The education and clinical training of Internal Medicine residents is a central focus in the Department of Medicine. We provide comprehensive training in general internal medicine for all residents, particularly those seeking a subspecialty fellowship, as well as abundant opportunities for residents interested in primary care and hospitalist medicine.
Combined training programs in Medicine-Pediatrics and Internal Medicine-Emergency Medicine (including a 6th year for EMIM-Critical Care certification) offer unique opportunities to individuals interested in dual certification. Preliminary interns participate in a curriculum similar to the categorical interns and develop a solid clinical base in internal medicine before entering their specialty residency.
The broad and flexible curriculum allows residents to put together a well rounded program suitable for their individual educational needs. Residents participate in a core curriculum that emphasizes the breadth and depth of internal medicine and a series of electives that allow them to explore areas of clinical and research interest.
The curriculum is based on three objectives. Residents will:
To meet these goals, residents gain clinical experience at three teaching hospitals and numerous ambulatory sites. Residency training is conducted at the University of Maryland Medical Center, at the modern and adjacent Veterans Affairs Medical Center, and at Mercy Medical Center -- a private community hospital within five minutes from University Center. Training in ambulatory care takes place at these sites as well as in clinics and private practices in Baltimore City and surrounding counties. Residents may also choose to do rotations at Area Health Education Centers (AHEC) in rural Western Maryland and on Maryland's Eastern Shore.
During the three year program, residents spend one-third or more of their time in ambulatory rotations, including a weekly continuity medical clinic, four Ambulatory Block Rotations, the Faculty Practice Offices, the emergency room, walk-in clinics and subspecialty clinics during consultation rotations. The timing of their clinic days is balanced with their inpatient responsibilities so that residents can focus their attention on each area.
Residents spend approximately half their time on inpatient rotations, including general medicine units, subspecialty services (e.g., cardiology, infectious diseases, oncology), medical and cardiac intensive care units, the medical consultation service and night/day floats. The rotation schedule is carefully arranged so that each resident has exposure to general medicine, all the subspecialties, clinical floors and intensive care units, while not allowing any one area to dominate. The remainder of their time is spent on clinical or research electives, including two electives in the intern year. A summary of the clinical rotations by year of training can be found in Curriculum in Internal Medicine. The entirety of our written curriculum, which details the competency based objectives for every required and elective rotation, can be accessed at Core Written Curriculum.
A Comprehensive mentoring program is an important component of our residency. We ensure that residents are paired with faculty with similar interests who guide residents as they develop and solidify their career goals. Faculty enthusiastically welcome residents to engage in research and take an active role in ensuring residents achieve success -- whether that is securing a subspecialty fellowship, or a primary care or hospitalist position.
Residents adjust their curricula based on their career goals. Residents planning a subspecialty career are strongly encouraged to engage in either clinical or basic science research activities. Residents receive close mentoring by faculty who have diverse clinical and basic science interests and provide abundant opportunities for residents to do investigative work. The Department supports residents whose research is accepted for presentation at regional or national meetings. The spring meeting of the Maryland Chapter of the American College of Physicians is an annual showcase of the residents' research and clinical case reports. At each year's May meeting, approximately 30 residents present their research or clinical vignettes.
For those planning a career in primary care, residents are encouraged to take rotations in geriatrics, women's health, sports medicine, neurology, endocrinology or rheumatology. Residents spend time in private practices in the community where they experience "real life" primary care and reach a deeper understanding of the business of medicine. They are also encouraged to spend a month at one of our AHECs where they learn the unique practice of rural medicine. Regardless of career choice, our residents are encouraged to seek a broad curriculum in ambulatory medicine from the many choices available.
An increasing number of residents are entering careers in hospitalist medicine.
Some residents will be hospitalists as a life-long career, while others are
hospitalists for a few years as they transition to a private practice or subspecialty
fellowship. Residents interested in hospitalist medicine are encouraged to take
electives that emphasize inpatient medicine, such as general medical consultation,
cardiology, infectious diseases, GI and pulmonary medicine, as well as rotations in
We also offer an Elective in Hospitalist Medicine that gives residents exposure to
medical consultation, quality assurance, utilization management, hospital administration and finance,
and delivery of evidence based care in the inpatient setting. Residents may also choose our
Procedure and Critical Care Consultation Elective. Here, residents consult on
services throughout the institution becoming proficient in key internal medicine procedures. We are implementing an exciting new curriculum in Patient Safety and Quality Improvement (PSQI). Under the guidance of our academic hospitalists and PSQI chief resident, elements of this curriculum are incorporated into a variety of conferences and the ongoing clinical QI projects. Residents participate in these projects as part of their assigned rotations and practice based learning exercises, thus developing skills useful in their future clinical careers in any setting.
