Special Concentrations
| Medical Informatics Concentration Substance Abuse Concentration Medical Education Track Preventive Medicine Residency Women’s Health Concentration |
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Special concentrations in Medical Education, Women’s Health, Substance Abuse and Medical Informatics are available for fellows who wish to focus on one of these areas. There is also the option of completing a Residency in Preventive Medicine. These concentrations are an optional part of the Family Medicine/General Internal Medicine Fellowship program and are fully integrated within the Fellowship. Often, fellows do not decide to pursue one of the special concentrations until after beginning their fellowship (typically during the first few months). However, some fellows apply specifically for a particular concentration and should mention this in their application and interview. Note that it is possible to be concentration in more than one area during the fellowship or no tracks at all. Below is a one-sentence statement about each concentration. An in-depth description of each is below.
- The Medical Informatics concentration trains fellows to assume roles in computer-based delivery of health services.
- The Preventive Medicine option fully prepares the fellow to become board certified in General Preventive Medicine.
- The Medical Education Track provides a framework for fellows interested in a career with a focus on medical education.
- The Substance Abuse concentration trains fellows to conduct advanced research in alcohol, and drug abuse, and offers the option of clinical specialty addictions experience and special teaching opportunities in national forums.
- The Women’s Health concentration includes research experience in Women’s Health under the mentorship of faculty who have made this the focus of their careers, and clinical experience in two interdisciplinary Women’s Health Centers.
Medical Informatics Concentration
- Medical Informatics training is offered at Boston University Medical Center and at the Boston VA Healthcare System.
- Boston University Medical Center training is part of the National Library of Medicine-funded Boston Research Training Program in Medical Informatics. This program includes Harvard Medical School and two of its teaching hospitals (Massachusetts General Hospital and Brigham and Women’s Hospital), Harvard School of Public Health, Massachusetts Institute of Technology, New England Medical Center, and Boston University Medical Center.
- Medical Informatics courses are taught in Boston University School of Medicine’s Division of Graduate Medical Sciences and in other schools of the university by physician and computer science faculty led by Robert H. Friedman, Chief of the Medical Informatics Systems (MISU) Clinic at BU and director of the FM-GIM Fellowship Program and by Timothy Bickmore, PhD, a computer scientist in the MISU.
- Training can lead to an MS degree. Fellows participate in medical informatics and perform supervised research in medical informatics.
- The training emphasizes effective application of computers and information technology to a variety of aspects of clinical care (including clinical decision-making) and to healthcare research.
- The Boston VA Healthcare System training is part of a VA Special Fellowship in Medical Informatics headed by Stephen Gaedhe, M.D., M.P.H., a general internist, informatician and graduate of the BU FM-GIM Fellowship Program.
- Training takes place in supervised research settings with a focus on the use of computers technology in clinical care, research, quality assurance, management, and clinical decision-making.
- Fellows take courses Medical Informatics courses at Boston University (described above).
- The Medical Informatics Track provides comprehensive training in Medical Informatics and prepares fellows for careers in this discipline. Since fellows will participate in all the other curricular components of the GIM Fellowship Program, the training prepares them for careers that focus on Medical Informatics research, program development and teaching.
Medical Education Concentration
The concentration in medical education provides a framework for fellows interested in a career with a focus on medical education. Fellows are mentored by experienced faculty in projects that improve their personal teaching skills and enhance academic competence in areas applicable to leading and improving educational programs. This track is designed to train physicians for academic careers in medical education.
Academic work is conducted in the broad field of medical education. Fellows are free to pursue mentored research or curriculum design on any feasible topic. Fellows have ample opportunity to present projects in various stages of development to peers and faculty. Some examples of recent fellow initiated projects include:
- Cross sectional assessment of medical student empathy from pre-clinical through clinical training
- Evaluation of a SOCS, structured observation of clinical skills, of 3rd year clerks
- Resident response to medical error
- Comparison of readiness for residency of Japanese compared to US medical school graduates
- Qualitative assessment of trainee perspective on bedside teaching
Personal teaching skills are enhanced through participation in clinical teaching seminars and practical teaching experiences. Practical teaching includes co-teaching experiences during which fellows are paired with senior faculty on a clinical service and direct observation of teaching encounters with detailed feedback is provided. Many types of additional teaching practicum are available and tailored to trainee interest. These include: ambulatory precepting, inpatient attending, problem based learning courses for pre-clinical students, physical diagnosis teaching, evidenced based medicine education, continuing medical education, and internet based education are just a few.
Fellows have opportunities to develop administrative skill through participation in an administrative practicum. These mentored experiences place fellows on a task force or standing committee responsible for an educationally critical area such as student assessment, curriculum design, faculty development etc. Mentors within the Dean’s office, the Clerkships or Residency are identified to work with fellows.
