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Internal Medicine Residency > Curriculum


The Ambulatory Care Curriculum is designed to train and produce a well-rounded general internist. All housestaff in the categorical program begin to build their own panel of patients in either the outpatient practice at either the Hospital, or the faculty practice offices of our distinguished faculty members. Each housestaff member is assigned to a team at each site for all three years, which acts as a small group practice. The program includes six months of supervised monthly ambulatory block time with an emphasis on psychosocial medicine, evidence-based medicine, clinical epidemiology, and preventive medicine. Special features of the monthly ambulatory blocks include outpatient morning report, an evidence based medicine course, psychosocial rounds, as well as videotaped sessions of housestaff performing patient histories. In addition, our home visits program that recently started has added a new dimension to the program.

All categorical housestaff maintain a primary care practice which includes patients that are referred from the inpatient general medical service, the Emergency Department, as well as standard new patient practice visits.

The teaching program is fully supportive of the Accreditation Council on Graduate Medical Education (ACGME) mandate that training in the ambulatory setting is of cardinal importance. The commitment of the individual house officer to the ambulatory care experience takes precedence over other activities provided by the program during such assignment.

The ambulatory care experience is enhanced by rotation through outpatient medical and surgical subspecialty clinics. For example, a resident may spend time in our cancer screening program doing sigmoidoscopies, in Ophthalmology clinic improving their fundoscopic and slit lamp skills, in the Rheumatology clinic performing joint aspirations, or in Gynecology clinic improving pelvic examination skills. The ambulatory care experience is further enhanced by optional assignments to local community outreach programs.

The Inpatient Service: Patients on the medical teaching service look upon the housestaff members as their primary hospital physicians. Housestaff write orders on all patients. Approximately 50% of the patients admitted to the Medical Service have been referred for admission by private physicians, who continue to be active in their care. The remaining 50% are admitted through the Outpatient and Emergency Departments where the admission decision is made by medical house officers assigned, on rotation, to that area. The illnesses of this latter group of patients are usually more acute and catastrophic. The role of the housestaff in their care of all patients is crucial to the eventual outcome. Each patient admitted through the Emergency Department and not referred for admission by private physician, is assigned to a member of the full-time teaching faculty, who provides an added dimension of supervision and teaching during the course of care.

Conferences and Teaching Rounds: Bedside teaching rounds are held daily throughout the work week with a general internist who is assigned for one month to a housestaff team. Additional conferences and teaching rounds are listed below.

- Core Conference two days per week (held at 8:00AM)
- Weekly Grand Rounds with invited lecturers from major medical institutions
- Weekly Professor Rounds and Intern Report with housestaff cases presented to subspecialty and generalist experts
- Daily Radiology Rounds with Hospital radiologists
- Weekly Geriatric Rounds with Geriatric NPs and Hospital and guest faculty
- Weekly Journal Club led by housestaff allowing for development of critical literature review
- Weekly Internal Medicine Review sessions throughout the year, open to all housestaff and attendings
- Weekly EKG Conference led by a senior cardiologist
- Monthly Performance Improvement Conference
- Monthly Morbidity and Mortality Conference
- The Ambulatory Block Conference schedule contains many conferences including weekly Psychosocial rounds, and Evidence-Based Medicine course, Ambulatory Morning Report, Primary Care Conference, and Home Visit Conference.

Emergency Department: The very active Emergency Department has been one of the most valuable teaching resources of the Department of Medicine. Twenty-four hours per day, especially during the busy weekday business hours, Downtown Hospital offers to the surrounding community a well-equipped emergency department staffed with highly experienced professionals. The medical housestaff is responsible for the care of all adult patients admitted from the Emergency Department and is involved in all decisions concerning admission of these patients. This affords the housestaff member an invaluable experience in significant clinical decision-making. Full-time emergency medicine faculty guide, teach, and supervise the housestaff that provides an academic program in emergency medicine.

Subspecialty Experience and Affiliated Medical Centers: During the month long assignments on individual subspecialties, residents will discharge their consultation and other obligations under the supervision of a faculty member. The 8 weeks of elective time for PGY-II or III's can be devoted to any clinical or research field the resident chooses, provided the arrangement is approved by the Program Director. Clinical rotations and electives at The New York-Presbyterian Hospitals and other institutions are available to NYDH residents. The resultant interaction between NYDH housestaff and Cornell Weill Medical College faculty can assist the housestaff in securing consideration for appointment to fellowship positions. Approximately 70% of our housestaff have ultimately gone on to subspecialty fellowship training. PGY-I and PGY-II residents also serve as house officers at Memorial Sloan Kettering Cancer Center, thus broadening the educational depth of our training program.

ABIM Certifying Exam: The successful completion of the certifying examination of the American Board of Internal Medicine is a major focus of our program. To this end, our core syllabus is presented in two formats simultaneously; bi-weekly conferences and a once to twice weekly Internal Medicine review course. The on-site Medical Library, staffed daily with a dedicated librarian, is a vast resource of educational materials including Internet access for searching the medical literature and direct links to the on-line resources of our affiliated institutions.

ACGME Accredititation: The most recent ACGME (RRC-IM) review of the Internal Medicine Residency Training Program, June 30, 2005, resulted in the longest accredititation cycle granted to an Internal Medicine program.

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