Curriculum in Internal Medicine

During the 36 months of training, residents in the categorical program participate in the following curriculum. The number of inpatient rotations -- or inpatient equivalents -- is fixed for each year of training and consists of floor rotations (general medicine, Med-ID and oncology), ICU's (MICU and CCU/telemetry), night and day floats, and Night Acting Chief Resident (NACR) rotations. With our academic year based on 13 four-week rotations, categorical interns have 8.5 inpatient equivalents, PGY-2's have 7 and PGY-3's have 6.5 blocks. There is some slight variation in the distribution of types of these inpatient equivalents, with categorical residents completing no more than 6 ICU months and no more than 4 months of night float over 3 years.

Interns in the preliminary program complete 9 inpatient equivalents (including 6-7 inpatient and 1.5-2 Day or Night Float blocks). Preliminary interns interested in anesthesiology complete 2 months of MICU as part of their CBY (clinical base year) requirement for anesthesiology and may request extra ICU months. 

We ensure that all interns have balanced experiences at both UMMC and the VA during inpatient and elective blocks.  Interns have a fall and spring Academic GIM (Y block) and upper level residents have six 2-week ambulatory (Y) blocks.  Continuity clinics occur weekly during electives and ECS rotations, and only once per block during general medicine rotations.  There are no clinics during ICU, CCU, night float or day float rotations. 

Rotations
Year 1
Categorical
Year 1
Preliminary
Year 2
Year 3
Inpatient services (including ICU's)
7
7
5.5
5
Night Float, Day Float, MAO
1.5
2
1.5
1
Night Acting Chief
0
0
0
0.5
Emergency Medicine
0.5
0
1
0.5
Ambulatory Blocks / FPO (AM electives, PM medical clinic)
0
0
3
3
Academic General Internal Medicine 1 0
0 0
Urgent care clinic (ECS) 1 0.5   0 0
Electives
1.5
3
1.5
2.5
Continuity Clinic
Yes
No
Yes
Yes
Vacation
4 weeks
4 weeks *
4 weeks
4 weeks

MAO = Medical Admitting Officer at Mercy Medical Center
FPO = Faculty Practice Offices (2 week ambulatory rotation)
ECS = Emergency Care Services (VA)
Vacation for interns = One 2 week block, 1 week during elective, and another week off at the end of the year from June 24-30 (if they are remaining at UMMC).  *Preliminary interns who are transitioning to residency at another institution are off June 24-30.
Vacation for upper level residents = One 2 week block and 2 single weeks taken anytime during electives.

We implemented a new rotation for categorical interns -- Academic GIM --in July 2016. During this 2-week block, interns spend every afternoon at their continuity clinic acclimating themselves to the ambulatory setting and adding patients to their panel. During the mornings, they do a variety of educational activities, including simulations, ultrasound skills, literature in medicine, IHI modules (for learning patient safety and quality improvement), interdisciplinary immersion (shadowing nurses), and attending a Risk Management meeting. The interns complete their Academic GIM block by November thus giving them a strong foundation for the rest of their intern year.  With the success of Academic GIM last year, we added a second Academic GIM block in the spring.

Conference and Inpatient Work Schedule

Our chief residents have created a marvelous web-based calendar in Google. You can access our conference schedule. Username = UMMC, password = applicant. 

7 am - 8 am

Work Rounds: First year residents pre-round on their patients in preparation for resident-run work rounds at 7 am. The team resident is responsible for supervising the clinical activities and for teaching the members of the team.


8:15 am - 11 am

Attending Rounds: Held 7 days per week at all inpatient sites. Led by the attending, these rounds are geared to the resident level and integrate clinical management and teaching with an emphasis on learning at the bedside.


12 - 1:30 pm (Tues, Thurs), 12 -12:45 (Mon, Wed, Fri)

Noon conferences with lunch:  These conferences are considered protected time.  Residents are released from consult services and morning clinics by 11:45 and their continuity clinics and afternoon consults do not start until 1:30 PM.  Nursing staff does not page residents during their education time unless it is urgent.  Various formats include a case-based conference, emphasizing problem solving and the evaluation and management of clinical problems, pre-clinic conferences on primary care topics, Journal Club, Board Review and Morbidity and Mortality conference. More details about our conferences are listed below.

Each senior resident write a manuscript on a comprehensive literature review of a topic of interest. The best manuscripts are selected for presentation at our Senior Resident Conferences in the spring.  All manuscripts are bound for distribution at the end of the year and are also available on our web site.  Waffle Day photoWe hold our monthly Morbidity, Mortality and Improvement Conference (includes Patient Safety and QI curriculum) and Medical Ethics Seminars. Medical Grand Rounds is our weekly premier conference for the Department of Medicine where expert speakers from the Maryland faculty and outside institutions present topics that are clinically relevant and timely.  During Journal Club, residents present a critically appraised topic in an evidenced based medicine format supported by a faculty mentor. This curriculum provides residents with the skills to perform an electronic search, conduct a critical appraisal of the literature and apply it to a clinical situation. Skills in epidemiology and biostatistics are emphasized. 

At the monthly Clinicopathologic Conference, clinicians are faced with analyzing a case history and developing a differential diagnosis. Every year a special historical CPC deals with an undiagnosed illness in a famous person. Examples of our previous historical CPC's include Alexander the Great, Edgar Allen Poe, Booker T. Washington and Abraham Lincoln were discussed.

Board Review: This year-long conference progresses through standard board review texts to cover the breadth and depth of internal medicine as residents prepare for their certifying exam from the ABIM. Residents develop the curriculum for each topic and deliver the material to their colleagues.

Acute Medicine Series: Held during the summer months, this series of conferences covers topics pertinent to acute inpatient medicine, such as respiratory failure, GI bleed, pulmonary edema and others. 


4 - 5 PM:

Sign-Out Rounds: These sessions are held daily between 4-5 pm and are led by the team resident. First year residents present the results of clinical work for the day and plans for subsequent management of their patients.  Residents directly transition patient care to the covering residents in person-to-person sign-outs.