The Internal Medicine Residency Program at BUMC offers residents specialized tracks, known as pathways, that provide individualized additional training in areas of expertise and distinction. Enrollment in pathways is open to residents in the fall of PGY2.
Urban Health and Health Equities Pathway
Human health and wellness are tightly linked with the communities in which we reside – our neighborhoods, our cultural communities, our built environment, and our socioeconomic realms. The Urban Health and Health Equities Pathway is designed for residents interested in delving more deeply into the Boston-based urban communities in which so many of our BMC patients live.
Residents in this pathway will receive advanced training in health disparities and medical management of clinical issues frequently seen in underserved patient populations. Residents will also gain exposure to a variety of urban health issues – including substance use, immigrant/refugee health, urban violence, hunger and food access, housing/homelessness and more.
Each year we accept two rising junior residents into the pathway after an application process. Each resident will have a variety of elective clinical experiences, including exposure to addiction medicine clinics, refugee clinic, work at healthcare for the homeless, needle exchange, and more. Residents also have one week of dedicated elective time to urban health. Educational activities include didactics on health disparities, training in health advocacy methods, and site visits to relevant social services organizations including urban farms, local advocacy organizations, community health centers, respite hospitals, and more.
Current resident projects include:
- Improvement in cervical cancer screening in refugee populations
- Development of intern educational conference on local community resources
Sample Urban Health Elective Week Schedule
|AM||Geriatric Home Visits||CSAC Methadone Clinic||Primary care of the Refugee patient||FAST-PATH HIV Clinic||Neighborhood Tour – North Dorchester|
|PM||Reading time||Suboxone Clinic||Urban Health didactics||ER Violence Intervention Advocacy Program||Shattuck Hospital Visit|
Sample Clinic Week Schedule
|AM||Continuity Clinic||Continuity Clinic||Continuity Clinic||Continuity Clinic||Academic Half-Day|
|PM||Healthcare for the Homeless – Pine Street Inn||Subspecialty Clinic||Subspecialty Clinic||Refugee Clinic||Administrative Half-Day|
Please contact the Urban Health and Health Equities Pathway director, Jenny Siegel, MD, with any questions at email@example.com.
Medical Educator Pathway
The Medical Educator Pathway is designed for residents interested in becoming clinician educators. The curriculum is aimed at developing resident skills related to giving effective educational presentations and teaching clinical reasoning, while simultaneously guiding residents towards implementing educational initiatives on campus and producing scholarly work.
The pathway is directed by Dr. Robert C Lowe, an award winning medical educator. Dr. Lowe uses the literature on medical education and learning theory to guide practical discussions and workshops for the residents. He also selects other dedicated faculty who provide expertise in areas such as mentoring, providing feedback, and highlighting career paths for clinician educators to speak with the residents throughout the year.
Opportunities available to residents include teaching medical students in classroom settings and on the wards, developing curriculum used by the residency program, and being observed while presenting clinical cases followed by receiving feedback.
Previous Med Ed Projects
- Development of the Boston Medical Center Resident Initiated Guide to Discussing Goals and Expectations (BRIDGE) document, a guideline to help residents properly orient interns and medical students at the beginning of an inpatient rotation, with a focus on effective communication and regular feedback.
- Drafting the Second Year Medical Student Cardiology Class Syllabus, which previously used only a commercial textbook.
- Developing a pilot program on mentoring MD/PhD Students prior to the transition from their research years to the beginning of their clinical rotations.
The HIV Pathway trains physicians in cutting-edge longitudinal care of patients with HIV. Caring for patients at the Center for Infectious Diseases at BMC is a unique opportunity to specialize in team-based HIV medicine as a resident. Boston Medical Center has one of the largest and most diverse HIV clinics in the Boston area. Of over 1,450 HIV-infected individuals in 2012:
- 60% were black or African American
- 20% were Latino
- 37% were women
- 43% were foreign-born
Physicians trained in general medicine, infectious diseases, and other subspecialties continue to be vital to the care of patients with HIV; therefore, participants in the HIV pathway will also have a variety of career paths.
Residents will develop expertise in management of HIV including anti-retrovirals and HIV-associated co-morbidities and will also become adept at caring for patients in a team which includes care management, social work, addiction treatment, peer advocates, nursing, pharmacy, and mental health providers.
Framingham Heart Study Pathway
The Framingham Heart Study is a long term cohort study, currently in it’s third generation, investigating risk factors for cardiovascular disease among the population of Framingham, Massachusetts. The FHS partners with the BU School of Medicine and School of Public Health under the leadership of principal investigator and BU Professor of Medicine Dr. Vasan Ramachandran.
The FHS Pathway offers residents training in clinical epidemiology and provides opportunities for mentored research with established FHS investigators. The pathway is designed for residents who are committed to a career in translational or clinical investigation. Pathway activities involve formal didactics (on research design and methods, introduction to biostatistics, and introduction to cardiovascular epidemiology), mentored original research, “hands-on” engagement in FHS research center activities, and structured career and peer mentorship.
