Internal Medicine Residency Curriculum
The educational goals of the Internal Medicine Residency Program are centered around the six ACGME competencies:
- Patient care
- Medical knowledge
- Interpersonal and communication skills
- Systems-based practice
- Professionalism
- Practice-based learning and improvement
The Internal Medicine Residency Program offers exceptional learning opportunities in a vast array of clinical settings, including outpatient and in-patient experience. We have dedicated teaching faculty and supportive staff who strive to ensure all of our residents have the best experience possible.
The program is currently using a “4+1” block schedule in order to provide the most experience possible. Each 2 to 4 week-long in-patient, ICU or elective subspecialty rotation block will be followed by 1 week of protected IM clinic time where residents can provide continuity of care to their patient panel and act as a genuine primary care provider.
Clinical Experience
Outpatient IM Clinic: Certified as a medical home, residents provide primary care service along with staff including: nurse, medical assistant, St. Louis College of Pharmacy/PharmD, pharmacy residents/students and pharmacy technician, social service specialist, office manager and administrative leadership. Phlebotomy is performed in the clinic by our nurse(s) and/or medical assistant.
Outpatient IM Ambulatory Care: Residents rotate in various on- and off-campus IM training sites where appointed faculty teach them ambulatory, guideline-based, contemporary best practices in primary care environment.
In-patient Service: Residents play a pivotal role in the multi-disciplinary teams comprised of 1 academic hospitalist faculty, 1 senior/junior resident, 2 interns, SLU and /or SABA 3rd/4th year medical students, a SLU physician assistant student, a teaching PharmD staff and pharmacy residents/students. Nursing staff and Case Management also interact daily with residents. Residents also actively participate in our Multidisciplinary Daily Rounds. Residents personally interact with a wide range of consultants to provide patient-centered care.
Critical Care Medicine: Residents spend a total of approximately 12 weeks during their PGY-1 in the medical ICU on campus. Junior and Senior Residents complete an additional 4-week rotation each year. The Critical Care experience helps to develop fast-pace clinical thinking in the care of severely-ill and fragile patients over a diverse spectrum of diseases. Residents are supervised by Critical Care Core Faculty members. A well-structured multi-disciplinary round offers clinical bedside teaching from the Intensivist and permits the residents to learn from other members of the team including an ICU-dedicated PharmD, nursing leadership and staff, Respiratory Therapy, Case Management and others. Residents learn and perform several important bedside procedures. As on the in-patient service, residents also interact with a wide range of consultants during their ICU experience.
Subspecialty Medicine: Residents have the opportunity to rotate in every Internal Medicine subspecialty, for both outpatient and in-patient services. Elective rotations play an important role in becoming a solid internist. Experiences in Cardiology, GI, Pulmonology, Nephrology, Hematology/Oncology, Infectious Diseases, Rheumatology and Endocrinology are offered. A 4-week rotation in both Geriatrics and Emergency Medicine is also integrated in the curriculum per ACGME requirement. In our program, Neurology is compulsory and Psychiatry is strongly encouraged.
Specialty Exposure: Residents have the opportunity to experience an additional wide range of specialties to broaden the scope of their future internal medicine practice. Available rotations include: Chemical Dependency Medicine, Dermatology, Wound Care, Podiatry, ENT, Gynecology/Women’s Health and Vascular Surgery. Our Internal Medicine program is strongly involved in sponsoring institutions plan of care and protocol development.
Educational Conferences
Morning Report: PGY-2 and PGY-3 residents discuss a clinical case with one or several core faculty member(s) three times a week, covering both out- and in-patient encounters. Medical students also attend, prepare and support discussion with senior residents. The department is also strongly involved in the sponsoring institutions plan of care and development of protocols and guidelines for COVID-19 patients.
Noon Conference: Organized core curriculum daily one-hour lecture series presented by our teaching faculty in all areas of General Internal or Subspecialty Medicine. Non-physician providers also participate in the education of the residents which include: Pharmacy, Social Medicine, Respiratory Therapy, Physical and Occupational Therapy. During the month of July, supplemental basic medicine and patient care concepts as well as non-medicine topics are presented as an extension to the intern’s Curriculum.
Mortality Review vs. Death Review: Each month, the ICU residents review all mortalities that occurred on the teaching service the preceding month. Core faculty guide the resident to critically analyze the clinical cause to identify gaps and develop solutions to improve outcomes.
Morbidity and Mortality (M&M) Conference: Each month one PGY-2 or PGY-3 resident performs a Root Cause Analysis on a real patient encounter where Safety and Quality-related care issues were thought to play a major role in disease progression or demise. Each resident is expected to present the case, utilize PSQI tools to identify gaps and perform a literature review to substantiate lessons learned. Each PGY-2 and PGY-3 resident is expected to complete an M&M presentation once a year.
Grand Rounds: Once a month from September to May invited speakers and/or faculty present a current topic to broaden overall knowledge and teach new tools that can positively impact multi-disciplinary patient care and promote the concept of lifelong learning.
Journal Club: PGY-2 and PGY-3 residents prepare a 30-minute presentation and discuss relevant information analyzed in primary or review scientific articles and/or newer guidelines from recent medical published literature in influential journals.
Medical Knowledge Self-Assessment Program (MKSAP): Once a month as part of the noon conference clinical curriculum, the chief and senior residents critically review questions from one section of the American College of Physicians (ACP)-derived MKSAP with residents as a preparatory exercise for the American Board of Internal Medicine (ABIM) examination.
Research Opportunities
In addition to providing an excellent education at the bedside and in the clinic, the IM Residency Program requires all residents to be actively involved in activities related to research. Opportunities for research are resident driven and cover a variety of topics.
The program is committed to engage all learners in expanding their skills by embracing research as part of the tools in medicine to enhance patient care. Several avenues are possible, all supervised by a Core Faculty mentor. Some projects may be simpler than others; some may require Institutional Board Review (IRB) approval.
Certainly, research projects can lead to publication or poster presentations. Protected time off clinical duties is allotted to all residents as part of the “+1” schedule block. Personal engagement of the resident remains the key factor for success.
Yearly, the Program participates in the ACP MO Chapter Poster competition.
Patient Safety and Quality: All residents are responsible to formulate a small scale prospective research project on an annual basis, usually using the PCSA (Plan, Do, Check, Act) cycle and A3 problem solving. The IM clinic offers great opportunities to identify gaps and serve as a solid base for a project.
Case Report: Residents can elect to write a case report or case series under the guidance of a faculty member and publish in a PubMed-indexed journal.
Clinical Vignette: Residents can elect to write a patient case and present it as a poster in a competition including the ACP (American College of Physicians), Missouri Chapter.