Each PGY- I internal medicine resident spends two weeks in rotations to explore aspects of ancillary services. During the intern year, each intern spends 2 weeks rotating through sites to include audiology, physical, occupational and speech therapy and pharmacy. Another week is spent rotating through psychiatry during training for basic fundamentals for the internist involving this specialty to include: recognition and treatment of anxiety and depression, when to refer to psychiatry, determination of capacity, emergency commitment information and common medication side effects/interactions.
PGY-1: 2-week Boot Camp Rotation
Each PGY- I internal medicine resident spends 2 weeks in the “Boot Camp”/ orientation rotation. This rotation prepares the intern for all aspects of their job performance and span the core competencies.
The following learning objectives are emphasized throughout the rotation:
I) Learners demonstrate an understanding and appreciation of the importance of I) primary care physician involvement; 2) medication reconciliation; 3) discussion of goals of care and advance
directives; 4) functional assessment; and 5) transitional care, during care transitions through reflective writing and conference presentation.
- Learners demonstrate an understanding of basic documentation skills and coding/billing requirements for both inpatient and outpatient training.
- Learners are introduced to basic research principles and complete IRB training
- Frameworks for various tasks including starting a medication, breaking bad news, and transition of care and are initially audited by faculty.
Physical Diagnosis Curriculum:
An average of a half-day per block is spent in a special Physical Diagnosis Curriculum, learning the fine points of key parts of the physical exam from expert clinicians who integrate state-of-the-art teaching tools in their bedside instruction. Another key focus of this curriculum is performing an “evidence-based” physical exam, rather than strictly the head-to-toe physical examination learned in medical school. Many areas of the physical examination are covered, including special instruction in the female pelvic examination.
As part of the training, learners are audited on transition of care, wellness, acute care notes, history and physical, progress notes, and discharge summaries during each ambulatory and inpatient rotation after the initial boot camp audit. Direct feedback will be provided in a timely fashion and documented on the audit sheet. Failure to meet the recommended standards established by the Clinical Competency Committee can extend the audits past the six-month time frame until the resident meets the required performance threshold
Ambulatory Practice Months
The foundation for longitudinal ambulatory practice training in the Program is the Community-Based Practice (CBP) Group. Each resident joins a CBP Group and returns to their practice at this site every 3 months for a block rotation. At each site, six residents manage their group’s panel of patients with faculty preceptor oversight. During each month they hone skills in providing longitudinal primary care to include wellness and physical examination, acute care, and telephone medicine. Between the block periods, there are half-days scheduled on non-leave restricted (inpatient ward and ICU) rotations.
Additional longitudinal ambulatory practice experiences scheduled during the CBP/Ambulatory Rotations include volunteer participation in the indigent clinic, a hospital affiliated clinic, and participation in the planned Elder House Call Program (EHCP).
Every resident cares for a panel of primary care patients. Clinic sessions are the main periods for patient interactions physicians are available to consult with their patients by phone or telemedicine and at other times by other members of their firm. Over 3 years, residents work closely with a faculty preceptor to provide primary care and acute care for patients with complex medical and social and behavioral problems. GIM residents also work closely with a preceptor to provide home care for frail elderly or otherwise homebound patients in the Elder House Call Program. Each GIM resident cares for a panel of patients at home, and coordinates visiting them during ambulatory months.
Public Health & Serving the Underserved
The residency program is founded on a commitment to train physicians to provide high quality care with specific exposure to underserved populations. The diverse clinical experiences — including the inpatient ward service, the indigent clinic and Elder House Call — enable residents to care for underserved populations in Northwest Georgia.
Small group learning sessions begin each half day of continuity clinic rotations. The curriculum is divided so that each resident will be provided the same topics during their firm rotation. The topics complement the residents’ practical experiences and comprise the Ambulatory Curriculum. The method of education utilizes a “flip the classroom” technique overseen by a faculty member. Planned curricula given during these weekly one-half-day small group didactic sessions include:
- selected core topics in primary care medicine and non-internal medicine specialty topics designed to support clinical experiences in these areas (e.g., Musculoskeletal Medicine, Dermatology, ENT, podiatry, ophthalmoscopy, gastroenterology).
- scheduled time for self-directed learning via a web-based ambulatory care curriculum covering multiple learning topics
- seminars designed to enhance knowledge and skills in practice management, informatics, and promote better understanding of health insurance and the broader health care system.
