Resident Training Program - Internal Medicine Residency

The education and clinical training of Internal Medicine residents is a central focus in the Department of Medicine. We provide comprehensive training in general internal medicine for residents seeking career in a subspecialty fellowship, primary care and hospital medicine.

Combined training programs in Medicine-Pediatrics and Internal Medicine-Emergency Medicine (including a 6th year for EMIM-Critical Care certification) offer unique opportunities to individuals interested in dual or triple certification. Preliminary interns participate in a curriculum similar to the categorical interns and develop a solid clinical base in internal medicine before entering their specialty residency.

The broad and flexible curriculum allows residents to put together a well-rounded program suitable for their individual educational needs. Residents participate in a comprehensive core curriculum that emphasizes the breadth and depth of internal medicine and a broad choice of electives that allow them to explore areas of clinical and research interest.

Goals of the Residency Education Program

Through their clinical training, residents:

• Learn the principles and knowledge necessary for the practice of general internal medicine balanced with a comprehensive exposure to the medical subspecialties.
• Gain clinical knowledge in diverse ambulatory and inpatient settings by caring for patients with a variety of illnesses and from many socioeconomic backgrounds.
• Receive a balanced exposure to patients with acute or life threatening illnesses and to those with chronic or subacute problems.
• Are immersed in a clinical learning environment that promotes wellness and supports a healthy work-life balance.
• Engage in a supportive community that addresses issues related to bias, anti-racism, community engagement.

To meet these goals, residents gain clinical experience at three teaching hospitals and numerous ambulatory sites. Residency training is conducted at the University of Maryland Medical Center, at the modern and adjacent Veterans Affairs Medical Center and at Mercy Medical Center -- a community hospital within five minutes from University Center. Training in ambulatory care takes place at these sites as well as in clinics and private practices in Baltimore City and surrounding counties.

The Clinical Learning Environment

We are deeply committed to ensuring our residents learn in a supportive environment that emphasizes clinical medicine, individualized mentoring and resident wellness.

Our efforts have resulted in a wonderful camaraderie among our residents.

Some examples of recent changes include dedicated educational time, a resident lounge, an X+Y format for scheduling rotations, comprehensive wellness curriculum, professional development, annual educational retreats with a fall retreat for the interns and ongoing social events.

The GME leadership at UMMC has been phenomenally supportive of our residents, including funding for hospitalists, moonlighting shifts and ancillary support.

Here are some highlights of our clinical curriculum and structure:

• At the UMMC and the VA, we have 4 general medicine teams (1 senior resident + 2 interns) in a team call structure. A Day Float resident helps the residents with admissions and a resident moonlighter cross covers to ensure the long call team leaves on time.
• At both UMMC and the VA, we have a Team Call System for the general medicine services with the Night Team arriving at 9 PM, and the long call team taking their last admission at 6 PM. The "drip method" limits admissions from 4-6 PM so everyone leaves at the end of their shift. A moonlighter handles all cross-cover issues from 6-9 PM.  With a Night Team covering 7 nights/week, interns and residents do not stay overnight on general medicine and Med-ID.
• The team attending is the physician of record for all patients on all services.  Hence, private practitioners and consultants may admit to our services, but the team attending, resident and intern assume primary responsibility for the patient.
• Patient care in the ICU's is done by residents, hospitalists and intensivists. At UMMC, an intensivist is present in the MICU 24/7/365. At night the intensivist and pulmonary-critical care fellow work with the senior resident and 2 interns in admitting and cross-covering patients. In the CCU, the senior resident and 2 interns admit and cross cover patients at night, with a cardiology fellow available for immediate assistance. At the VA, the MICU and CCU services are covered at night by the ICU resident and interns on a night float rotation. Interns on VA ICU rotations do not stay overnight.     
• Call on all services at all sites - including floor teams and ICU's at all sites - is every fourth night.
• We track resident duty hours through a self-reporting method to ensure compliance with all ACGME Duty Hour Requirements.
  
• Interns are strictly capped at 5 admissions per long call or night float shift with upper level residents capped at 10 supervisory admissions.
• Interdisciplinary teams and discharge planners facilitate patient care. Broad ancillary services at all sites make patient care efficient and effective.
• All sites have full electronic medical records, with EPIC at UMMC and Mercy, and CPRS at the VA.  
• Non-teaching services admit patients at all sites to help patient flow and ensure we meet all ACGME rules. At UMMC, we have non-teaching services for general medicine, step-down intermediate care unit (IMC), BMT, renal transplant services and bone marrow transplant unit. The VA and Mercy have general medicine nonteaching services. 

Leadership and Teaching Skills

The development of leadership and teaching skills is an important part of residency training. Throughout their rotations, residents develop the necessary skills to be clinical supervisors and teachers of the medical teams. By taking on progressive responsibilities, residents become comfortable dealing with a wide variety of clinical situations, including patient care, interpersonal situations and teaching.

Residents attend an annual educational retreat where they improve their skills in giving feedback, teaching in small groups, managing conflict, and team building. An annual educational retreat for interns in the fall helps to boost their skills early in the year and provides a dinner social event to enjoy time with their classmates. A best resident-teacher award is given to a senior resident each year -- reaffirming the importance placed on excellence in teaching as part of each resident's core responsibilities.

Our residents consistently receive the majority of the teaching awards given by the medical students, including AOA Honor Society and the Gold Humanism Honor Society.