We are deeply committed to residency reform, ensuring that residents work and learn in an environment with ample support services and with a minimum of stress. Our enormous efforts to realize these goals have resulted in a wonderful morale among our residents and an outstanding review from the RRC with a full 11-year accreditation from the RRC -- their highest level! We work diligently to be compliant with all ACGME Duty Hour Requirements, ensuring that all residents work <80 hours/week on average, have 8-10 hours off between duty shifts, are on duty <16 hours for interns and <28 hours for upper level residents, and have 4 full days off each month. With implementation of the July 2011 ACGME Duty Hour Requirements, we have undergone a major restructuring of our rotations to ensure full compliance, optimal patient safety, and positive resident morale. The GME leadership at UMMC has been phenomenally supportive of our residents, including funding for additional residency positions, hospitalists, moonlighting shifts, and ancillary support. They are fully aligned with our educational mission and those of the ACGME. These changes have had a very positive for our residents and maintain our high standards for residency education.
All these components ensure that the service needs of the hospital do not diminish our primary mission - the education of our medical residents.
The development of leadership and teaching skills is an important part of residency training. Throughout their rotations, residents develop the necessary skills to be clinical supervisors and teachers of the medical teams. By taking on progressive responsibilities, residents become comfortable dealing with a wide variety of clinical situations, including patient care, interpersonal situations and teaching. Residents attend an annual educational retreat where they improve their skills in giving feedback, teaching in small groups, specific teaching skills for medical students, managing conflict, and team building. These themes are also stressed in the outpatient setting where residents are the primary care providers for their panel of patients. We also have an educational retreat for the new interns during their orientation time, where they enhance their basic skills and explore principles of life-long learning, management daily patient care, importance of interns as student teachers, and professionalism. A best resident-teacher award is given to a senior resident each year -- reaffirming the importance placed on excellence in teaching as part of each resident's core responsibilities.
Ongoing communication between the residents and the faculty is highly valued and is considered critical to our success. We have developed a comprehensive curriculum using competency-based objectives and evaluations. Our web-based evaluation system of resident competence provides continuous feedback for residents, attendings and the program director. Residents are evaluated every month by the attending and receive an immediate email that they have an evaluation ready for viewing. Similarly, residents evaluate their attendings' teaching abilities and the educational value of the rotations every month, providing real-time feedback to Dr. Wolfsthal and the attending. A highly successful Peer Evaluation System allows residents to evaluate their interns and for interns to evaluate their supervising residents. Nurses in the clinics and various inpatient units also assess residents' skills. Students evaluate residents on their clinical, teaching and leadership skills, and the residents also evaluate their third and fourth year medical students. This comprehensive multi-source feedback system ensures that residents are continually striving to improve their skills in a positive and nurturing environment. Residents meet with Dr. Wolfsthal in a formal semi-annual feedback session where we review the resident's clinical performance, career interests, and educational goals for the coming year. Through the Postgraduate Education Committee, resident representatives from each class review feedback about the program and rotations, and contribute to the educational process. An Annual Needs Assessment gives residents another way to evaluate the overall residency and its components. Residents and faculty from all the divisions actively participate in this review process to continuously improve the curriculum and meet the needs of our residents.
A wide variety of conferences are held throughout the week -- each with a different format and purpose -- and provide residents with diverse learning environments. A highlight of each day is Morning Report, which also includes the Ambulatory Core Curriculum and Senior Resident Conferences. We are in the process of revamping our entire Core Conference Curriculum in all venues to ensure residents have a comprehensive exposure to the entirety of internal medicine and the skills necessary for their success. Our monthly Resident Research Forum provides a venue for residents to present their ongoing research to their peers and faculty. Medical Grand Rounds is the premier didactic conference of the week. Other conferences include the Clinicopathologic Conference (CPC), Ambulatory Care Seminars, and Board Review. Journal Club includes a comprehensive epidemiology and evidence-based medicine curriculum. Morbidity and Mortality Conference includes a comprehensive curriculum in patient safety and quality improvement. The Acute Medicine Series is held early in the year to provide residents with a foundation for the evaluations and management of acute illnesses. The Ethics Seminars are held throughout the year. Residents are also welcome to attend any of the weekly subspecialty conferences. Please see Curriculum in Internal Medicine for more information about our conferences.
Residents have on-line access to all our major conferences through Blackboard. You are welcome to view our Acute Medicine Lecture Series, Ambulatory Care Seminars, CATS from Journal Club and our Senior Resident Conferences on our Blackboard site. Enter the username and password imres to access the conferences. It is a marvelous compendium for our residents and provides a valuable educational resource throughout the year.