Internal Medicine Curriculum
The curriculum of the Internal Medicine Residency Program has been formulated to provide residents with in-depth clinical experience in internal medicine and its subspecialties, accompanied by a program of didactic activities designed to enhance the assimilation of medical knowledge and prepare residents for board certification in internal medicine.
During the first postgraduate year, each resident experiences a defined core of rotations designed to foster independent thinking, the assumption of responsibility, and the acquisition and refinement of basic skills needed by all internists. Each resident is assigned rotations on the various hospital inpatient services, with the goal of mastering the core skills of inpatient internal medicine. Adequate preparation for the subsequent years' ambulatory experiences is assured through one-month block rotations in the Acute Care Clinic, a block rotation encompassing various non-medical specialties, and the Emergency Center, as well as the block rotations in the general medicine clinic. Elective months are allocated to the completion of internal medicine subspecialty rotations.
The second and third years of our residency program are structured to provide preparation for the major career tracks that an internist might pursue: either primary care general internal medicine or advanced training in one of the subspecialties of internal medicine.
Internal medicine residents are assigned to the department's inpatient teaching services in each year of the residency. The curriculum for these rotations emphasizes the pathophysiology, diagnosis, and management of acute medical illness in the inpatient setting, along with the assumption of progressive responsibility.
Staff Medicine: Staff Services are a key element of the inpatient teaching program of the residency. Patients from the residents' outpatient clinics and patients who present to the Beaumont Emergency Center who have no physician on the Beaumont Staff are cared for on these services by teams of first and third-year residents who are supervised by attending staff chosen for their dedication and commitment to the residency program. The residents are expected and encouraged to function independently and make all significant patient management decisions; the attending functions as a teacher and as a knowledgeable advisor to the resident team. Residents are involved on the Staff Services for a significant portion of their first and third years.
Hospitalist General Medicine: Hospitalist General Medicine Services are designed to give residents the opportunity to evaluate and manage patients with a broad array of clinical problems that are cared for by a hospitalist. Working in close collaboration with fulltime and private practice hospitalists, residents assume responsibility for directing the care of a panel of hospitalized patients.
Night Float: Every internal medicine resident has a one-month night float rotation in each year of the residency curriculum. The night float team provides cross-coverage for the Staff Medicine and Hospitalist General Medicine teams, and admits patients to both teams. The night float team makes daily teaching rounds with the team accepting its admissions and its faculty attending.
The rotations in the department's critical care units provide structured experiences in state-of-the-art facilities, wherein residents provide care to critically ill patients in an environment that emphasizes progressive responsibility and the use of "cutting-edge" knowledge.
Medical Intensive Care Unit: The resident curriculum in the Medical Intensive Care Unit is predicated upon the principle of progressive resident responsibility for patient care. All first-year residents are assigned to a one-month rotation in the Medical Intensive Care Unit, during which they care for a limited panel of patients under the direct supervision of senior medical residents and the faculty intensivists. Through these activities, the interns develop an understanding of the basic principles of medical critical care, while acquiring supervised experience in the performance of invasive critical care procedures. Senior medical residents manage a full panel of patients under the supervision of our hospital-based critical care specialists, direct the hospital's CPR team, and provide the interns with ongoing supervision.
The patient care activities of the team are augmented by a structured academic program. The team rounds daily with an assigned critical care faculty physician. These rounds are supplemented by daily X-ray rounds, a formal didactic lecture series (including sessions on procedural skills), and journal club.
Coronary Care Unit: Senior medical residents care for a panel of patients with complex cardiac disease with guidance from our internationally-acclaimed cardiology faculty. The team rounds daily with an assigned faculty cardiologist, and participates in the numerous conferences of the Cardiology Division, including "Professor Rounds" and sessions devoted to electrocardiogram interpretation and assessment of hemodynamic data.
