Categorical

Resident's Handbook

(Traditional Three-Year Program)

NRMP 206616

The three-year program consists of inpatient and outpatient experiences in assigned and elective rotations designed to give residents a broad exposure to the discipline of internal medicine and to prepare them for the practice of internal medicine or further training in the subspecialties of internal medicine.

The PGY-I Year

All residents accepted as PGY-I residents in this program are expected to complete three years of training in internal medicine, leading to board certification. It is during this critical year that the interns acquire the basic attitudes and work habits which will remain with them for their careers as physicians.

The internal medicine resident service of 416 teaching beds provides an excellent opportunity for first-year residents to care for a large and varied patient population with an appropriate distribution of medical problems. First-year residents have major responsibility for the primary care of these patients in an academic environment. First-year residents are responsible for gathering an initial data base, developing diagnostic and therapeutic plans and maintaining accurate medical records. They are given the opportunity to perform procedures and function as the physician of record in a supervised environment. The residents work with third- and fourth-year medical students assigned to their service, and countersign student orders. First-year residents function under the appropriate supervision of second- and third-year residents and faculty attending, as members of the university teams.

Rotations for the PGY-I year consist of three to four months of general internal medicine ward service at the VA Medical Center and three to four months on general internal medicine ward services at the community hospitals. When assigned to these services, first-year residents are on call every fourth night at the community Hospitals; VA has night float service. . Additionally, PGY-I residents complete a one-month block rotation in cardiology, ICU, and two months of elective rotations of their choice of ID, GI, or pulmonary.

First-year residents on-call are encouraged to leave the hospital at noon. the following day, provided all patient care responsibilities are completed. Efforts are made by all of the hospitals to ensure that residents are given one full day off per week from hospital duties.

Changes in emphasis by the American Board of Internal Medicine have stressed the importance of outpatient care and require to the intern to receive a thorough education in ambulatory care.

The PGY-II and PGY-III Years

PGY-II and PGY-III resident rotations are very similar, organized into a 24-month block, with 50 percent of the time spent on rotations which provide meaningful patient responsibility as required by the ABIM. The senior resident assumes more responsibility in complex patient evaluation and in the supervision of junior residents and medical students. Residents assigned to the VA medical service receive experience in ICU and critical care settings as well as experience as a general medical consultant. One month block ambulatory care rotations are available at three of the hospital sites to increase outpatient experiences.

The remaining months are spent on elective rotations, geared to the individual resident's career interests. Residents interact with faculty from all of the disciplines of medicine, serving as a consultative specialist and interacting with other services and disciplines. There is a required emergency room rotation in the second or third year.

Residents are assigned to a continuity clinic one half-day per week. Over a period of three years, the resident has an opportunity to develop a meaningful relationship with a single population of patients in an environment which permits continuity of care. The patient mix in the long-term general internal medicine clinics is excellent and provides experience in all aspects of ambulatory general internal medicine. Residents are given the opportunity to perform a number of outpatient procedures such as flexible sigmoidoscopy, treadmill testing, and Holter monitoring.


At community hospitals, night call responsibilities are every fourth night when assigned to ward services and one to two times per month when on elective rotations. Efforts are made by all hospitals to provide residents with a full day off per week.

Categorical Curriculum


Postgraduate Year I

- 4 months Inpatient Service

  VAMC

- 4 months Inpatient Service

  JCMC, HVMC or BRMC

- 3 months of elective (subspecialty)
- 1 month ICU/CCU rotation at VAMC, HVMC, or BRMC

Postgraduate Year II

- 3 months Inpatient Service

  VAMC

- 3 months Inpatient Service

  JCMC, HVMC or BRMC

- 1 month ICU/CCU rotation

- 1 month Neurology
- 1 month Geriatrics
- 1 month Emergency
- 2 months electives (subspecialty or general)

Post Graduate Year III

- 3 months Inpatient Service

  VAMC

- 2 months Inpatient Service

  JCMC, HVMC, or BRMC

- 1 month ICU/CCU

- 1 month Emergency Room
- 4 months electives (subspecialty or general)



Key:

JCMC-JohnsonCityMedicalCenter

VAMC-VeteransAdministrationMedicalCenter

BRMC-BristolRegionalMedicalCenter

HVMC-HolstonValleyHospital and MedicalCenter