The Training Program
Our program offers outstanding clinical and research training in all areas of internal medicine. Through diverse and complementary experiences at our major teaching hospitals, and with the guidance and supervision of a strong medical school faculty, house officers attain skills in all aspects of patient care. They may choose among a wide variety of electives, developing areas of special concentration or enrichment throughout their training.
We offer both a three-year categorical program in Internal Medicine and a preliminary program. Residents may also opt for special programs such as the Primary Care Track, or the ABIM Research Pathway. Although categorical and preliminary interns work side by side, preliminary interns have options for electives not available to categorical trainees until their second and third years. It is assumed that all three-year trainees who successfully complete their internships will stay on for the second and third years.
The intense inpatient and outpatient clinical teaching opportunities offered at BMC, affiliated community health centers and the VA remain the cornerstone of teaching and learning for our residents. In addition, we have a variety of formal teaching activities designed to enhance the learning that occurs during clinical rotations. These include: daily morning reports, daily noon conferences, monthly morbidity & mortality rounds, weekly department grand rounds, weekly clinical reasoning conferences, physical diagnosis rounds and “boot camps” in EBM, patient safety and physician-patient communication during the ambulatory weeks. Educational methods vary from short to long case discussions, interactive seminars, bedside rounds and didactic lectures.
A sample conference schedule during the ambulatory week:
|7.45-8.30||Core curriculum||Case discussion||Core curriculum||Case discussion||Subspecialty conference|
|9-12||Academic half day|
Ambulatory Case Conferences are held twice a week throughout the year. Residents attend these sessions during their clinic weeks (every 4th week in the 3+1 system). This conference is led by the ambulatory chief resident along with faculty discussants. Discussions focus on outpatient topics and issues that relate to ambulatory care and case presentations are the principal format used.
Ambulatory Core Curriculum sessions are held twice a week led by the ambulatory chief resident and faculty. We have selected key topics from the Yale ambulatory curriculum as the core curriculum across the year. 2 topics are covered each week repeated every week for 4 weeks (different resident cohorts on weeks 1, 2, 3 and 4 of a four week block) so that all residents receive education on the same topics. The educational method is a combination of case discussion and didactics.
Academic half days: Friday mornings during the ambulatory week are dedicated educational half days. Typically, the morning starts with a subspecialty conference followed by an academic seminar. The seminar is then followed by the Department of Medicine Grand Rounds. Areas covered in the academic seminars include EBM, Patient safety and Quality Improvement, Physician-Patient communication and Physical Diagnosis. These seminars are interactive, taught by experts in the various fields and allow for skills practice.
A sample weekly conference schedule:
|10-11 am||Morning report (HAC)||Morning report (HAC)||Morning report (HAC)||Morning report (HAC)||Morning report (HAC)|
|12-1 pm||Noon conference||Intern report Resident journal club and board review||C-REX||Noon conference||Department of Medicine Grand Rounds|
|2-3 pm||Resident Report (ENC)||Resident Report (ENC)||Resident Report (ENC)||Resident Report (ENC)||Resident Report (ENC)|
|1-4 pm||Attending Rounds (varies by team)||Attending Rounds (varies by team)||Attending Rounds (varies by team)||Attending Rounds (varies by team)||Attending Rounds (varies by team)|
Resident Reports are held daily from 10 to 11 am on the Harrison Avenue Campus and 2 pm to 3 pm on the East Newton Campus. These conferences are led by the inpatient chief residents with a focus on diagnosis and management of patients actively being cared for on the medical service. Residents present cases to the chief resident and a faculty discussant with the goal of promoting in-depth interactive discussions of clinical data and reasoning, diagnosis and management. Cases may be newly admitted patients or recently admitted complex or interesting patients. Based on the case being presented, clinical questions are generated and evidence supporting diagnostic strategies and management decisions are presented.
