Internal Medicine Residency Program
This program is being offered for hospitals in rural areas to train newly graduated physicians to become specialists in Internal Medicine. These hospitals would need to have the patient population, medical staff, and funding that would allow hiring of program director as well as associate director if needed. Based on ACGME guidelines, these hospitals will need to provide a 50% salary support for program director as well as an associate program director depending on the size of the residency program. We will provide all of the resident lectures as well as the faculty for weekly conferences, Grand Rounds, and morning reports. We will help with board exam preparation well as administer examinations during the residency training.
Accreditation may not occur if there is noncompliance with the ACGME guidelines as listed here. We will therefore make sure that the program will not only comply, but also maintain its compliance with all the aspects of the ACGME rules and restrictions for the entire three years of the residency program.
There are three aspects of the internal medicine residency program:
Curriculum
PGY-I:
Required:
- Inpatient General Medicine Ward
- Ambulatory Medicine
- Intensive Care Unit
- Musculoskeletal Medicine
- Emergency Medicine
Electives:
- Endocrinology
- Nephrology
- Gastroenterology
- Hematology/Oncology
- Infectious Diseases
- Hepatology
- Pulmonary
Required:
Inpatient General Medicine Ward (20 weeks): During this rotation, residents are to evaluate, diagnose, and treat the following conditions and symptoms:
- DVT / thromboembolism
- Diabetes mellitus out of control and Diabetic ketoacidosis
- Community-acquired pneumonia, aspiration pneumonia, institutionally-acquired pneumonia, and other forms of pneumonia
- Acute and chronic renal failure
- Cellulitis/erysipelas/osteomyelitis/diabetic foot ulcers
- Asthma and COPD exacerbations
- Urinary tract infections, pyelonephritis, and urinary tract infections with sepsis
- Hypertensive urgency and emergencies, formerly called malignant hypertension
- Endocarditis
- Meningitis, Encephalitis
- Coronary artery disease the use of non-invasive testing and consultants
- New onset atrial fibrillation
- Anasarca/CHF/ascites/nephrotic syndrome
- Anemia
- Hypothyroidism
- Hyperthyroidism
- Acid-base disorders, Hyponatremia, Hypernatremia, Hypokalemia, Hyperkalemia
- Decubiti
- Acute monoarticular arthritis
- Obstipation/bowel obstruction
- CVA
- Depression
- Alcohol withdrawal syndrome
- Diverticulitis
- Exacerbations of systemic lupus erythematosus
- Seizure
- Sickle cell anemia disorders
- Chest Pain
- Dyspnea
- Headache
- Facial Pain
- Mental status changes
- delirium
- Stupor/coma
- Acute abdominal pain
- New fever
- New rash
- Lower extremity edema
- Anorexia, constipation, diarrhea, nausea/emesis
- Hematochezia
- Cough
- Dizziness
- Swollen joint
- Weakness
Ambulatory Medicine (12 weeks) Residents are expected to be able to diagnose and treat these conditions and perform outpatient procedures listed on an ambulatory setting:
- Allergic asthma and non-allergic asthma
- Allergic rhinitis and non-allergic rhinitis
- Acute and chronic urticaria
- Anaphylaxis
- Acute and chronic otitis media
- Acute and chronic sinusitis
- Common variable immunodeficiency
- Contact dermatitis
- Pityriasis rosea
- Skin cancer (See Also: Lecture)
- Urticaria
- Acne
- Rosacea
- Psoriasis
- Atopic and contact dermatitis
- Bacterial and fungal skin infections
- Herpes simplex and zoster
- Warts
- Scabies
- Drug reactions
- Insect bites
- Eczema
- Lichen planus
- Lichen simplex
- Pigmentation disorders
- Alopecia
- Corns and calluses
- Skin manifestations of serious systemic diseases
- Procedures: Punch and shave skin biopsies
- Procedures: Remove warts and skin tags
- Headaches, dizziness, etc.
- Multiple sclerosis
- Parkinson’s disease
- Myasthenia gravis
- Epilepsy
- Procedures: Be able to perform screening and a detailed neurological exam
- Procedures: Be able to perform at least ten electrocardiograms per day
- Procedures: Be able to perform treadmill tests
- Procedures: Be able to perform cardiac scintigraphy
- Procedures: Be able to perform stress electrocardiography
- Procedures: Identify abnormalities on ultrasounds, barium studies, CT scans, plain radiographs, etc.
