During the 36 months of training, residents in the categorical program participate in the following curriculum. The number of inpatient rotations -- or inpatient equivalents -- is fixed for each year of training and consists of floor rotations (general medicine, Med-ID and oncology), ICU's (MICU and CCU/telemetry), night and day floats, and Night Acting Chief Resident (NACR) rotations. With our academic year based on 13 four-week rotations, categorical interns have 8.5 inpatient equivalents, PGY-2's have 7 and PGY-3's have 6.5 blocks. There is some slight variation in the distribution of types of these inpatient rotations, with categorical residents completing no more than 6 ICU months and no more than 4 months of night float over 3 years.

Interns in the preliminary program complete 9 inpatient equivalents (including 6-7 inpatient and 1.5-2 Day or Night Float blocks). Preliminary interns interested in anesthesiology complete 2 months of MICU as part of their CBY (clinical base year) requirement for anesthesiology and may request extra ICU months.

We ensure that all interns have balanced experiences at both UMMC and the VA during inpatient and elective blocks. Interns have a fall and spring Academic GIM (Y block) and upper level residents have six 2-week ambulatory (Y) blocks. Continuity clinics occur weekly during electives and ECS rotations, and only once per block during general medicine rotations. There are no clinics during ICU, CCU, night float or day float rotations.

Rotations Year 1
Categorical
Year 1
Preliminary
Year 2 Year 3
Inpatient services (including ICU's) 7 7 5.5 5
Night Float, Day Float, MAO 1.5 2 1.5 1
Night Acting Chief 0 0 0 0.5
Emergency Medicine 0.5 0 1 0.5
Ambulatory Blocks / FPO (AM electives, PM medical clinic) 0 0 3 3
Academic General Internal Medicine 1 0 0 0
Urgent care clinic (ECS) 1 0.5 0 0
Electives 1.5 3 1.5 2.5
Continuity Clinic Yes No Yes Yes
Vacation 4 weeks 4 weeks * 4 weeks 4 weeks
  • MAO = Medical Admitting Officer at Mercy Medical Center
  • FPO = Faculty Practice Offices (2 week ambulatory rotation)
  • ECS = Emergency Care Services (VA)

Vacation

  • Categorical interns have one 2 week block, 1 week during elective, and another week off at the end of the year from June 24-30 (if they are remaining at UMMC).
  • * Preliminary interns who are transitioning to residency at another institution do not have paid vacation from June 24-30.
  • Vacation for upper level residents: One 2 week block and 2 single weeks taken anytime during electives.

We implemented a new rotation for categorical interns -- Academic GIM -- in July 2016. During this 2-week block, interns spend every afternoon at their continuity clinic acclimating themselves to the ambulatory setting and adding patients to their panel. During the mornings, they do a variety of educational activities, including simulations, ultrasound skills, literature in medicine, IHI modules (for learning patient safety and quality improvement) and interdisciplinary immersion (shadowing nurses). The interns complete their Academic GIM block by November thus giving them a strong foundation for the rest of their intern year. Interns complete a second Academic GIM block in the spring that includes afternoon continuity clinics and intern-selected morning sessions in primary care and subspecialty clinics.

Conference and Inpatient Work Schedule

7 - 8 am

Work Rounds

First year residents pre-round on their patients in preparation for resident-run work rounds at 7 am. The team resident is responsible for supervising the clinical activities and for teaching the members of the team.


8:15 - 11 am

Attending Rounds

Held 7 days per week at all inpatient sites. Led by the faculty, these rounds integrate clinical management and teaching with an emphasis on learning at the bedside.


12 - 1 pm

Noon Conferences with Lunch

These conferences are considered protected time. Residents are released from consult services and morning clinics by 11:45 and their continuity clinics and afternoon consults do not start until 1:30 PM. Nursing staff do not page residents during their education time unless it is urgent. Various formats include a case-based conference, emphasizing problem solving and the evaluation and management of clinical problems, primary care topics, Journal Club, Board Review and Morbidity and Mortality conference. More details about our conferences are listed below.

Each senior resident writes a manuscript on a comprehensive literature review of a topic of interest. The best manuscripts are selected for presentation at our Senior Resident Conferences in the spring. All manuscripts are bound for distribution at the end of the year. Waffle Day photoWe hold our monthly Morbidity, Mortality and Improvement Conference (includes Patient Safety and QI curriculum) and Medical Ethics Seminars. Medical Grand Rounds is our weekly premier conference for the Department of Medicine where expert speakers from the Maryland faculty and outside institutions present topics that are clinically relevant and timely. During Journal Club, residents present a critically appraised topic in an evidenced based medicine format supported by a faculty mentor. This curriculum provides residents with the skills to perform an electronic search, conduct a critical appraisal of the literature and apply it to a clinical situation. Skills in epidemiology and biostatistics are emphasized.

At the monthly Clinicopathologic Conference, clinicians are challenged with analyzing a case history and developing a differential diagnosis. Every year a special historical CPC deals with an undiagnosed illness in a famous person. Examples of our previous historical CPC's include Alexander the Great, Edgar Allen Poe, Booker T. Washington, Eleanor Roosevelt and Abraham Lincoln.

Board Review

MKSAP questions are integrated into case conferences to prepare residents for their certifying exam from the ABIM. Residents take an In-Training Exam every summer, which gives them feedback on their knowledge base in each subspecialty. Individualized coaching for board review sessions are available.

Acute Medicine Series

Held during the summer months, this series of conferences covers topics pertinent to acute inpatient medicine, such as respiratory failure, GI bleed, pulmonary edema and others.

Yale Curriculum in Primary Care

Delivered by residents on their ambulatory blocks, residents learn basic and complex care of patients in the outpatient setting in a round table seminar setting guided by GIM faculty.


4 - 5 pm

Sign-Out Rounds

These sessions are held daily between 4-5 pm and are led by the team resident. First year residents present the results of clinical work for the day and plans for subsequent management of their patients. Residents directly transition patient care to the covering residents in person-to-person sign-outs.

When on Call on GIM Services

  • 4 - 6 pm: Drip admission process with interns taking no more than 2 admissions within these 2 hours and no more than 1 admission in the final hour.
  • 12 - 9 pm: The Day Float resident takes admissions after the long call team reaches their cap and assists with any clinical work for the teams during the afternoon and for the on-call team until 9 PM.
  • 6 - 9 pm: A moonlighter does all the patient cross-cover during this time, relieving the on-call team from this responsibility.
  • 9 pm: Long call ends and the on-call team signs out to the Night Float Team.
  • 9 pm - 7 am: Residents and interns on the Night Float team admit patients and cross cover patients on the floor services.