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Curriculum - Internal Medicine at MedStar Union Memorial

Rotations   

Our residents progress through a structured program that gives them progressive responsibility in caring for patients.  Below is a description of the rotations an intern will experience.  As categoricals progress through training, there will be less time spent on general medicine and ICU and more time in ambulatory medicine and electives. 

PGY-1

General Medicine Service (GMS).  Each intern will spend from 4 to 5 and ½ blocks on the general medicine service.  This is where the bulk of the learning is done in your intern year.  We have no subspecialty ward services (consultant services only) at MedStar Union Memorial, so you will have the opportunity to be the primary physician taking care of a true range of illnesses from a 25 y/o woman with a lupus flare to an 89 y/o man with unstable angina.  You and your senior resident will be managing the scope of internal medicine and all of the subspecialties in one place.  Of course, you will have an excellent teaching attending who is one of our core faculty by your side as you care for and learn from these patients and a whole host of capable consultants who are ready and willing to help out if you need their expertise. 

Intensive Care Unit (ICU).  Interns do anywhere from 1.5 to 2.5 blocks of ICU which is routinely one of the favorite rotations.  Although rigorous with early mornings, the learning curve is high and our core critical care staff of five intensivists is second to none. 

Ambulatory.  The resident ambulatory experience has received a major overhaul in the last couple of years and we are continually evolving to make it a great experience for both residents and patients.  Under the guidance of our ambulatory director, Dr. Radhika Vij, the clinic has embraced the block philosophy of scheduling over recent years.  Each of our categorical residents now spends two consecutive weeks in an ambulatory block during which they have 10 continuity clinics, 8 subspecialty clinics and 2 academic half-days. This period is totally protected from call or other duties and has two golden weekends within it. This also means when ambulatory block is done and you move on to GMS, ICU, or elective, you won’t have to divide your time and attention rushing off to clinic when your patients on the floor need you the most.  To make this system work, you will have a number of practice partners who share a complimentary schedule and are in the clinic during the times when you aren’t. This way, continuity with your patients doesn’t suffer since they become familiar not only with you, but with your partners. Residents are in ambulatory block for 2.5 to 3 blocks per year. 

Elective.  Each intern has 1 to 1.5 blocks of elective to choose from.  There are a wide-range of elective both within medicine and its subspecialties and outside of internal medicine, such as dermatology and pathology.  Most electives are taken in two week blocks to maximize your exposure to different disciplines. 

Night Medicine.  As there is day medicine, there must also be night medicine. This important rotation is referring to what is typically called ‘night float.’  However, we don’t care for the term ‘float’ since it suggests a job without much structure, supervision or teaching. On night medicine, you have all of those things.  As an intern, you will have 2 to 2.5 blocks of night medicine, which includes both ICU and GMS coverage.  You will admit patients with the senior resident and night sub-intern and cross-cover any patients who belong to the day interns. The GMS job is six nights per week and ICU is actually every other night (since there are two interns assigned) and both weekends.  You will always have supervision from a senior resident and attending interaction and feedback every morning. Although, nobody LOVES working nights, our interns usually find benefit in this rotation since they usually have more time to put their thoughts together when admitting patients and they also get a chance to practice their skills more independently. In the end, nights are also the reality of providing continuous coverage to patients while still allowing reasonable, humane work hours. 

 Vacation.  Of course you have vacation!  Right now, every resident has four weeks of vacation that they can take in 2 two-week blocks or 1 four-week block.  I am also working on a holiday schedule for the upcoming academic year which would allow one more week of vacation to total five!  I can’t make any promises yet, but I think it will work. 

PGY-2

Aside from the rotations mentioned above, our junior residents have a month of neurology in their second year.  Under the direction of Dr. Ramesh Khurana, the residents enjoy a very busy and interesting month in a specialty that is so closely related to internal medicine and so vital to our understanding of basic medicine. 

PGY-3

Aside from the rotations mentioned above, our most senior residents rotate four weeks with our geriatrics and palliative care team.  This team is scholarly, multidisciplinary, extremely well-organized, and an integral part of our training program.  The geriatrics and palliative care rotation allows the residents to witness a different approach to patient care and equips them with the knowledge and skills necessary to navigate the often difficult concepts that accompany caring for elderly patients or those at the end of their lives. 

Senior residents also spend four weeks in the emergency department.  This popular rotation allows residents to see patient care ‘from the other side.’  Residents gain an appreciation for what an ER doc encounters and the types of quick decisions they must make in order to keep patients stable.