Fellows matriculate in the SPH in the M.Sc. in Health Services Research. This concentration allows fellows with an educational interest to take a curriculum design course at the School of Education, and research methods course applicable to educational research, qualitative research methods and survey design. Fellows also participate in other core components of the fellowship program such as the Academic Conference. This conference covers topics such as working with a mentor, time management, writing and reviewing abstracts for meeting presentations, writing for medical journals, developing a resume and others that are critical for success in academic medicine. Like all our GIM fellows, those in the Educational track present their work at local, regional and national meetings.
Since its inception, the BU GIM Fellowship has provided a sound foundation for generalists interested in academic careers focused on medical education. Past fellows serve as clerkship directors, residency directors and associate directors, and key clinical educational faculty at many medical centers across the country.
The Boston University Preventive Medicine (PM) Residency has a close affiliation with the GIM and FM Fellowship. Some participants in the PM residency apply to the fellowship program with a focus on academic medicine and subsequently elect to do the residency after acceptance into the fellowship program, whereas others come specifically for the residency program in Preventive Medicine with an intention to pursue a public health career. The Preventive Medicine Residency was started as an offshoot of the GIM Fellowship in the late 1980s. Unlike either the FM or GIM fellowship program, it is an accredited program through the Accreditation Council on Graduate Medical Education (ACGME). The BU PM Residency was accredited for 5 years in October 2002. Because the fellowship is not an ACGME accredited program, all fellowship activities count toward the PM Residency. The national requirements of the PM Residency largely overlap with the fellowship requirements:
- A clinical internship. All our PM residents complete a complete clinical residency in the United States prior to entering the program. Usually these are internal medicine, family medicine or pediatrics programs. Our program is not accredited to offer this option.
- An academic year consisting of a Masters degree at an accredited School of Public Health. Our PM residents complete one of three degree options: Masters of Science in Epidemiology, Masters of Science in Health Services or Masters of Public Health. Each degree qualifies for the national requirements, although PM residents in the MSc degree programs are required to take an additional course in Environmental health. See description of SPH training for more information.
- A “practicum year”, which includes a variety of scenarios nationally. In our program, this includes clinical (e.g. primary care) exposure, research projects and practical experience in a public health setting. This varies widely from program to program around the country. All of the fellowship activities apart from the SPH are counted toward the practicum year. In addition, the PM residents are required to do a project at a Federal, State, or Local public health agency that is the equivalent of one month of full time work. See below for more details on the public health agency experience.
Our program runs the academic and practicum simultaneously over the two years and do not accept applicants to do only the practicum year.
Requirements above and beyond the general fellowship curriculum (see fellowship curriculum for more information) include a twice-monthly lecture series covering clinical preventive medicine and public health topics, field trips and a one-month equivalent experience in a public health agency.
Lecture Series and Field Trips
The curriculum for the lecture series and field trips runs over a two-year basis. It includes outside speakers, usually public health physicians or experts in public health topics, as well as talks by the residents themselves. The field trips involve ½ day visits to local sites of interest that help round out the experience of the residents. Examples of recent field trip sites include occupational medicine office at industrial sites (including factory tours), state lab for infectious diseases, and substance abuse treatment programs.
Board Certification
Participation in the PM residency leads to board eligibility. The PM residency graduates are expected to take the PM boards in November after they graduate. To help the residents prepare, an in-service exam is offered each year and the lecture series is geared to give specific knowledge that will be useful to pass the board exams.
Public Health Agency Experience
The public health agency experience includes an individualized program for each PM resident that combines the resident’s interest with a public health agency needs. As a general rule, these are run on a longitudinal basis at a Boston area agency site. On occasion, PM residents can take a leave of absence from Boston to work at a distant site, either nationally or internationally. Examples of recent experiences include:
- Working with the Massachusetts State Department of Public Health (DPH) to craft a document on the burden of cancer in Massachusetts by a resident interested in cancer control. (Career interest: Cancer control)
- Participating in a state task force on Suicide prevention through DPH (Career and research interest: adherence to depression guideline)
- Working with DPH vaccine control to promote flu vaccination among health care personnel and hospitalized patients
- Organizing a coalition of colleges and emergency response agencies to develop guidelines for treatment of intoxicated college students (Career and research interest: substance abuse prevention in young persons)
- Teaching Obstetric Care Lifesaving to Eastern European obstetrical care practitioners, organized by international organizations
- Directing a state-wide community based study on osteoporosis prevention, funded by DPH (clinical and research interest: bone health/women’s health)
- Developing patient education materials in foreign languages for specific populations serviced by neighborhood health centers.