Continuity Clinic: All of our medical residents are assigned to the outpatient continuity clinic for three one-month block rotations in each year of the residency. These blocks occur every fourth month throughout residency, allowing continuity of care with an assigned panel of patients. Residents are assigned to a clinic team with a team attending who oversees the management of their patients. These teams function as group practices, providing for cross-coverage and communication regarding the group's patients via the electronic medical record. This opportunity allows the residents to become familiar with the principles and practice of internal medicine in the outpatient setting, by caring for their own individual panels of patients over time, and by participating in the daily didactic sessions in the clinic. Each clinic session is supervised by at least five faculty members, all of whom have been selected for their interest and expertise in outpatient medicine.
Outpatient Rotations: Internal medicine residents gain additional outpatient experience through electives based in the outpatient clinic, in the Nutrition and Preventive Medicine Clinic, and in the office practices of selected internists. These rotations offer the resident an intensive exposure to outpatient medicine free of concurrent inpatient duties. Elective subspecialty rotations based in the outpatient setting are available in each medical subspecialty.
Residents are assigned to rotations in all of the subspecialties of internal medicine, and have the opportunity to elect experiences in many of the other departments in the hospital. During these rotations, residents master the core didactic material of the respective subspecialties, while gaining experience in the various roles of the subspecialist. Our program's increased emphasis on ambulatory medicine is evident in the medical subspecialty rotations. All of the medical subspecialties offer significant activity based in various outpatient settings as a major component of their curriculum. Several of the divisions now offer supplemental elective rotations that are exclusively based in the ambulatory arena.
First-year residents in the internal medicine residency program are given a one month rotation in the Emergency Center, where they work under the direct supervision of our Emergency Medicine faculty, and participate in the academic activities of the Department of Emergency Medicine.
Morning Report is conducted by the chief medical residents and designated faculty. Selected clinical material is reviewed in depth, and active participation is encouraged. All residents and students assigned to inpatient medical services are expected to attend.
Intern Morning Report takes place weekly for the first 6 months of the year. It is designed to give specific attention to issues that every intern needs to know. This includes the basic approach to common problems, discharge planning, communication skills, palliative care and basic test interpretation.
Senior Morning Report occurs every Thursday. At this conference, senior residents assigned to the Staff and Hospitalist General Medicine services present a brief patient vignette followed by a literature review that addresses clinical questions that were key to the case presented. This literature is discussed by employing EBM principles, with assistance from our EBM faculty.
Patient Management Rounds led by the senior resident, take place daily on each patient care team.
Teaching Rounds by faculty occur daily for each inpatient team and in the critical care units.
Program Director's rounds are scheduled with each team during the month. These sessions involve formal, bedside teaching with one of the Program Directors or senior faculty.
Medical Grand Rounds are held every Wednesday, and include presentations from our faculty and guest speakers. One session per month is reserved for the departmental Morbidity and Mortality conference.
Noon Didactic Conference occurs daily, Monday through Friday. A three-year rotating curriculum is followed in the selection of noon conference topics. Pathophysiology, basic science review, clinical presentations, and review of current concepts are emphasized. A board review series utilizing audience response technology is included. We also incorporate case-based and interactive ethics conferences, and practical, outpatient-based topic reviews.
ECG Conference is held monthly to provide formal instruction in ECG interpretation to first-year residents as well as other interested residents and medical students.
Subspecialty conferences are offered in all medical subspecialties. Residents are expected to participate in the didactic program of the respective subspecialties during rotations on these services, and are encouraged to attend whenever possible throughout the year.
Clinic Conferences/Topics in Primary Care are provided daily for residents on clinic block months. The core curriculum of ambulatory care topics is reviewed in these sessions. The residents participating in their Clinic Block months present the topics. Clinic team attending physicians and Chief Residents also attend and provide comments and feedback.
Journal Club/Evidence-Based Medicine Curriculum takes place as part of the clinic conference series. Development of critical reading skills is emphasized, along with medical decision-making and biostatistics. Papers are discussed in small group format to improve participation and learning. Each month a different clinic team, under the guidance of one of the EBM faculty, will prepare the discussion based on a clinical question.
MICU Ethics Conference is presented monthly, reviewing ethical questions surrounding the care of critically ill patients.
The Stanford Clinical Teaching Skills Curriculum is provided annually for all second-year residents through a series of eight interactive small-group learning sessions