General Internal Medicine
The Section of General Internal Medicine (SGIM), located at Boston Medical Center and the Boston VA Medical Center, sponsors a wide array of educational, patient care, and research activities. The Section was founded in 1974, at a time in which increasing medical specialization had occurred, yet a need existed to establish a departmental focus for teaching fundamental concepts of internal medicine and for research in clinical epidemiology and health services. Since those early days the Section has grown to play a central role in the department’s clinical, educational, and research missions.
- Jeffrey Samet, MD, is Chief of the Section of General Internal Medicine at Boston University School of Medicine.
- At Boston Medical Center, Peter Davidson, MD, is Associate Section Chief for Clinical Affairs;
- Christopher Shanahan, MD, is Director of the Community Medicine Unit;
- Karen Freund, MD, is Director of the Women’s Health Research Unit (WHRU);
- Robert Friedman, MD, is Director of the Medical Information Systems Unit (MISU);
- Richard Saitz, MD, is Director of the Clinical Addiction Research and Education (CARE) Unit;
- Arlene Ash, PhD, is Director of the Health Care Research (HCR) Unit.;
- Angela Jackson, MD, is Director of the Primary Care Residency Training Program;
- Warren Hershman, MD, is Director of Medical Student Education;
- Jason Worcester, MD, is Medical Director of the Harrison Pavilion Ambulatory Practice;
- Janice Quan, MD, is Medical Director of the Newton Pavilion Ambulatory Practice;
- Subha Ramani, MD, is Director of the Medical Consultation Service
The General Internal Medicine Fellowship Program is led by Robert Friedman, MD (Director) and Jane Liebschutz, MD (Associate Director).
The General Internal Medicine Group Practice is designed to function as a model system, providing primary care for its patients while giving the house staff experience in continuity of care, health care screening, and the broad spectrum of outpatient medical problems. The house staff and attending staff, organized into small teams, share responsibilities for this practice. Practice is conducted in several languages: English, Spanish, French, Portuguese, and two dialects of Creole.
The Primary Care Training Program (PCTP), started in 1974, is one of the oldest primary care programs in the country and continues to be a national leader in generalist training. The PCTP prides itself in training superb, well-rounded internists, well equipped to pursue a wide variety of career paths. An innovative curriculum provides residents with both comprehensive training in the care of acutely ill inpatients and with diverse ambulatory experiences. Over the past 24 years, 80% of the almost 300 program graduates have chosen careers in general internal medicine, and over half have chosen to practice in medically underserved communities.
The Community Medicine Unit’s mission is to support the development and management of clinical, educational, and research programs with a community focus. The unit can trace the ancestry of its mission to the earliest days of the Section and over the last 25 or so years in which it evolved to administer the BMC Internal Medicine Joint Hire Program (JHP). This program, established in 1992 is an innovative program to jointly recruit and hire excellent clinician educators/investigators between the academic hospital and the community health centers. Creating and preserving robust links for communication and collaboration with the Boston HealthNet as well as with the affiliated HealthNet community health center medical directors and their staff physicians has been a priority.
The research activities of the Section are largely pursued through the Research Units: CARE, HRU, MISU and WHRU. The research activities among faculty include issues pertaining to the health of an urban population. The Clinical Addictions Research and Education (CARE) Unit, established in 1991, examines clinical and health services aspects of alcohol and drug abusers including HIV infected patients, victims of violence, and specific minority populations. The methodologies employed include randomized controlled trials, cohort studies, and qualitative analyses. Funding for these activities comes from the National Institutes of Health, including the National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, and the National Institute of Mental Health as well as the Massachusetts Department of Public Health and the Robert Wood Johnson Foundation.
The Health Care Research (HCR) Unit studies a number of areas, such as physician practice patterns and cost-containment strategies. The Unit’s studies include the impact of DRGs on medical practice as well as variations in physician practice patterns thoughout the United States. Many of the projects of the Unit involve measurement of the quality of hospital and ambulatory medical care.
The Medical Information Systems Unit (MISU), established in 1978, focuses on computer applications in clinical medicine. The Unit has developed an innovative computerized telecommunications system that has been shown to help physicians monitor the clinical status of their ambulatory patients in their homes and counsel patients to change their health behavior. The system can counsel patients on taking medication, diet, exercise, and cigarette smoking, and can monitor chronic diseases such as hypertension, diabetes, and heart disease. Funding has been obtained from several NIH institutes.
