Internal Medicine Residency Program: Program Structure

Training Tracks 

The Department of Medicine at St. Elizabeth's Medical Center offers ACGME accredited training in two categories: Internal Medicine Categorical and Internal Medicine Preliminary.

The Internship year is similar for both Categorical and Preliminary interns. Preliminary Interns do not have a half-day per week outpatient continuity clinic. They may also use their Elective and Ambulatory time to pursue rotations relevant to the field they will enter in the PGY-2 year (e.g. Anesthesia, Dermatology, Neurology, etc). During the last 3 years Preliminary Interns have continued on in Residencies in Anesthesia, Dermatology, Emergency Medicine, Neurology, Ophthalmology, Radiology, and Rehabilitation Medicine.

The academic year at St. Elizabeth's Medical Center is divided into thirteen, four-week, blocks.

Ward Rotations

There are 10 Medical Ward Teams who care for inpatients in General Medicine, Cardiology, and in the Medical and Cardiology Step-Down Units. Each ward team consists of one second or third year resident, one intern, and one or two medical students from Tufts University. The average number of patients carried by each team is 8-10 and each ward service is capped at 16 patients (interns are capped at 12 patients). While on the ward rotation, teams admit patients three out of every four days, taking long call until 8 p.m. every fourth day (see ON-CALL STRUCTURE).

While on the wards house staff work closely with Faculty from the Hospital Medicine Service, Pulmonary Division (Medical Step Down Unit), Cardiology Division (Telemetry floors and Intermediate Cardiac Care Unit), and a dedicated group of Primary Care Physicians (most located on campus or nearby). PGY-3 residents spend 4 weeks working on the Hematology-Oncology service. During this rotation the resident works closely with a Hematology-Oncology Fellow and Attending. Mornings are spent covering inpatients on the Hematology-Oncology Service while afternoons are devoted to the outpatient clinics.

ICU and CCU Rotations

There are 14 ICU beds on the medical service (physically connected 7-bed MICU and 7-bed CCU). The CCU team consists of an Attending Cardiologist, a Cardiology Fellow, a senior resident and two interns who take call every fourth night (in rotation with the interns and residents assigned to the MICU service). The MICU teams consist of a Pulmonary and Critical Care Attending and Fellow, three junior residents, and two interns. Call is taken every fourth night (in rotation with the interns and residents assigned to the CCU service). Fellows serve as active back up and come in at night to assist with difficult cases.

On-Call Structure

The program provides 7-day a week float coverage for all ward services. There is no overnight call for interns and residents rotating on ward services. The ward schedule is based on a 4-day rotating schedule: four teams take Night Float transfers and new admissions until 3 pm, two Long Call teams admit patients from 3 pm to 8 pm, two teams are Post-Long Call and do not admit patients or take transfers. Cardiology teams work 6/7 days a week, and do not take call.  They admit only cardiology patients. For all Ward Teams the number of admissions and transfers are strictly capped. All house staff assigned to the Wards get one or two weekend days off every week. Two to three Senior Tufts Medical Students are also assigned to the Unit Team

Interns and Residents rotating in the Medical ICU and CCU take overnight call every fourth night, leaving by noon the next day. Interns and residents on the intensive care unit services are ensured at least one full day off every week (either Friday, Saturday, Sunday or Monday).

PGY-2 Night Float Rotation

The PGY-2 Night Float Rotation provides an opportunity for residents to admit and manage a broad variety of medical cases, while reducing the work and hours of floor teams. Each night, two PGY-2 night floats admit new patients and provide back up for float interns. Intern night floats provide cross coverage for patients on the medical ward services. The night float shift starts at 8:00 PM and ends at 7:00 am. House officers on the Night Float Rotation work six days per week for a total of two weeks. The remaining two weeks are usually assigned for vacation, elective, or ambulatory rotations.

Intern Float Rotation

Each block four interns are assigned to the float rotation with two interns on duty at any one time. Intern floats provide cross-coverage for medical ward patients. Over the course of the 28-day rotation, each intern works 18 shifts and has 10 full days off.

Electives

The table below shows the elective rotations available to house officers. For subspecialty rotations, residents divide their time between outpatient clinics and inpatient consultation services. When rotating on the Cardiology, Hematology-Oncology, Nephrology, Infectious Diseases, Pulmonary, and Gastroenterology Services, interns and residents work closely with Subspecialty Attendings, Fellows and fourth year medical students. On average, 33-50% of the elective is devoted to outpatient subspecialty work and the remainder to inpatient (consultation) work. Additional Elective Rotations are available in Anesthesia, Endocrinology, Geriatrics, Pathology, Patient Safety, Radiology, Rehabilitation Medicine, Rheumatology, and Women’s Health. Residents with a well-conceived plan can perform one Elective off site. Residents on the elective rotation get weekends and holidays off. PGY-2 and PGY-3 residents with a well-conceived research plan and a designated faculty mentor can use one elective block to pursue a research project.

Emergency Medicine

House officers rotate for a total of two, 4-week blocks in the Emergency Room (once as an intern and once during the PGY-3 year). The Emergency Room is staffed by one or two board certified Emergency Physicians 24 hours a day. Each emergency medicine rotation consists of approximately 18 shifts over the course of 4 weeks. During the Emergency Medicine rotation Medical House Officers play an active role in the triage and management of a diverse number of patients with different levels of acuity.

Neurology

PGY-3 Residents spend 4-weeks rotating on the Neurology Service working closely with Neurology Residents and Attendings.  Mornings are spent seeing patients on the inpatient Neurology Service while afternoons are devoted to work on the Neurology Consultation Service.

Ambulatory Care Rotation 

During each of the PGY-1, PGY-2, and PGY-3 years, house officers perform one to two 4-week Ambulatory Care Rotations. While on the Ambulatory Rotation, House Officers are still able to attend weekly didactic sessions such as morning report, Morbidity & Mortality Conference, Journal Club, and the noontime lecture series. The Ambulatory experience includes an Adolescent Medicine rotation conducted in clinics located at the Boston College Health Service with preceptors from the St. Elizabeth’s faculty. Other rotations covered during the Ambulatory Block include Dermatology, Office Gynecology, Non-operative Orthopedics and Sports Medicine, Medical Ophthalmology, Non-Operative Otorhinolaryngology, Rheumatology, Endocrinology, Occupational Medicine, Travel Medicine, Walk-In Clinic, and the Center for Weight Control. There are additional rotations available in Home Care, Rehabilitation Medicine, and Women’s Health.

Continuity Clinic

The Continuity Clinic and Ambulatory experience is under the leadership of Dr. Abbas Zaidi, Associate Program Director. Dr. Zaidi, a former Chief Medical Resident and dedicated General Internist, has received teaching awards from both Medical Students and Medical House Staff. Categorical residents spend one-half day per week in a continuity clinic conducted in a general medicine setting. All continuity clinics are on campus or within easy walking distance. Each resident is assigned to one General Internist and works closely with that Attending Physician for three years. The focus is on managing a panel of patients with a broad array of illnesses over time. The Ambulatory program utilizes the Yale University Primary Care Curriculum (a comprehensive set of cases) to supplement the outpatient experience.

Research

There is a long and rich tradition of resident participation in research projects (see Resident Research). Numerous opportunities exist for residents to engage in either clinical or basic science research. PGY-3 residents can use some of their elective time to participate in research projects. Research opportunities in each Division of the Department of Medicine are actively publicized on the Intranet page, “Research for Residents.”