Intensive Care Unit (4 weeks): This will include both evaluation and treatment of the following conditions as well as performing the procedures listed:
- Acute ischemic syndromes
- Cardiac arrhythmia’s
- Cardiopulmonary arrest
- Cardiac tamponade
- Congestive heart failure
- Coagulopathies
- Drug overdose/toxicology emergencies
- Upper or lower gastrointestinal bleeding
- Hemodynamic instability
- Hypertension
- Hypothermia
- Hyperthermia
- Infectious diseases
- Acute and chronic liver failure
- Acid -base and metabolic emergencies
- Pregnancy
- Renal failure
- Respiratory or ventilatory failure (ARDS, Asthma, COPD, Empyema, Interstitial Lung Disease, Pneumonia, Pulmonary vasculitis, Pulmonary alveolar hemorrhage syndromes)
- Pulmonary embolism
- Sepsis
- Stroke
- Transplant Complications
- Procedures:
- Central line placement: Femoral (n = 5)
- Central line placement: Internal jugular (n = 5)
- Central line placement: Subclavian (n = 5)
- Pulmonary artery catheter placement and interpretation of pulmonary artery catheter data (n= 10)
- Arterial line placement radial (n = 5) and Femoral (n = 5)
- ABG collection and interpretation (n = 5)
- Intubation and mechanical ventilation (n = 8)
- Nasogastric and oral-gastric intubation (n = 3)
- Lumbar puncture (n = 5)
- Thoracentesis (n = 5)
- Paracentesis ( n = 6)
- Chest tube thoracotomy (optional) ( n = 5)
Musculoskeletal Medicine / Pain Management (4 weeks)
- Myalgias
- Carpal tunnel syndrome
- Soft tissue rheumatism
- Bursitis
- Epicondylitis
- Tendonitis
- Fibromyalgia
- Rheumatoid arthritis
- Osteoarthritis
- Spondyloarthropathies
- Crystal-induced arthropathies
- Systemic Lupus erythematosus
- Inflammatory myopathies
- Mixed connective tissue disease
- Systemic sclerosis
- Giant cell arteritis
- Polymyalgia rheumatica
- Differential diagnosis of vasculitis fibromyalgia
- Procedure: Perform joint aspiration of large synovial joints and be able to interpret synovial fluid analyses.
- Procedure: Interpret plain radiographs and MRI
- Procedure: Be able to inject into the shoulder, elbow, knee, or wrist joints
- Procedure: Be able to inject into the subacromial, olecranon, trochanteric, and anserine bursae
- Procedure: Be able to inject into the carpal tunnel
- Procedures: Be able to perform a nerve block, epidural, pain pump refill, or trigger point injection
- Procedures: Be able to perform cryotherapy
- Chest pain
- Abdonimal pain
- Cardiac dysrhythmias
- Altered Mental Status including coma
- Dizziness
- Hypotension
- Syncope
- Gastrointestinal Bleeding
- Severe Hypertension
- Dyspnea
- Musculoskeletal Trauma
- Abnormal Uterine Bleeding
- Procedure: Be able to perform endotracheal intubation, lumbar puncture, ABG collection, central line placement, I and D of an abscess, and basic suturing techniques
Electives (12 weeks):
- Vitamin D deficiency
- Critical Hypocalcemia and Hypercalcemia Hyperparathyroidism
Gynecomastia - Hirsutism
- Amenorrhea and Impotence Polycystic Ovarian Syndrome (PCOs) and associated disorders (insulin resistance, metabolic syndrome, infertility)
- Posterior Pituitary Dysfunction (SIADH, Diabetes Insipidus)
- Paget’s disease
- Osteomalacia
- Osteopenia and Osteoporosis
- Cushing’s syndromes and Adrenal insufficiency Incidental adrenal mass
- Pituitary Apoplexy and Empty Sella
- Primary Dyslipidemias
- Secondary hyperlipidemias
- Anatomic thyroid abnormalities (goiter, multinodular, etc.)
