Internship
Internship includes rotations on inpatient general medical wards, inpatient subspecialty wards, medical intensive care, cardiac intensive care, emergency medicine, ambulatory care, and 4 weeks of vacation. For details, see Internship Rotations. All categorical interns also have a weekly continuity clinic and ambulatory experience (continuity clinic is optional for preliminary interns).
The majority and core of inpatient general internal medicine training occurs at Boston Medical Center (BMC) and is complemented by a shorter experience at the Boston Veterans Administration Hospital (VA). At all hospitals, the intern is responsible for patient evaluation and selection of appropriate management strategies. Interns are the primary decision-makers on the teams and are given guidance and support by the residents and attendings. At BMC, the experience emphasizes acute medical illnesses prevalent in an inner city patient population as well as a variety of patients at all levels of complexity referred to a major tertiary medical center. On the inpatient general medicine service at the VA, interns are responsible for patients with a broad spectrum of problems with significant cardiovascular, pulmonary, and oncologic pathology. The inpatient ward teams are structured such that the intern works with another intern, third and/or fourth year BU medical students, a resident and a teaching attending. At the VA all BMC house staff work alongside house staff from Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center.
Interns have inpatient specialty ward experiences at BMC on the Hematology/Oncology, Renal, and Geriatric services. All interns will not spend time on every service during the year, but most will do at least one month on one of the three services. The Hematology/Oncology service at BMC provides training in the evaluation and management of a referral population with a wide range of malignancies and hematologic disorders. The Geriatric service is the inpatient site for the acute care of elderly patients whose primary care physicians are Geriatricians at BMC, allowing for excellent continuity of care. In addition, we have rotations in pulmonary medicine and cardiology at the VA that is a referral center for patients with acute and chronic pulmonary and cardiac disease from all over New England. All house officers have the opportunity to choose these rotations as interns and residents.
Interns obtain training in intensive care in the Medical Intensive Care Unit (MICU) at BMC and the VA, where they manage critically ill patients under the supervision of Pulmonary/Critical Care fellows and attending staff. The Cardiac Care Unit (CCU) experience is also obtained at BMC and the VA. Interns learn to manage acute cardiac diseases with an emphasis on acute coronary syndromes, decompensated heart failure and cardiomyopathies, and arrhythmias. The Interventional Cardiology program and the Electrophysiology laboratory are important resources for Cardiology training. In both the MICU and CCU teams are structured with two interns, two residents, a fellow, and attending. There are dedicated teaching conferences during these months in the corresponding subspecialties.
Training in Emergency Medicine is obtained at the BMC Emergency Department, where interns evaluate and treat patients with medical emergencies under the supervision of residents and Emergency Medicine faculty. Interns evaluate patients in acute and non-acute settings in the ED in order to gain experience in appropriate emergent management. In the BMC Emergency Department, which is the busiest in the state of Massachusetts and one of only two level-1 trauma centers in eastern Massachusetts, Internal Medicine house officers work side-by-side with colleagues from Surgery, Pediatrics, Obstetrics/Gynecology, Psychiatry and Emergency Medicine.
Interns do not spend any time on a night float rotation, which is a rotation solely for junior and senior residents. Interns do work overnight, however, and this occurs on the inpatient general medicine wards and intensive care units. Overnight call occurs every 8th night on the wards and every 4th night in the intensive care units.
