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 a categorical PGY-I resident 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 over 1000 beds, at 3 different sites 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. They are responsible for gathering initial data, 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. A first-year resident functions at all times under the appropriate supervision of second- and third-year residents and faculty attending physicians, as vital members of the health care team.
Rotations for the PGY-I year consist of one to two quarters of general internal medicine ward service at the VA Medical Center and one quarter of general internal medicine ward services in the community hospitals. When assigned to these services, first-year residents are on call until 8pm approximately every 4th night at the community hospitals and rotate up to the night equally to ensure exposure to different environments even in the same facility. The VA has a night medicine service staffed by senior residents. Additionally, PGY-I residents complete block continuity clinics and several elective rotations. A two week rotation with the Department of Psychiatry at the VA also enhances the knowledge of basic mood disorders, delirium and substance abuse treatment.
The PGY-II and PGY-III Years
The PGY-II and PGY-III resident rotations are very similar, organized into 26 blocks per year, with 50 percent of the time spent on ICU, Night Medicine and Inpatient rotations. 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. One block ambulatory care rotations are available for all three training years at the VA to increase outpatient experiences.
The remaining months are spent on elective rotations, geared to the required subspecialty rotations as well as 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 during the second or third year.
Residents are assigned to a continuity clinic team and work in blocks with their preceptor. 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 joint injections, PFTs, along with the required ABIM procedures.
At community hospitals, night medicine is shared among the residents on the rotation. Call is approximately every 4th day until 8 pm and weekend coverage is shared. Several approximate 8 hour shifts per week are done by residents on elective rotations.
Categorical Curriculum (Scheduled in Blocks, but months given as estimate)
Post Graduate Year I
- 4-5 months Inpatient Service – VAMC
- 3 months Inpatient Service – JCMC or HVMC
- 2 months of elective (subspecialty)
- 2 months Block Continuity Clinic
Post Graduate Year II
- 2-3 months Inpatient Service – VAMC
- 3 months Inpatient Service – JCMC or HVMC
- 1 month ICU/CCU rotation
- 2 months Block Continuity Clinic
- 4 months electives (subspecialty or general)
Post Graduate Year III
- 1.5 months Inpatient Service – VAMC
- 2-3 months Inpatient Service – JCMC or HVMC
- 2 month ICU/CCU
- 2 months Block Continuity Clinic
- 5 months electives (subspecialty or general)
Key:
JCMC-Johnson City Medical Center
VAMC-Veterans Administration Medical Center
BRMC-Bristol Regional Medical Center
HVMC-Holston Valley Hospital and Medical Center