- Hypothyroidism, Hyperthyroidism, Thyroiditis and Thyroid cancer
- Secondary-Endocrine Hypertension (primary aldosteronism, pheochromocytoma, Cushing’s syndrome
- Primary, Secondary and Tertiary Hyperparathyroidism
- Primary and Secondary Hypogonadism
- Androgen and estrogen replacement therapies
- Hypoituitaryism and Excess Pituitary Hormone Disorders
- Hyponatremia and SIADH
- Radiological evaluation of pituitary tumors
- Pheochromocytoma
- Thyroid storm and myxedema
- Impaired Fasting Glucose (IFG) and Glucose Intolerance (IGT)
- Obesity and the Metabolic Syndrome
- Type 1 and Type 2 Diabetes
- Diabetes mellitus
- Metabolic bone disorders
- Procedure: Be able to perform nuclear medicine procedures, ultrasound studies and fine needle aspiration biopsies.
- Procedure: Be able to perform and understand DXA scans and results.
- Sodium Balance
- Potassium Balance
- Disorders of calcium and magnesium balances
- Simple and Mixed Acidosis
- Simple and Mixed Alkalosis
- Acute and Chronic Renal Failure
- Systemic Hypertension
- Metabolic Syndrome
- Primary and Secondary Hypertension
- Diabetes Mellitus
- Type 1 and Type 2 Diabetes
- Acute and Chronic glomerular, tubular and interstitial diseases
- Procedure: Interpret blood and urine biochemistry results
- Procedure: Be able to perform and interpret microscopic urinalysis
- Procedure: Be able to perform medical microbiology and anatomical histopathology in the evaluation and treatment of patients with renal disease
- Procedure: Be able to perform dialysis
- Dysphasia
- Heartburn
- Nausea and vomiting
- Abdominal pain
- Diarrhea
- Constipation
- Gastrointestinal bleeding
- Jaundice
- Ascites
- Geriatric gastroenterology GERD
- Advanced liver disease
- Acute gastrointestinal bleeding from the upper and lower GI tract
- Caustic ingestion and foreign body extraction
- Acute abdomen
- Intestinal obstruction
- Severe diarrhea including acute presentations of IBD Intestinal ischemia
- Acute and Chronic pancreatitis
- Biliary tract obstruction and cholangitis
- Acute hepatic failure
- Motility disorders of the gastrointestinal tract
- Ileus
- Bowel obstruction
- Volvulus
- Free air in the peritoneal cavity or mediastinum
- Bowel wall edema (thumbprinting)
- Fecal impaction
- Calcifications
- Lesions
- Disorders of the esophagus including esophagitis, esophageal spasm, and achalasia
- Intestinal motility disorders
- Malabsorption and maldigestion including mucosal diseases and pancreatic insufficiency
- Infectious diseases of viral, bacterial, mycotic, or parasitic etiology including HIV and its gastrointestinal manifestations
- Immununologically-based diseases
- Etiologies of hepatitis and cholestasis
- Pathophysiology and treatment of portal hypertension
- Premalignant and malignant processes
- Crohn’s disease, ulcerative colitis and proctitis
- Anatomy and blood supply of the gastrointestinal tract
- Role of the stomach, pancreas, and bile with respect to digestion
- Mechanisms and sites of nutrient and electrolyte absorption by the small intestine and colon
- Regulation of gastric, pancreatic, biliary, and intestinal secretion
- The role of the liver in the: synthesis and release of essential metabolic factors such as albumin and prothrombin into the blood, metabolism and detoxification of a number of substances, and synthesis and secretion of bile
- Barret’s/Non-Barret’s epithelium
- Gastroenterology Procedures (sources for the following can be found by clicking here):
- Upper and lower Barium contrast x-rays, recognizing ulcers, filling defects, masses, strictures, etc.
- Ultrasonography
- Computed tomography
- Magnetic resonance imaging
- Vascular, pancreatic, and biliary radiology
- Nuclear imaging and isotopically based tests including breath analysis and cyanocobalamin absorption
- Plain X-rays of the abdomen
- RUQ ultrasound, recognizing common ultrasound abnormalities such as ascites, gallstones, intrahepatic biliary tract dilatation, and liver and abdominal absecesses.
- Cholangiograms and pancreatograms and recognize stones, strictures, neoplasms, and the signs of chronic pancreatitis.