The Women’s Health Research Unit (WHRU) is one of only twelve sites nationally honored as a Center of Excellence in Women’s Health by the Department of Health and Human Services Office on Women’s Health. The Unit includes a model practice for women, The Boston University Medical Associates’ Women’s Health Group that focuses on providing coordinated and comprehensive, one-stop services to women. The practice includes all primary and preventive medical care, psychological services, and case coordination. The Women’s Health Group is part of Boston Medical Center’s multidisciplinary Breast Health Center, providing consultation and care to women with benign and malignant breast disease. The Unit is active in post-graduate and continuing medical education. The Unit established the Boston University Breast and Cervical Cancer Training Institute, funded through the Massachusetts Department of Public Health, to provide continuing education on a broad array of women’s health issues to health care providers throughout the state. The Unit is an active site for medical students, residents, and fellows to receive training in the ambulatory care of women. The Unit also plays a major role in the training of future researchers and leaders in Women’s Health. The Unit is one of only six Women’s Health Fellowship Programs, funded through the Veterans Administration. The Unit is also funded as one of 24 sites with an NIH K-12 mentored research training awards, which trains faculty scholars towards of the goal of becoming independent investigators in women’s health research. Research activities of the Unit include clinical epidemiologic and health services research investigations into a wide range of women’s health topics. A focus of the research in the Unit is understanding health disparities in care to minority women, and developing interventions to eliminate these disparities. Research in the Unit has spanned a breadth of issues related to women’s health and gender differences, including cardiovascular and cerebrovascular disease, diabetes, hypertension, hormone replacement therapy, breast cancer screening and treatment, eating disorders, depression, and violence against women.
Research opportunities, as well as technical assistance, are available to fellows and house officers who wish to participate in ongoing projects or to undertake their own projects in each of the Research Units of the Section of General Internal Medicine.
The Section of General Internal Medicine at the Boston VA Health Care System Medical Center (BVAHCS) commenced in 1987. It is currently headed by Louis Fiore, MD who is also Co-Director of MAVERIC, (Massachusetts Veterans Epidemiology Research and Information Center). Jay Orlander, MD, is an Associate Program Director of the Medical Residency Program and of the BU GIM Fellowship Program; Margaret Seaver, MD, is Director of the Comprehensive Women’s Health Center; Stephan Gaehde, MD, is Director of Emergency Services, and Program Director of the Medical Informatics Fellowship; Sandy Wahi-Gururaj, MD, is an Assistant Program Director of the Medical Residency Program and Director of Medical Student Education and Dan Berlowitz, MD, is Vice Chair for Health Services Research.
The Section at BVAHCS is extensively involved in house officer and fellowship training. Faculty participate in program administration and supervise trainees at all levels. Research opportunities for trainee exist through Epidemiology, Clinical Trials, and Health Services Research programs. An accredited residency in preventive medicine is supervised jointly with the Section of Preventive Medicine. The Section at the VA runs a unique clinic for patients with active medical problems, called the Ambulatory Diagnostic and Treatment Center (ADTC). Here, house officers manage outpatients with active medical problems such as involuntary weight loss, poorly controlled hypertension, or pulmonary mass lesions. The unit is staffed by residents in the Boston University Internal Medicine Program.
A General Internal Medicine Fellowship program, based on both campuses, established in 1982, offers advanced training in general internal medicine with concurrent work toward a Masters degree through Boston University School of Public Health. An accredited residency in preventive medicine is supervised jointly with the Section of Preventive Medicine. The Section of General Internal Medicine fellowship program emphasizes the development of research and teaching skills in general internal medicine and ambulatory care. There are special tracks in Women’s Health, Preventive Medicine, Health Services Research, Medical Informatics and Care to Underserved Communities. Research skills are developed through didactic instruction and supervised research experiences. Fellows also learn teaching methods, have opportunities for supervised teaching, and participate in a management skills training seminar. During the two years of training, fellows matriculate in the Boston University School of Public Health and earn a Masters of Science (MSc) degree, concentration in either epidemiology and health services. By completing the fellowship, fellows are prepared to assume academic general internal medicine faculty positions as educators, researchers or administrators and similar positions in public health and industry. All 70 graduates of the program, which was founded in 1980, hold these types of positions throughout the United States.