The BMC internal medicine residency program has a long tradition of training outstanding clinicians, yet the leadership readily embraces changes to continuously improve clinical training and the educational curriculum. The program leadership works closely with chief residents, other core educators and invites input from residents in designing innovative programs. Examples of a few innovations are given below.
In the new 3+1 model which started in July 2010, our categorical and primary care residents alternate between 3 weeks of inpatient or elective rotations and 1 week of ambulatory experiences. This enables residents to have dedicated inpatient and outpatient clinical experiences, hone clinical skills in the respective areas of clinical medicine and attend educational conferences that form the core of inpatient and ambulatory medicine. Practically speaking, this means that residents no longer have to interrupt their afternoon on the wards or ICU to go to clinic!
The Academic half days were initiated in July 2009 as a dedicated educational half day during the ambulatory week. Interactive seminars on important topics such as EBM, communication skills, patient safety and physical diagnosis were the focus of these half days. Given its success, these half days have been incorporated into the ambulatory weeks on Fridays, using a “boot camp” approach where we go from the EBM boot camp to patient safety and QI boot camp and so on. These seminars are interactive, taught by experts in the various fields and allow for skills practice.
The C-REX (clinical reasoning exercise) is a one hour conference held weekly on Wednesdays. Complicated cases are presented and discussed by the house staff in the presence of expert clinician faculty discussants focusing on clinical reasoning, diagnostic and management strategies.
Resident Reports are held twice daily and are taught by expert bedside diagnosticians. The emphasis is on the complete spectrum of clinical skills: history taking, systematic examination, interpretation and clinical significance of findings as well as and clinical reasoning. These reports are aimed at junior and senior residents are taught at an appropriately advanced level. Starting in 2011, the summaries of each Resident Report have been posted online. These summaries are searchable by topic and include links to useful articles and reviews.
A 5-station physical exam OSCE is organized for incoming interns during the orientation week, using real patients recruited from various clinics and observed by faculty. We use this exercise as needs assessment to inform us about global deficiencies in physical exam skills among incoming residents and also as an immediate one-on-one teaching and feedback tool.