- Additional Gastroenterology Procedures (sources for the following can be found by clicking here and viewing the “Gastroenterology Procedural Lecture Series” at the bottom of the page):
- Flexible sigmoidoscopies to a depth of 60+ cm recognizing common colorectal pathology (hemorrhoids, polyps, and cancer)
- Biopsies, manipulating forceps
- Polypectomy, using both biopsy and snare techniques Sclerotherapy and banding with variceal hemorrhages Injection therapy, heater probe, and electorcautery with bleeding lesions of the upper and lower gastrointestinal tract
- Invasive therapeutic techniques including transhepatic cholangiography and drainage, transhepatic liver biopsy, percutaneous gastrostomy placement, vascular embolization, and placement of internal proto-systemic shunts (TIPS)
- Percutaneous endoscopic gastrostomy
- Placement of feeding tubes
- Placement of Sengstaken-Blakemore or Minnesota tubes for tamponade of bleeding varices
- Percutaneous liver biopsy, identify suitable biopsy site by percussion/palpation or ultrasound
- Paracentesis, indlucing the ability to diagnose ascites using percussion (shifting dullness) and ultrasound
- Capsule Endoscopy
- Basic endoscopy including: intubating the esophagus under direct visualization, understanding normal and post-surgical anatomy, and reaching the proximal small bowel during an upper endoscopy and the cecum during a colonoscopy in almost all patients.
- pH studies and basic esophageal and anorectal motility studies.
- Acute/Chronic Leukemia and Lymphoma
- Febrile and Afebrile Neutropenic Disorders
- Myelodysplastic syndromes and myeloproliterative syndromes
- Bone Marrow Review
- Thrombocytopenia
- Breast cancer
- Lung cancer
- Colon cancer
- Prostate cancer
- Skin cancers
- Cervical cancer
- Hypercalcemia
- Spinal cord compression
- Brain metastasis
- SIADH
- Tumor lysis syndrome
- Superior vena syndrome
- Respiratory failure and effusions
- Somatic and neutropathic
- Anemia Overall
- Microcytic, macrocytic, and normocytic (including hemolytic) anemia
- DIC
- TTP
- Platelet dysfunction
- Von Willebrand’s disease
- Procedures: Be able to perform chemotherapy
- Procedures: Be able to distribute the correct drug treatments (speak with your mentor for more information here)
- Febrile Neutropenia
- Nosocomial and Community Acquired Pneumonia Cellulitis
- Chronic Wound Infections
- Endocarditis
- Infections in Solid Organ Transplant Patients Multi-drug Resistant Organisms such as MRSA and VRE
- Sepsis Syndrome
- Meningitis
- FUO
- STD’s
- Diarrhea
- Rashes
- West Nile Virus
- Bioterrorism
- Upper respiratory tract infections
- Pleuropulmonary and bronchial infections
- Urinary tract infections
- Peritonitis and other intra-abdominal infections
- Cardiovascular infections
- Central nervous system infections
- Skin and soft tissue infections
- Infections related to trauma, burns, and human and animal bites
- Gastrointestinal infections and food poisoning syndromes
- Bone and joint infections
- Infections of reproductive organs
- Infections of the eye
- Viral hepatitis
- Nosocomial infections
- Infectious and non-infectious complications of HIV infection and acquired immunodeficiency syndrome Infections in the immunocompromised or neutropenic hosts
- Infections in acute leukemia and lymphoma
- Transplant-related infections, including bone marrow and solid organ
- Infections in geriatric patients
- Infections in travelers
- Infections related to intravenous drug abuse
- Procedure: Diagnosis of HIV, Initial Evaluation, and Selection of Antiretroviral Agents Prevention and Treatment of Opportunistic Infections
- Viral hepatitis
- Autoimmune liver disease (autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis)
- Nonalcoholic steatohepatitis (NASH)
- Inherited liver disorders (hemochromatosis, Wilson’s disease, alpha one antitrypsin deficiency) Non-cirrhotic portal hypertension
- Hepatocellular carcinoma
- Ascites
- Hepatic hydrothorax
- Hepatopulmonary syndrome encephalopathy
- Portal hypertensive bleeding
- Spontaneous bacterial peritonitis
- Pruritus
- Autonomic neuropathy
- Metabolic abnormalities
- Hepatorenal syndrome
- Procedure: Be able to perform central line placement, thoracentesis, lumbar puncture, etc.