- A quality improvement project is required each year and usually is completed related to clinic based opportunities for improvement
Special Courses and Conferences
Each year, residents are encouraged to present clinical vignettes or research, and to learn about the academic activities encompassed by general internal medicine and associated career possibilities. Attendance at meetings, together with associate membership in ACP (sponsored by the training program), fosters a sense of professional identity as general internists. Residents are encouraged to submit material for presentation at both regional and national meetings.
Evidence-Based Medicine/System Based Lecture Series (EBM/SBP)
The content consists of the following topic areas: core principles of EBM, medical informatics, common clinical problems, issues in doctor-patient communication, skills for ambulatory practice, critical appraisal of published research in journal club format, teaching and presentation skills, and principles of quality improvement. More intensive experience in the Medical House Staff Practice will also occur during this month.
Core Principles of EBM
In order to be able to practice evidence-based medicine, several skills must be learned and refined. They include:
- Asking pertinent, answerable questions
- Finding the best evidence
- Critically appraising the data
- Extracting the clinical message
- Applying this information to an individual patient.
Additional important topics such as absolute risk reduction (ARR), relative risk reduction (RRR), and number needed to treat (NNT) are covered in a group of interactive, problem-based teaching sessions.
Physicians live in a world of information, and its efficient management is mandatory in order to remain an informed clinician. The informatics curriculum has three major goals:
Residents become familiar with different sources of medical information and ways to manage them.
Residents learn to search medical databases that are available through Hamilton Medical Center/Medical College of Georgia
Residents become familiar with hardware and software now available to physicians
Common Clinical Problems
These sessions focus on a multi-disciplinary and evidence-based approach to common problems seen on inpatient and outpatient services by general internists
Issues in Doctor-Patient Communication
- Addressing medication and healthcare-related cost hurdles faced by patients
- Medication non-adherence in general
- Lifestyle counseling and motivational interviewing
Critical Appraisal of Published Research
A goal of this curriculum is to encourage residents to use evidence from patients, colleagues, the literature, and themselves to guide their activities in diagnosis, prognosis, and treatment. By the end of the curriculum, each resident should be a “learned skeptic,” and should opt for practice based on the best evidence wherever possible.
Each resident prepares and presents an evidence-based evaluation of a medical treatment, practice or guideline at an Academic Half Day conference scheduled at the end of the month, and also leads and participates in several journal clubs.
Teaching and Presentation Skills
Interns will have the opportunity to improve their teaching and presentation skills. A session dealing with effective ways to provide feedback should help interns in other components of their residency training. Interns will also receive guidance and specific feedback about the journal club and end-of-month presentations.
Principles of Quality Improvement/Health Care Systems
Interns learn the principles and explore the application of quality improvement initiatives to the practice of medicine. A series of four sessions focus on this critical component of systems-based practice, emphasizing a multi-disciplinary and evidence-based approach to continuously improving healthcare delivery and outcomes. A series of sessions focuses on the overall structure of the U.S. healthcare system and financing structures.
Business of Medicine and Leadership
Via a series of Ted Talks, integrated with job shadowing with physician leaders in the health system, each PGY-3 resident will use this 2-week rotation to prepare for practice /fellowship by further refining their knowledge of the physician leadership roles and responsibilities with another 2 weeks will be spent on the “Business of Medicine” to include a coding and documentation curriculum.
Elder House Call Program
PGY-2 and PGY-3 GIM residents provide longitudinal, comprehensive, primary care to patients in the Elder House Call Program. The aim of this is to provide routine and urgent care to frail homebound patients, and avoid unnecessary hospitalization.
The patient population consists of frail (25% annual mortality) mostly elderly, homebound patients who wish to remain at home and whose families are devoted to helping them. Patient age range varies, with the mean about 75. They are referred from local physicians, families, social services agencies, and other agencies in the area.
The Home Visiting Team includes a faculty member, a general internal medicine resident, a nurse, and a patient care coordinator. In addition, the program frequently utilizes the services provided Hamilton Home Health Care to include skilled nursing, personal care, physical therapy, occupational therapy, speech therapy, social work, and hospice care.
A faculty member supervises each house staff member. Initial orientation and the first several house calls are done jointly by a resident and faculty. The attending reviews resident visits after their completion. The attending is available to the resident for a phone consultation during the time of each visit and when addressing patient issues when considered ready for indirect supervision with phone consultation immediately available.