Internal Medicine Residency Didactics
Morning reports are held every morning from 8 a.m. to 9 a.m. An assigned resident presents a case and discusses the topic related to the case with a focus on evidence-based medicine, in the presence of a supervising attending physician who provides expert opinion and practical insight to the case. The chief medical resident serves as the moderator and helps engage the audience. Unscripted morning reports are special sessions in which an assigned resident presents a case impromptu and the chief medical resident and the attending physician moderate the discussion in an interactive way with the goal of bolstering the audience’s critical thinking skills Other morning report sessions are designated to include MKSAP/UWorld Internal Medicine board examination questions to supplement the Academic Enrichment Program and to help third year residents with their board preparation. Friday mornings are dedicated to Clinical Pearls of Medicine sessions, where an attending physician provides useful practical insights into common topics encountered during residency training (see Clinical Pearls of Medicine). Grand rounds take place every Wednesday morning in place of a morning report.
Academic Half Day
Academic half-day sessions occur on Mondays of the ambulatory block. During these sessions, a topic from PEAC (Physician Education and Assessment Center), a structured outpatient curriculum developed by Johns Hopkins School of Medicine, is presented by a senior resident under the supervision of either the outpatient associate program director or a core faculty member. These sessions are conducted in a flipped-classroom approach with all members of the audience completing a pre-test prior to the session to promote active learning and participation.
Noon conferences are held daily. The majority are lectures that are delivered by faculty members. Lecture topics are planned by the chief medical residents and focus on core topics that are heavily represented on the American Board of Internal Medicine examination. Additional days are dedicated for other activities such as Jeopardy, Health and Wellness, Morbidity and Mortality Conferences, Harm-Free Care Rounds, etc. as detailed below.
Jeopardy competitions are held monthly. The Jeopardy session encompasses questions related to the topics from subspecialties that were discussed during morning reports and noon conferences that month. The residents divide into two to four teams and engage in a friendly and lively competition to see which team scores the highest.
Morbidity and Mortality Conferences
Morbidity and Mortality (M&M) conferences are an ACGME-mandated educational series that occur monthly and are presented by the chief medical residents. The purpose of M&M is to enhance the residents’ education and to identify opportunities for improvement in individual practice to optimize clinical care.
Harm-Free Care Rounds
Harm-Free Care Rounds are a novel approach to identify areas where preventable harm was caused to patients during their hospitalization, particularly events such as catheter-associated urinary tract infections (CAUTIs), central-line associated bloodstream infections (CLABSIs), hospital-acquired pneumonias, hospital-acquired Clostridioides difficile infections, pressure ulcers, pulmonary embolisms, surgical site infections, etc. The review is done by a PGY3 and a PGY2 resident once every 2 months during noon conference, and the purpose of this review is to analyze the patient’s case by reviewing their charts, finding out the timeline of the infections, and what alternative measures could have been performed to prevent or mitigate the harm caused in question, keeping the National Health Safety Network (NSHN) guidelines as the core.
Health and Wellness Conferences
Health and Wellness Conferences (H&W) are noon conferences that occur monthly. Fatigue and burnout are common amongst all residents nationwide, and we provide a protected time for our residents and interns to engage in fun and wellness-centered activities at the workplace, such as international potluck, yoga/weight management classes, jeopardy, and charades amongst others. The activities are planned by the Wellness Committee members composed of representatives from each resident class. The committee also plans group activities that occur after work, such as running club, city outings, visiting museums and many others.
Business Meetings occur monthly with all the residents and the program leadership. These meetings are opportunities to address any issue raised by the Residency Committee (see Committees) and discuss ongoing improvements in an open forum. Many positive changes to the program have been implemented as a result of the residents’ feedback. Lunch is provided during these meetings and we celebrate monthly birthdays and resident achievements.
Research Methodology Education
The program utilizes the expertise of Dr. Deborah Zucker, faculty at Tufts University School of Medicine, to provide residents with the basic know-how of conducting a research project and performing basic biostatistical analysis, facilitated through noon conference sessions.
Clinical Pearls of Medicine (CPM)
On Friday mornings, instead of the traditional morning report, CPM sessions are held, which are either in medicine, cardiology, or clinical ethics. An attending physician who is an expert in one of these topics conducts the session, wherein clinically relevant vignettes and factoids are taught to the residents in a protected environment.
Intern Reports are held every Monday at noon. These sessions are exclusively for the interns with the goal to learn how to formulate and approach a clinical question and explain the process of how the clinical answer was obtained using an evidence-based approach. This is also a protected time and place to share thoughts and experiences with other interns and with the chief medical residents.
Fallon Rounds are held every Tuesday in the afternoon. These are conferences dedicated for the interns with the aim of learning how to present a clinical case, formulate a differential diagnosis, and use critical thinking that will lead to the most probable diagnosis. These are led by Dr. Paul Fallon, a core faculty and a member of the Clinical Competency Committee with the help of the chief medical residents.
Journal Club is an academic activity designed for residents to learn how to analyze a journal article. Each second year resident is assigned a faculty mentor and a study design (RCT, meta-analysis, diagnostic, cohort, or case control study). Residents meet with their mentors prior to their presentation to obtain guidance in article selection, result analysis and study appraisal. Residents present the Journal Club to the rest of the residents and lead discussion of validity of the study and impact on clinical practice.
These are noon conferences dedicated to discussing ICU cases. The second and third year residents are engaged in reviewing select cases to assess the presence of any medical and/or non-medical error(s) and identify opportunities for improvement while using supporting evidence from current literature. These are supervised by the fellows and attending physicians in the department of pulmonary and critical care medicine.
Dedicated Internal Medicine Board review sessions are held for third year residents every Monday at noon and two other days of the week in the evenings. During this protected time, the senior residents engage in review sessions with the Associate Program Director. In addition to the Academic Enrichment Program (see below), the program purchases MKSAP review books with question banks for residents during their second year to aid in board preparation.
Academic Enrichment Program
We have established a strong and well-structured Academic Enrichment Program for all residents to strengthen their medical knowledge and to prepare for the ABIM board exam, using renowned study aids such as the New England Journal of Medicine’s Knowledge Plus platform.
During these sessions, attendings and/or former graduates who matched into competitive fellowships are invited to discuss their experiences in their respective fields. These talks are designed to help the residents form their career interests with a better understanding of the field of interest.
Mini-CEX (Clinical Evaluation Exercise) Cases
Core faculty and the chief medical residents conduct one-on-one sessions with each resident using a simulated patient case to assess their history taking skills, and their clinical approach to the case using critical thinking skills. Once the history is obtained, physical exam findings are provided, and lab and imaging data are provided as needed. The resident then presents the assessment and plan based on the information provided. The goal of these sessions is to provide extensive feedback on history taking, data collection and interpretation, presentation skills, and management skills using critical thinking. The ultimate goal is to establish lifelong learning habits through evidence-based medicine and critical thinking.
Rapid Response/Code Training
We dedicate some noon conference sessions to discuss and practice rapid responses and codes. The residents have an opportunity to handle codes in a protected environment using patient simulators. In addition, frequent mock codes provide residents with the opportunity to practice and strengthen confidence and leadership skills in high acuity situations.
Several sub-specialty divisions offer weekly conferences focusing on clinical cases, clinical and basic science research, and residents are encouraged to attend these conferences as well.