Internal Medicine Residency Program Structure
The Department of Medicine at St. Elizabeth's Medical Center is proud to offer ACGME-accredited training in two categories: Categorical and Preliminary. The internship year is similar for both Categorical and Preliminary interns except that preliminary interns do not have a scheduled outpatient continuity clinic. The program offers 16 Categorical and 6 Preliminary positions annually.
Summary of Rotations
Internal medicine residency training at St. Elizabeth's Medical Center is a comprehensive clinical experience encompassing several educational opportunities located at St. Elizabeth's Boston campus.
Medicine and Cardiology Wards
Our ward experience is divided into two general medicine teams (Teams A and C), pulmonary (Team B), Day Float team, mini-hospitalist team (Team X) and Cardiology team.
- Team A consists of one PGY-3 and two PGY-1s (one medical and one psychiatry intern). Team A is supervised by a hospitalist attending. Team A is geographically located primarily on one floor.
- Team B consists of one PGY-2 and one PGY-1. Team B is supervised by a pulmonary fellow and attending. Team B is geographically located primarily on two floors.
- Team C consists of one PGY-2 and two PGY-1s. Team C is supervised by a hospitalist attending. Team C is geographically located primarily on one floor.
- Day Float team consists of one PGY-2 and one PGY-1. Their primary role is to admit patients from the Emergency Department. They will allow the other ward teams to have uninterrupted bedside teaching rounds. Moreover, the Day Float team will be exposed to diverse pathology while focusing on mastering admission skills.
- Mini-hospitalist team (Team X) is a new team that was introduced in the year 2017-2018. This is primarily led by a PGY-3 alone. This is to give the PGY-3 an experience of how it is to be a hospitalist. The PGY-3 is supervised by a hospitalist.
- Cardiology team consists of one PGY-3, one PGY-2, and two PGY-1s. Although they function as one team, they will be divided into two “mini-teams”: one PGY-3 and one PGY-1, and another consisting of one PGY-2 and one PGY1. The cardiology team is supervised by a dedicated fellow and attending. The cardiology team is geographically located primarily on one floor.
- Night Float team consists of two PGY-2s and two PGY-1s and operates as two “mini-teams” to promote team work. Their primary role is to admit medical, pulmonary, and cardiology patients overnight, as well as cross-covering patients on Teams A, B, C, and Cardiology.
Our ICU team is collectively responsible for caring for both medical and cardiovascular patients – they round separately with both the pulmonary/critical care and cardiology teams. The team consists of two PGY-3 residents, two PGY-2 residents and four PGY-1s. All PGY-3 and PGY-2 residents take 24+4 hour calls every 4th day. There is a night float system for the interns who work from 7 p.m. to 7 a.m. for four-five consecutive nights.
Our ICU is a state-of-the-art 28-bed multidisciplinary ICU which opened in December of 2013. As a tertiary referral center for the Steward Health Care System, the ICU team is constantly exposed to many critically-ill patients with diverse pathology. The team gets firsthand experience responding to rapid responses and codes, and managing very complex cases including those with rare diagnoses.
We also have electronic ICU (e-ICU) from 7 p.m. to 7 a.m. with capabilities of video monitoring of patients, their vital signs, lab studies, and imaging. The e-ICU attending is easily accessible via designated telephones and they serve to help with the critical care of the patients in addition to the primary pulmonary and cardiology fellows/attendings.
Emergency Medicine, Neurology and Medical Consults
Residents rotate in the emergency department during their PGY-1 year and again as a PGY-3. The emergency department is staffed by one to two emergency department physicians 24 hours a day. Each emergency medicine rotation consists of approximately six 8-hour shifts over the course of a week.
PGY-3 residents rotate on the inpatient neurology consult service. The team consists of one PGY-3, a neurology resident from Tufts Medical Center and a neuro-hospitalist.
PGY-3 residents rotate on the inpatient medical consult service. PGY-3 residents evaluate all inpatient medical consults and round with a dedicated hospitalist. Additional responsibilities during this rotation include reviewing and presenting cases at the department of medicine mortality conference.
Through our 4+2 block system, two consecutive weeks of every six weeks will be spent in an ambulatory setting without any conflict of inpatient responsibilities.
During the ambulatory block, all categorical residents and interns spend two full days or four half days per week in their continuity clinic conducted in a primary care office. Each resident is assigned to a preceptor and works closely with that attending physician for three years. The focus is on learning how to manage a broad array of illnesses in an outpatient setting and the most important aspects of primary care including preventive medicine and evidence based practices. This opportunity allows for building longitudinal relationships with a panel of patients.
During the ambulatory block, all residents and interns spend remaining half-days in various specialty and subspecialty ambulatory areas. Clinical experiences are available in cardiology, endocrinology, gastroenterology, hematology/oncology, infectious diseases, nephrology, neurology, non-operative otolaryngology, pain management, pulmonary and geriatrics. We have now expanded these clinics to include Dermatology clinics, Allergy & Immunology clinics & Wound Care Center with Hyperbaric Oxygen Therapy. We are in the process of further expanding this experience to include additional subspecialties.
Academic and Administrative Time
During the ambulatory week, all residents will get three half- days that are used for academic and administrative duties. Monday mornings are designated for Physician Education and Assessment Center (PEAC) modules (see Conferences) with the outpatient Associate Program Director. Friday afternoons are designated as Administrative Half days during which one hour is dedicated to our Quality Improvement (QI) forum and the remainder of time is provided for the residents to complete any outstanding medical documentation and/or residency-related administrative duties. A Study Half day allows residents to independently study and prepare for any upcoming rotations and/or board exams, and also to conduct any research or quality improvement activities.
We offer elective rotations in cardiology, endocrinology, gastroenterology, infectious diseases, nephrology, pulmonary medicine, rheumatology, neurology, addiction medicine, and emergency medicine.
Residents may do one elective off site (up to four weeks in duration) during their second or third year of residency training with the approval of the program director.
- Global Health Elective – We offer residents the opportunity to participate in international elective in Uganda. This program is led by one of our Emergency Department attending physicians, Dr. Ed O’Neil. (click this link to view information about the program - www.omnimed.org).
- Research – PGY-2 and PGY-3 residents with a well-conceived research plan and a designated faculty mentor can use one elective block to pursue a research project instead of their away elective.
- Simulation Lab – We have scheduled simulation teaching sessions at the Simulation Lab at Tufts, run by our Associate Program Director, Andrew Moraco, MD who is also a pulmonary and critical care attending.