In addition to these individual activities, PM fellows also have exposure to some standard health agency activities: meetings of the board of the local and state departments of public health, a meeting of the board of registration, a hearing at the state legislature, etc.
Fellows have chosen to focus on substance abuse as a topic area for development of their academic careers under general medicine faculty mentorship in the Clinical Addiction Research and Education (CARE) Unit in the Sectional of General Internal Medicine at Boston University School of Medicine/Boston Medical Center. The experience of these fellows includes all of the other experiences of the other General Internal Medicine fellows, except that his/her clinical, educational and research experiences focus on alcohol, tobacco and/or other drugs.
Research is conducted in collaboration with mentors who have external funding for multiple ongoing clinical and health services research studies and have been nationally recognized for their research. Examples of recent topic areas of focus for fellows are: homelessness and relapse, medical burden of illness in patients with addictions, primary care and substance abuse, HIV and alcohol problems. Examples of ongoing externally funded projects include: a randomized trial of a primary medical care linkage intervention for patients in an inpatient detoxification unit, a randomized trial of a motivational interviewing brief intervention for alcohol problems in hospitalized medical patients, a cohort and cost-effectiveness study of patients with HIV and alcohol problems, and a randomized trial of an adherence intervention for patients with HIV and alcohol problems.
The CARE Unit has support from two National Institutes of Health R25 education grants, one from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and another from the National Institute on Drug Abuse (NIDA). The NIDA Clinical Addiction Research and Education (CARE) project supports a generalist fellow to pursue mentored drug abuse research and to participate in teaching activities including a 4-day immersion training experience for chief residents. The NIAAA Alcohol Clinical Training (ACT) project provides a fellow with mentored teaching experience (teaching of faculty at national meetings), a mentored research experience, and the opportunity to participate in the development of novel teaching strategies for alcohol problems. In addition to these research and education experiences, optional clinical experiences are available at an on-site inpatient detoxification unit and a local methadone maintenance treatment program.
The BU General Internal Medicine Fellowship is proud to offer a formal Women’s Health Track providing research, teaching, and clinical experiences in Women’s Health. In 1994, funding from the Department of Veterans Affairs made it possible to create this track designed to train physicians for academic careers in Women’s Health.
Research is conducted in the broad field of Women’s Health, under the supervision of faculty with national reputations in this area. Although fellows are free to pursue research on any feasible topic, some examples of ongoing research projects include:
- Patient navigation to improve outcomes following abnormal cancer screening
- Exercise intervention to improve cardiovascular outcomes
- Investigation of Women’s Health delivery systems
- Haitian Health Study: a community-based survey looking at screening practices of Haitian women
- Evaluation of cultural competence curriculum
Clinical experiences include two half-day sessions of continuity care, and additional time for elective experiences in areas such as:
- Breast health — including training on needle biopsy and aspiration procedures
- Obstetrics and gynecology
- Osteoporosis
- Women’s cardiology
- Post-traumatic stress disorder
- Military sexual trauma
Fellows will develop other skills such as:
- Administrative: organizing a monthly Women’s Health Conference Series for the VA Medical Center
- Teaching: co-teaching lectures and seminars to house-staff and other health care providers
The Women’s Health Unit at Boston Medical Center was founded in 1986 as one of the first academic comprehensive health care practices for women. Primary, preventive, gynecologic and mental health care is provided by a team of general internists, nurse practitioners, and psychologists. In collaboration with Surgical Oncology and Radiology, the Women’s Health Unit created the Breast Health Center in 1989, which provides state-of-the-art, coordinated care for women with benign and malignant breast disease.
In early 1994, the Boston VA Medical Center became one of only eight sites nationally to be funded for a Comprehensive Women’s Health Center, which, like the Women’s Health Unit, is interdisciplinary and patient-centered in its clinical approach. The Women Veterans Health Center profits from a close affiliation with the Women’s Health Science Division of the National Center for Post-Traumatic Stress Disorder, the first of its kind nationally. Regular team meetings include mental health professionals which fosters a holistic, biopsychosocial approach to patient care.
Boston University has been designated as a National Center of Excellence in Women’s Health by the U.S. Department of Health and Human Services, the longest standing Center of Excellence in New England. The Women Veterans Health Center has been named a VA Clinical Program of Excellence.
The Women’s Health Fellow has access to all the resources of the entire fellowship program. Likewise, fellows not identified as the women’s health fellow also have access to the women’s health training resources.
Fellows who have completed the women’s health fellowship have gone on to academic careers in women’s health research, women’s health education, and administration of women’s health clinical programs. Recent graduates are currently faculty members at Boston University, Rush Medical Center, Vanderbilt Medical Center, Wake Forest University, Emory Medical Center, and Hershey Medical Center.
