Internal Medicine Residency Curriculum

During your training, you will develop the skills necessary to become internal medicine specialists capable of managing diverse patients with a broad range of disease. Your training at Huntington Hospitalwill allow you to pursue a career in general internal medicine, hospital medicine or go on to sub-specialty training.

Curriculum

Grand Rounds: Monthly didactic conferences presented by subject matter experts. Morbidity and Mortality: Systems-based approach to reviewing M&M that occurred on resident related patient cases.. Our conference was recognized nationally by the Institute for Healthcare Improvement and the Society for Hospital Medicine.

Morning Report: Daily didactics for all residents focused on a patient case. Moderated by chief resident and faculty.

Journal Club: Monthly session led by faculty and focused on teaching residents how to interpret and critique evidence based literature.

Board Review: Follows ACP curriculum designed to provide residents with high-yield content to prepare for the ABIM exam. Includes MKSAP questions and videos.

Quality Improvement Conferences: Patient Safety and Quality Improvement are a focus in the residency program. Lectures, workshops and small-group sessions are part of the curriculum and centered around a resident-driven project to improve an aspect of our hospital’s system. Noon Conference: Daily series of ongoing and repeating didactic lectures covering a wide range of internal medicine topics.

Attending Rounds: Bedside teaching rounds are held on all inpatient services seven days per week. The emphasis is on developing fundamental clinical skills, diagnostic reasoning, pathophysiology, and professionalism. Emphasis is on evidence-based medicine and creating an environment that optimizes learning and patient care.

Residency Skills Lab: Residents receive training in procedures on state-of-the-art simulation models, participate in code scenarios and patient scenarios to improve competency and patient communication.

Medical Case Conference: Weekly formal case presentation by resident team focused on a patient case seen during the month. Attended by faculty, medical staff and is a CME sponsored event.

Goals & Objectives

Rotation Objectives

Each rotation will have common and specific goals and objectives. Please review each one prior to starting that rotation. The objectives will not be the only things you will learn on each rotation but they are what you will be measured by.

Program expectations of medicine residents:

1. Recognize that you are ultimately accountable for your own patient care and education and this requires continuous effort. You understand the connection between effort and results.

2. Seek feedback and be willing to improve performance if needed. You understand that feedback is sometimes difficult to accept but studies show that resistance to feedback often predict poor performance.

3. Self-reflect to foster personal growth. You will develop strategies for self-assessment

4. Help your teammates if they are struggling and if unable seek help on their behalf. You will support your team.

5. Attend at least 80% of all educational conferences if you are able. You will organize your day to prioritize education sessions and help your colleagues do the same.

6. Be on time and be prepared. You will demonstrate respect for your instructors and colleagues by being on time and doing any assigned reading and work.

7. Develop and commit to a reading plan. You will read something substantial almost every day.

8. Provide feedback to the program to optimize your experience and your colleagues. Your feedback is one of the most important ways the program can improve.

9. Embody the core values of honesty, integrity, caring, compassion, empathy, respect and trustworthiness. You will remember that you represent your profession and your institution.

Supervision

You will be supervised by an attending physician for all patients you encounter either by:

1. Direct Supervision - The supervising physician will be physically present with you and your patient

2. Indirect Supervision - the supervising physician is not physically present within the hospital or other site of patient care but is immediately available by telephone and/or other electronic modalities and is available to provide Direct Supervision

For some aspects of patient care, the supervising physician may be a more senior resident or fellow.

Evaluation

You will be evaluated during residency via multiple sources. Each rotation will use a combination of the methods below:

1. Direct observation by attending physicians

2. Multisource feedback by interprofessional team members (e.g. nurses, case managers, social workers, pharmacist, etc.) as well as peers and students

3. Self-evaluation

4. Clinical quality data evaluation (patient census, clinical metrics, etc.)

5. Chart review

6. Research Projects and Scholarly activities

7. Knowledge Testing (Board Review Questions)

8. Participation level (case conferences, morning report)

Evaluation Scale for each skill (Patient Care, Medical Knowledge, Communication, Systems-based Practice, Practice-based learning, Professionalism)

1. Remedial: You cannot achieve goal even with assistance

2. Emerging Skills: You may act under proactive, ongoing full supervision

3. Nearly Competent: You may act under reactive supervision (i.e. supervision is readily available upon request)

4. Competent: You may act independently

5. Outstanding: You may act as a supervisor/instructor

Most interns will start with 2 and progress to 3 on most measures by the end of the year. Most PGY2/3 residents will start with 3 and progress on most measures to 4 by the end of the residency.

The goal of the residency training program is to achieve the level of competency where the resident is able to act independently and be ready for unsupervised practice.

Rotation-Specific Goals and Objectives

Cardiology

Critical Care - PGY1

Critical Care - PGY 2+3

Dispensary Rotation

Emergency Medicine

Gastroenterology

Hematology-Oncology

Internal Medicine - PGY 1

Internal Medicine - PGY 2+3

Nephrology

Neurology

Outpatient Dermatology

Outpatient Liver

Outpatient Ophthalmology

Outpatient Orthopedics

Outpatient Otolaryngology (Ear, Nose & Throat)

Primary Care Continuity Clinic - PGY 1

Primary Care Continuity Clinic - PGY 2+3

Rotation Schedule

PGY 1

  • House Service - 5 months (includes 1 month float rotation)
  • Critical Care / Pulmonology
  • Cardiology
  • Gastroenterology
  • Nephrology
  • Neurology
  • ER - 2 two week or a single one month rotation
  • Vacation

PGY 2

  • House Service -5 months (includes 1 month float rotation)
  • Critical Care/ Pulmonary
  • Cardiology
  • Hematology/Oncology
  • Dispensary Clinics
  • LAC-USC electives - 1 month. Resident will be assigned one services from the following options: Endocrinology, Hematology, Infectious Disease or Rheumatology.
  • Outpatient elective - 1 month. Resident will select two half-month rotations from the following options: Dermatology, Orthopedics, Otolaryngology, Ophthalmology, Hepatology, Gynecology, Outpatient Medicine, Palliative Care or individually arranged elective
  • Vacation

PGY 3

  • House Service- 5 months (includes 1 month float rotation)
  • Critical Care/ Pulmonary
  • Dispensary Clinics
  • Geriatrics - ½ month
  • LAC-USC electives - 2 months. Resident will be assigned two services from the following options: Hematology, Infectious Disease, Endocrinology or Rheumatology.
  • Outpatient Electives - 1 ½ months : Resident may select three half-month rotations from the following options: Dermatology, Orthopedics, Otolaryngology, Ophthalmology, Hepatology, Gynecology, Outpatient Medicine, Palliative Care or individually arranged elective
  • Vacation

Categorical residents will complete the three-year curriculum.
Preliminary Residents will complete the PGY1 curriculum.

Scholarly Activity

Internal Medicine residents are encouraged in their pursuit of scholarly activity throughout their residency. Residents are required to complete a research project during their second year and present it at the Annual Resident Research Poster Presentation. Funding is available for residents to present their research at national and regional conferences.

Our faculty continues to pursue activities in basic science and clinical research. Projects cross over a wide expanse of specialties including cardiology, critical care, infectious disease and global medicine. Ambulatory care and quality management projects are also part of faculty and resident scholarly development.