Ward Attending Rounds: Formal teaching rounds led by the team attending occur during inpatient rotations. At BMC, the service attending is also the teaching attending and we believe this congruence is of great value in providing high quality clinical education in the setting of direct patient care. The learning during these sessions focuses on real time diagnostic and management issues surrounding patients currently admitted to the team. Periodic bedside teaching is strongly encouraged dedicated to clinical skills teaching.
Department of Medicine Grand Rounds are held weekly on Fridays between noon and 1 pm as the primary Department teaching conference for all faculty and house staff. The grand rounds are presented by invited experts who are national leaders in their respective fields from within and outside the institution. The sessions include clinical problem solving exercises of challenging cases, recent developments in medical research and occasionally new developments and mandates in medical education.
C-REX (Clinical reasoning exercises): Our weekly conference, Clinical Reasoning Exercise (CREX), is an opportunity for house officers and attending staff to polish and refine their skills in developing diagnostic and management strategies based on bedside clinical observations and sound reasoning. Complex, challenging cases will be presented and discussed in a manner which allows the group to draw clinical inferences, to develop testable hypotheses, and to interact in a safe and collegial environment. The focus is more on how we think than on what we know, and we look to master clinicians from Medicine and other disciplines to help us understand the process of clinical reasoning.
Noon Conferences are held on Mondays and Thursdays from 12 noon to 1 pm. BUSM / BMC faculty, with expertise in specific areas, present topics which form the core curriculum of mainly inpatient medicine typically in didactic format. These topics cover all commonly encountered diseases and problems on the medical service, medical consult service, units and emergency department. Lunch is provided for housestaff.
Morbidity & Mortality conferences have been long held on the last Wednesday of each month presented by a chief resident. The focus is on cases with unexpected adverse outcomes; both clinical and systems errors are discussed. The forum provides a safe environment for housestaff and faculty to learn from diagnostic and therapeutic errors. It is attended by housestaff, faculty including those with leadership roles in QI and safety, pathologists, pharmacists, nursing leadership are invited as appropriate. The conference concludes with take home points and discussion of strategies to rectify avoidable errors in the future.
Intern Conferences are held twice weekly: on Tuesday between 12 pm and 1pm and Friday in place of resident report. This is a protected (i.e. beeper-free) conference for interns only. Tuesday Intern Conference is a large group session which typically is a didactic session on core medicine topics. However, teaching formats can vary with case presentations, discussion of hospital systems, discussion of patient safety and quality issues, review of common diagnostic tests, physical diagnosis etc. Friday Intern Report is a new small group, case-based discussion which is meant to enhance interns’ ability to reason through complex cases.
Resident Board Review Sessions and Journal Clubs alternate every Tuesday between 12 noon and 1 pm. Junior and senior residents present articles at journal clubs from recent literature to their peers and a faculty discussant. The goals include both critical appraisal of study methodology, results and relevance to patient care. Landmark trials may also be reviewed at these session with a focus on promoting knowledge of these trials rather than detailed appraisal of study method. Faculty experts in EBM facilitate these discussions. Board review sessions are presented by chief residents with faculty experts present to review sample Internal Medicine board questions. Lunch is provided.
Research, Scholarship and Career development dinners are held 5-6 times a year. These focus on fellowship choices, application and interviewing with presentations by chief residents and fellowship directors; research and scholarship showcasing the many types of research opportunities within the department presented by the Department Chairman and several outstanding clinical investigator faculty; career opportunities as generalists or specialists facilitated by a variety of faculty with different career tracks.
Town meetings are held once a month instead of the noon conference. These are attended by housestaff, chief residents and program directors. Examples of topics discussed include: changes in clinical rotations or call structure, discussion of evaluations, electronic medical records, brainstorming around the residency curriculum and teaching sessions etc.
In addition, special conferences and presentations occur throughout the year including the Franz J. Ingelfinger, William B. Castle, Philip Kramer, and Lauren Harris visiting professorships. Each November, the service commemorates the Evans Memorial Department of Clinical Research with a three day-long series of seminars and presentations of scholarly work completed by house officers, fellows, and faculty.