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Internal Medicine Residency Curriculum

Internal medicine residents at Mercy Catholic Medical Center

The Internal Medicine Residency at Mercy Catholic Medical Center consists of four program curricular: Clinical Rotations, Ambulatory Care, Conference Schedule and Academic Pursuits.

Clinical Rotations

Inpatient Rotations
Each team of a general internal medicine (floor) and intensive care (unit) rotation consists of a teaching attending, resident, interns and medical students. Training is optimized by limiting the number of patients under each intern’s care to no more than 10 to 12 patients on the general medical floors and four to six patients in the intensive care units. This clinical load permits adequate time for reading and other learning activities. Call is taken every fourth night. A night-float system also offers interns and residents adequate time for patient care and rest. Multiple ancillary services are provided by the hospitals, including performing phlebotomies, starting IV lines and obtaining EKGs among others. These services free the interns and residents from scut work and provide more time for learning and clinical care in a pleasant working environment.

Emergency Medicine
With hospitals in both urban and suburban settings, the clinical rotation in Emergency Medicine provides interns and residents with a broad array of clinical scenarios. Under the supervision of board-certified medical school faculty physicians, interns and residents effectively operate as the primary physician for each patient. In addition to providing trauma, acute and sub-acute care, the Emergency Department provides excellent support and education in toxicology. Dr. James R. Roberts, Department Chief, and other health professionals possess extensive backgrounds in academic emergency medicine. Interns spend one month in this rotation, during which time they have the opportunity to attend emergency medicine conferences. Residents in the second and third year spend one month each year serving as medical consultant to the Emergency Department and as the admitting (or triage) officer.

Elective Rotations
Seven elective months are offered over the three-year program, with at least six of these months devoted to internal medicine subspecialties. With prior departmental approval, one elective rotation can be taken at an outside institution sometime during the second or third year.

Systems-Based Practice Rotations
An innovative Systems-Based Practice Workshop Rotation permits PGY-1s to experience healthcare from the perspective of professionals in other fields such as hospice, home health, nursing, and pharmacy. Geriatric/Consult Rotations All third-year residents spend a month in geriatric/consult service. The consult service includes pre-operative evaluations and pre- and post-operative care for patients on other services. Geriatric care includes nursing home visits, hospice visits and wound care rounds on LTAC.

Ambulatory Care

In conjunction with today’s medical focus on providing efficient and cost-effective outpatient care, the house staff is provided extensive opportunities to develop expertise in ambulatory care using the following components:

Weekly Ambulatory Care Longitudinal Experience
Interns and residents work in an outpatient setting, including the medical clinic at Mercy Fitzgerald Hospital or the private office of a member of the teaching faculty, one afternoon each week throughout the three-year residency program. The patient population consists of individuals recently discharged from the hospital, as well as members of the community who enroll for care in the medical clinic. Each trainee will develop a panel of patients whom he or she will follow throughout their three-year experience. Under the supervision of the ambulatory instructor, the trainee can develop the skills required of a general internist including knowledge of preventive care guidelines, cost-effectiveness of various tests and skills in office management. Suggested readings from the literature are provided by the ambulatory instructor.

Ambulatory Care Block Rotation
During this month-long rotation, the trainee participates in a variety of outpatient experiences. Required sessions include nephrology, oncology, endocrinology, infectious diseases and musculoskeletal clinic. All are assigned to a gynecology session(s). There is also an opportunity to select other outpatient ambulatory experiences. During the rotation, the program's associate director meets each week with the participants to present and discuss articles concentrating on ambulatory care. In addition, the senior residents present at journal club on an ambulatory topic of their choice.

Conferences

Core Subspecialty Lectures
M, T, Th, F, 7:45 a.m. – 9:00 a.m.
Members of the teaching faculty discuss the pathophysiology and management of common medical disorders, and provide up-to-date information on a variety of topics. The comprehensive information presented during these lectures is vital to the preparation for the ABIM's Certifying Examination in Internal Medicine.

Systems Based Learning Improvement Conference
W, 7:45 a.m. – 8:45 a.m.
A large variety of topics outside of clinical medicine are offered as a way towards becoming an effective clinician. Examples of these subjects include medical informatics, statistics, ethics, communication skills, financial strategies and risk management/malpractice.

Grand Rounds
W, 12:00 p.m. – 1:00 p.m.
Visiting professors and local faculty discuss current issues in medical care.

Case Management Conference
M, T, Th, F, 12:00 p.m. – 1:00 p.m.
Second- and third-year residents either present an interesting case with management issues or conduct morning report in which admissions from the previous day or evening are discussed.

Clinical Pathology Conference
12:00 p.m.
During this monthly conference, the chief resident prepares a clinical summary of an interesting case with a confirmed diagnosis. A resident reviews the differential diagnoses and discusses the issues surrounding the case. A pathologist and radiologist review their respective studies involved in establishing the diagnosis.

Difficult Case Conference
12:00 p.m.
Conducted once each month, a difficult case conference gives a resident an opportunity to present a case that offers a particularly challenging diagnostic dilemma. Journal Club 12:00 p.m. Once each month, a resident reviews a recent article and critiques the study's methodology and derived conclusions as a way of developing the critical-thinking approach to reading medical literature.

Communication Skills Conference
12:00 p.m.
Each month, our Director of Behavioral Medicine reviews common psychosocial problems seen in general medical settings, and discusses inpatient and outpatient cases. Residents have the opportunity to develop their interviewing skills through role-playing and feedback from faculty and the clinical psychologist.

Academic Pursuits

Mercy Catholic Medical Center offers residents numerous opportunities to pursue academic interests beyond the hospitals' walls.