University of Maryland Medical Center - Internal Medicine Residency Training Sites
The University of Maryland Medical Center, a private not-for-profit hospital, is a major tertiary and primary care facility with approximately 750 beds and over 38,000 admissions each year.
The medical services consist of over 200 beds divided among a variety of general medicine and subspecialty services.
In all units, doctors, students, nurses, clinical pharmacists and support staff work as a team to promote unified and comprehensive care for every patient.
Each medical service is a mixture of patients -- some admitted to the care of the teaching attending and others admitted by full-time faculty attendings. The residents provide the patients' primary care under the supervision of the teaching attending. We have robust non-teaching services where general medicine, oncology and intermediate care (IMC) patients are admitted. Community physicians transfer all the care of their patients to the resident teaching services. First year residents are responsible for the day to day evaluation and management of their patients. Upper level residents are the leaders of each team and have significant clinical, supervisory and teaching responsibilities.
Medical Inpatient Units
There are 9 medical teams at UMMC, including 4 general medical services, an ID service, 2 MICU Teams, 1 Primary Cardiology Team, and a Cancer Center Service (leukemia and hematologic malignancies). Teams are structured with the senior resident as team leader supervising interns, subinterns and third year medical students. Attending rounds are held daily. Call on all services is every fourth day. Intern admissions are strictly capped at 5 admissions per call.
Resident teams are assisted in their daily work by an interdisciplinary team, including a case manager, physical and occupational therapists, social workers, phlebotomy and IV teams, substance abuse counselors and respiratory therapists. Discharge coordinators assist residents in preparing patients for discharge and improving efficiency. Residents use EPIC as their EMR which can also be accessed from their smart phones, tablets and their home via a VPN system. Resident enjoy the efficiency of our Dragon voice recognition.
General Medicine and Med-ID Teams
The non-ICU services consist of 4 General Medicine services (Med 1-4) and an Infectious Disease service (Med-ID). The Med 1-4 services are organized in a Team Call system with the Med-ID team having individual call with close resident supervision. Med 1-4 consist of one resident and 2 interns who take call as a team every 4th day until 9 PM. The Med-ID service has ID faculty and fellow supervision, with 1 resident and 3 interns. Interns take their last admission at 6 PM (also with a "drip method" of staggered admissions) and sign out to the Night Team at 9 PM. Third and fourth year medical students are members of all teams. A senior resident moonlighter works from 5-9 PM Monday-Friday to address all the cross-cover issues and the Med-ID Day Float assists that service by taking admissions until 9 PM. .
A fully staffed 7-day/week Night Team System covers all the floor teams. Interns and residents on general medicine and ID services take admissions using a "drip method" with their last admission at 6 pm so that residents can leave by 9 PM and have 8-10 hours off between duty shifts. Interns and residents only stay overnight while only while on MICU and CCU/telemetry at UMMC, and residents stay overnight on their Cancer Center rotations. Our Fatigue Management Policy requires a 45 minutes nap during 28 hour calls. Nocturnists and intensivists are present throughout the night shifts and assist with patient care and supervision.
Medical Intensive Care Unit and elective in Intermediate Care Unit
The MICU consists of 2 teams, each with an intensivist, 1 fellow, 2 residents, 3 interns and 1 subintern each caring for 10 patients (remainder are cared for by NPs). Our state-of-the-art 29-bed MICU has 24/7 intensivists in the MICU at all times. Interns and residents rotate in 2-week blocks raking overnight call every 4th day for 28 hours with intensivists and fellows supervising the resident and interns overnight.
The IMC is a non-teaching service in that residents are not assigned to this rotation. However, they may choose an IMC elective where they work closely with the hospitalist in caring for critically ill patients and enhance their POCUS skills.
Primary Cardiology Service and elective in Advanced Heart Failure/CCU
The PCS - Primary Cardiology Service focuses on caring for patients with ischemia heart disease, MI's, valvular heart disease and arrhythmias. The team consists of a cardiology attending, 1 fellow, 3 residents, 3 interns and 1 subintern. There is no overnight call on PCS with a night float resident covers the service at night.
The Advanced Heart Failure Service/CCU is a 2-week elective where residents work alongside fellows and nurse practitioners to care for complex patients with CHF, pulmonary hypertension and transplant needs. They have an elective-type schedule working Monday-Friday with no overnight call.
The Leukemia Service in the NCI-Designated Greenebaum Cancer Center has 4 residents on the team. Overnight call is every 4th day with upper level residents working for no more than 28 hours/shift.
Residents can choose an elective on the Mixed Tumor Service where they care for patients with solid tumors while working with an attending, fellows and nurse practitioners. They have an elective-type schedule working Monday-Friday with no overnight call.
Non-teaching services care for our patients and help off-load the resident services, are essential to the success of our residency program and reflect the strong financial support we enjoy from the institution. Hospitalists staff these services providing an extra layer of supervision at night and also ensuring compliance with the number of admissions to the teaching service.
Our Emergency Department is comprehensive and state-of-the-art clinical service, staffed 24/7 by outstanding EM faculty. Approximately half the patients on the medical services are admitted through the ED, where over 50,000 patients are evaluated and treated annually. First year residents do a 2-week rotation in the ED caring for patients with diverse medical conditions under the supervision of full-time faculty. Maryland Express Care, an integrated consultation and critical care transport system for patients from all points within the state and region, adds patient diversity to the educational experience.