- Procedure: Be able to perform high volume paracenteses
- Dyspnea
- COPD
- Asthma
- Pulmonary Fibrosis Sleep Apnea Syndromes DVT/PTE
- Sarcoidosis
- Lung cancer
- Plural Effusion
- Community Acquired Pneumonia Histoplasmosis
- Tuberculosis
- Procedure: Be able to interpret PFT’s
- Procedure: Be able to perform thoracentesis
PGY-II:
Inpatient General Medicine Ward (16 weeks)
Ambulatory Medicine (12 weeks)
Intensive Care Unit (8 weeks)
Musculoskeletal Medicine / Pain Management (4 weeks)
Emergency Medicine / Electives (12 weeks)
PGY-III:
Inpatient Wards (16 weeks)
Ambulatory Medicine (10 weeks)
Intensive Care Unit (10 weeks)
Musculoskeletal Medicine / Pain Management (4 weeks)
Emergency Medicine / Electives (10 weeks)
Vacation (2 weeks)
Conferences
Morning Report
These are held daily at 8 am Monday thru Friday. The morning report is attended by department chair or program director, a subspecialist, chief resident, residents, and interns on ward service.
Noon Conference
Core internal medicine lectures are given Monday thru Thursday at noon. Lunch is served. These conferences are interactive and attention is focused on real life practical aspect of each topic presented.
Journal Club
Relevant journal articles are reviewed every week on Wednesdays at 7am. This exercise will last one hour and will be attended by chief resident and the visiting professor.
Grand Rounds
These are held each Friday at noon. The speaker will be the visiting professor for that particular week. The focus of grand rounds would be to present state of art knowledge about important topics in each specialty.
General Competencies for Internal Medicine Residency
Internal Medicine Residency Program here is committed to a longitudinal, competency-based curriculum outlined by the Accreditation Council for Graduate Medical Education (ACGME). The ACGME general competencies include:
- Patient Care
- Medical Knowledge
- Practice-Based Learning and Improvement
- Interpersonal and Communication Skills
- Professionalism
- Systems-Based Practice
1) Patient Care
Residents must be able to provide patient care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and care at the end of life. Residents are expected to:
- Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
- Gather essential and accurate information about their patients
- Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence and clinical judgment
- Develop and carry out patient management plans
- Counsel and educate patients and their families
- Use information technology to support patient care decisions and patient education
- Perform competently all medical and invasive procedures considered essential for the area of practice
- Provide health care services aimed at preventing health problems or maintaining health
- Work with health care professionals, including those from other disciplines, to provide patient-focused care
2) Medical Knowledge
Residents must demonstrate knowledge of established and evolving biomedical, clinical and social sciences, as well as the application of this knowledge to patient care and the education of others. Residents are expected to:
- Demonstrate an investigatory and analytic thinking approach to clinical situations
- Know and apply the basic and clinically supportive sciences which are appropriate to their discipline
3) Practice-Based Learning and Improvement
Residents must be able to use scientific methods and evidence to investigate, evaluate and improve their patient care practices. Residents are expected to:
- Analyze practice experience and perform practice-based improvement activities using a systematic methodology
- Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
- Obtain and use information about their own population of patients and the larger population from which their patients are drawn
- Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
- Use information technology to manage information, access online medical information and support their own education
- Facilitate the learning of students and other health care professionals
4) Interpersonal and Communication Skills
Residents must demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families, and other members of health care teams. Residents are expected to:
- Create and sustain a therapeutic and ethically sound relationship with patients
- Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning and writing skills
- Work effectively with others as a member or leader of a health care team or other professional group
5) Professionalism
Residents must demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession and society. Residents are expected to:
- Demonstrate respect, compassion and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; and a commitment to excellence and ongoing professional development
- Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices
- Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities
6) Systems-Based Practice
Residents must demonstrate an understanding of the contexts and systems in which health care is provided, as well as the ability to apply this knowledge to improve and optimize health care. Residents are expected to:
- Understand how their patient care and other professional practices affect other health care professionals, the health care organization and the larger society, as well as how these elements of the system affect their own practice
- Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources
- Practice cost-effective health care and resource allocation that does not compromise quality of care
- Advocate for quality patient care and assist patients in dealing with system complexities
- Know how to partner with health care managers and health care providers to assess, coordinate and improve health care and know how these activities can affect system performance
Learn more about the internal medicine residency program by contacting us today!