Bassett Medical Center has a long-standing tradition of teaching physicians and practicing both the art and science of medicine. The Internal Medicine Residency training program's written curriculum is used in concert with the ACGME general competencies and subcompetencies. The curriculum includes concise rotation specific physician activities that allow the learner to develop in all of the ACGME subcompetencies, including communication skills, interpersonal skills, professionalism, transitions of care, and quality improvement and safety. It also allows exposure to other regional patient care venues and engagement with the community. The Internal Medicine program includes rotations on all internal medicine subspecialties.

Categorical Internal Medicine

The Internal Medicine residency training curriculum is designed to provide education and training opportunities that allow residents to acquire competencies in ambulatory medicine, intensive care medicine, inpatient medicine, and emergency medicine; as well as in management of disease in specialties and subspecialty categories of internal medicine.

Residents spend approximately one-third of their training in the inpatient medicine setting and the remaining time in outpatient experiences. Teaching is facilitated by our dedicated Columbia appointed full-time faculty, which provides a 3:1 faculty-to-resident ratio. Focus on patient-centered-care, teaching and improvement are the highest commitment of our faculty. Residents have the autonomy to progressively assume greater responsibility for patient care decisions as one's knowledge and skills increase over the 3 years of training.

Inpatient Services

Medical Wards

There are 3 general internal medicine teams on the inpatient service. Care of the patient is substantially provided by the resident and intern. The ward attending's role includes responsibility as consultant and teacher on attending rounds.

Additional formal and informal consultative services are readily available from all subspecialties. The intern's responsibilities include, but are not limited to, thorough initial inpatient evaluations, daily progress notes, and all orders deemed appropriate by the inpatient team. The composition of each inpatient team can vary, but traditionally there is 1 resident and 2 interns on the ward team. The intern is expected to pre-round on his or her patients before morning rounds and should be able to present the events of the past 24 hours in a clear concise manner. Morning report occurs at 0630 with the residents. This exchange of information with the night float resident and all ward residents is chaired by the Chief Resident or designee. Attending teaching rounds occur daily. Formal bedside evaluation of patients and teaching related thereto should exceed 4.5 hours a week. The resident is responsible for having a patient be examined at the bedside every day. A multidisciplinary team meeting occurs for up to 1/2 hour each day, coordinated by the nursing team leader. While on the inpatient medical wards, all residents have one 24-hour period off each week.

Night Float

A night float system is in place 7 days a week. The night float team, consisting of a senior resident and an intern, manages acute overnight care for the general medicine service from 1830 to 0630. Residents evaluate and admit new patients and interns provide cross-coverage for the patients on the medical service. The senior resident presents a case at morning report each Thursday.

Intensive Care Unit

All training in critical care within the Department of Medicine occurs through participation as a member of the ICU service. There are 2 full-time staff intensivists that provide supervision and teaching for the team allowing for an in-depth experience in the care of critically ill patients including performance of an array of procedures. The team consists of 1 resident (PGY-2/3), 2 interns, and 1 student. For the interns, the typical day shifts are 0600-1630 or 0600-1930. Rounds begin at 0730 and are shared by the team. Residents cover, on average, a 12-hour shift with sign out occurring at 1900 daily. This exchange of information with the ICU night resident is chaired by the attending intensivist. Didactic sessions are held daily covering a basic core curriculum for the house staff rotating through the unit. In addition, the ICU setting affords the opportunity to become certified to perform standard procedures.

Outpatient Experiences

Continuity Clinics

Medicine residents in the Categorical Internal Medicine tracks begin a campus-based, longitudinal, continuity clinic in the PGY-1 year. This allows residents to follow patients throughout the course of residency. Supervision of continuity clinics is conducted by physicians in the Division of General Medicine. Residents will care for their continuity clinic patients within multidisciplinary care teams led by General Medicine faculty attending physicians.

Subspecialty Clinics

Residents spend 2-4 outpatient weeks in all 10 medical subspecialties. The elective subspecialty experience includes supervised clinics and consultative service functions. Carefully designed curricula, pre- and post-testing, and one-on-one teaching make these rotations exceptional experiences.

Other Clinics

Residents have the opportunity to gain exposure to outpatients in a variety of other settings, including regional clinics, and the full spectrum of elective subspecialty clinics. Residents can select a non-medical specialty block which includes participation in specialties such as gynecology, ENT, and orthopedics, which commonly intersect with primary care practice.

Evaluation and Feedback

Evaluations of You

At the end of each rotation, an evaluation is completed by the faculty members you worked with. You are evaluated based on procedural skills, fund of medical knowledge, medical management ability, patient communication and relationship skills, acceptance of supervision, work ethic, patient-centered focus, understanding and application of socioeconomic principles, and medical record completion. It is the responsibility of the resident to establish a meeting time with the attending at the beginning of the rotation to review the curriculum, goals and objectives; in the middle of the rotation to review your performance and to identify areas that need attention; and at the end of the rotation to do a final review of your performance and achievement of the curriculum goals and objectives.

All residents meet twice a year with the Program Director for a performance review. The Program Director uses this time to review evaluations and procedure certification reports and provides feedback on areas for improvement as well as strengths. This is also an opportunity to discuss the resident's future plans.

Evaluations by You

At the end of each rotation, you have the opportunity to evaluate the program content, use of ancillary services, and faculty teaching skills. Evaluations by you of the various services and faculty are strongly encouraged. All comments are strictly confidential. A summary report is developed annually and reviewed by the program director and the clinical chiefs (there are no names or rotation dates on these reports). Data collected is used to monitor and improve the quality of the residency training programs.