Quality Improvement & Patient Safety (QIPS) Pathway
The Quality Improvement & Patient Safety (QIPS) Pathway is designed for those seeking leadership in improving our healthcare system. All internal medicine residents at Boston Medical Center participate in quality improvement projects in their second year. The project teams are usually headed by members of the QI Pathway. Many lead further projects in their senior year targeted towards their particular interests. Residents who are selected for the QIPS Pathway are those that want to take improvement further and truly make it a part of their career in medicine. The QIPS Pathway is designed to create the future leaders of medicine. It focuses on promoting the knowledge, teamwork, and teaching skills necessary to take on a leadership role in improving systems of care, both locally and abroad.
While in the pathway, residents become deeply involved in the operations of our medical center to promote exceptional care for our patients including the following:
- Joining various operations committees
- Working directly with the executive leadership and board of trustees
- Collaborating with the Massachusetts Medical Society and in the Massachusetts Chapter of the American College of Physicians Council of Residents.
- Serving in numerous roles in concert with the Institute for Healthcare Improvement (IHI), such as co-chairing the National Forum for Quality Improvement in Health Care
- Attending the Academy for Emerging Leaders in Patient Safety (formerly the Telluride Patient Safety Round Table) and being chosen as ACMQ National Quality Scholars and Lown Right Care Educators.
Residents frequently obtain funding for improvement projects. A $25,000 grant was recently awarded to a QIPS resident to improve transitions of care. Boston Medical Center is a leading hospital in supporting its residents in Quality Improvement both with financial resources and by encouraging and welcoming resident attendance at meetings with top hospital executives.
Recent Projects in the Pathway Include:
- Efforts to improve hand hygiene in the intensive care unit
- Smoking cessation in high risk patients
- Optimizing medication reconciliation
- Increasing adverse event reporting
QIPS Core Competencies
- IHI self-study certificate
- Completion of the ACP/APDIM Cost Conscious Care Curriculum
- Experience with the Boston Medical Center QIPS office including involvement in Root Cause analysis meetings, medical-legal meetings, and multi-disciplinary (RNs, IT, administration) project implementations
- Involvement in at least one QIPS and/or IT Committee at BMC
- Development and implementation of a QIPS project either by the individual or in conjunction with other members in the pathway
- VA Patient safety elective (At least 1 elective block)
- Mentoring with QIPS experts in the Department of Medicine, VA, and at BMC level
Global Health Pathway
Residents within the pathway will engage in a series of clinical and didactic experiences around Boston aimed at developing their knowledge of both the clinical and philosophical aspects of global health. This will be joined with two global health trips in the second and third year, as well as networking with organizations and personnel working within global health.
Clinical exposure within a global health pertinent ambulatory location (refugee clinic, travel clinic, TB clinic, HIV clinic) will replace some of the specialty clinic slots for GHP residents during their ambulatory weeks.
Topics include but are not limited to: epidemiology of global health issues; data sources in global health; overview of donor and implementation organizations in global health; global health ethics; HIV; TB; malaria; neglected tropical diseases; non-communicable diseases; and building a career in global health.
Resident will complete a scholarly project (e.i. educational resource, clinical research, case report, etc) as part of their participation within the pathway. There will be afternoons granted within the primary care weeks towards this, as well as the potential of asking for an elective block PGY-3 year for projects with sufficient scope.
Clinical Informatics Pathway
The Clinical Informatics Pathway provides advanced opportunities for trainees to develop knowledge of health information systems’ role within healthcare.
Clinical informatics is defined as “analyzing, designing, developing, implementing, and evaluating information and communication systems that enhance individual and population health outcomes, improve patient care, and strengthen the clinician-patient relationship.” As information science and electronic applications become critical pillars in clinical medicine, it is essential to train and develop physician leaders with advanced skills, knowledge, and experience in the field of clinical informatics. Physicians with expertise in clinical informatics can collaborate with information technology non-clinicians to improve patient care, reduce healthcare waste, and improve the clinician and patient experience with electronic health systems and other electronic applications/devices that interact with health care.
Increasing the pool of physicians with clinical informatics expertise are priorities for health care systems at the local and national level. There are ACGME accredited Clinical Informatics fellowships and a Board Exam (out of ABPM) that can be pursued on a career journey in clinical informatics. Clinical informaticists go on to roles that vary widely, including academic medicine, software development, data analytics, and hospital administration.
The Clinical Informatics Pathway
The Pathway will provide for educational experiences in academic and pragmatic clinical informatics. This includes gaining skills, knowledge, and attitudes related to understanding the interplay between health care delivery and IT systems, electronic health records, electronic clinical decision support, data analytics and inter-professional collaboration between physicians and health IT analysts. Trainees will develop skills and knowledge via experiential learning and academic inquiry, including but not limited to the following:
- Involvement in hospital operations and clinical IT planning, implementation, and maintenance activities.
- Exposure to data analysis, implementation science, and operational strategy.
- Opportunities to advance peer education in EHR and informatics skills.
- Participation in physician-focused advanced EHR training with the option for more technical access to EHR build.
- Mentorship by informatics leadership.
- Exposure to the intersection of quality improvement and informatics through co-participation in educational and scholarly activities of the Quality Improvement and Patient Safety pathway, with the potential for collaboration on quality improvement projects.
- To expose residents interested in addressing systems-issues through the use of information technology to the field of clinical informatics.
- To cultivate an interest in and understanding of clinical informatics through hands-on and didactic opportunities to experience the many facets of clinical informatics.
- To prepare residents for application to Fellowship in Clinical Informatics should they so desire.