Internal Medicine Residency Didactics

The Morning report begins with an image (a chest x-ray, an electrocardiogram, a rash, a urinalysis, a peripheral blood smear, etc.) and a question or two (often based on the previous day's report). Morning report then continues with the presentation of one or two cases from either the inpatient or outpatient settings. Morning Report is directed by the chief residents and a faculty member (general Internist or subspecialist) recognized for excellence in teaching in that content area. The Morning report cases are summarized daily on our intranet site and the complete text version of at least one related article is attached. The daily images and questions are also posted on the Intranet site. The repository of MR cases, images, and questions remain available throughout the year on the Intranet and can be used to prepare for board examinations.

Although there is much overlap, some of the educational needs of interns differ from those of residents. To ensure excellence in intern teaching each week the interns meet weekly with the program director and chief residents for intern report. These one-hour sessions take the format of morning report and emphasize evidence-based medicine.

Teaching Attending Rounds

Teaching attending rounds are conducted for 90 minutes four days per week. The focus is on new cases and discussing management issues on previously admitted patients. Teaching attendings come both from the subspecialties and from general internal medicine/primary care. All have been selected for their commitment to teaching and skills as superb educators. A growing Hospitalist Service provides additional bedside and didactic teaching.

The Noon Conference

This schedule covers a broad variety of topics from routine outpatient management of essential hypertension to complex electrophysiological analysis of arrhythmias. During the initial three months we offer an orientation and emergency lecture series. A partial list of topics covered includes:

• Electrocardiography- arrhythmias
• Management of acute MI, acute coronary syndromes, heart failure
• Management of acute respiratory failure, invasive and non-invasive ventilation
• Acute COPD exacerbation, acute asthma
• Hemoptysis
• Community-acquired pneumonia
• Interpretation of blood gases and pulmonary function tests
• Acute renal failure
• Life threatening acid base disturbances
• Hypertensive emergencies
• Diabetic emergencies
• Endocrine emergencies
• Sepsis, Meningitis
• Hemodynamic monitoring, resuscitation, central lines
• Acute abdomen, GI and biliary emergencies, GI bleeding
• Rheumatologic emergencies
• Overdoses and poisoning
• Oncologic emergencies
• Thromboembolism
• Acute stroke, status epilepticus, coma, delirium

After completion of the Orientation/Emergency Lecture series a broad array of topics including inpatient and outpatient (primary care) medicine is covered. In addition, there are lectures on ethics, healthcare economics, medical legal medicine, patient safety, professionalism, and "resident as teacher."

Grand Rounds

Grand Rounds presentations are delivered every Wednesday from September to June. The speakers comprise national and international experts and many members of the St. Elizabeths Medical Center Department of Medicine faculty. The talks provide updates in areas of interest to Internal Medicine Practitioners as well as the latest breakthroughs in diagnostics, therapeutics, and clinical and translational research.

The Resident Evidence-Based Medicine Lecture

This lecture provides the PGY-2 or PGY-3 resident an opportunity to review a focused clinical question (e.g., What is the role of anticoagulation in atrial fibrillation? Should smokers undergo annual screening for lung cancer? Should steroid be given in late phase acute lung injury?) In so doing the resident strengthens his/her skills in literature review, PowerPoint slide preparation, and public speaking (the lecture is presented to the interns, residents, and program directors).

Resident Board Review

This is a weekly multifaceted conference. Members of the faculty give focused board review lectures and residents also have reserved time to watch board review tapes. The Department of Medicine purchases Med Study board review books for each PGY-3 resident.

PGY-2 and PGY-3 residents present key recent articles at the bimonthly

Resident's Journal Club

Journal Club is an academic activity designed so that residents learn how to clinically appraise a journal article. Each resident is assigned to a mentor and to a study design (RCT, meta-analysis, diagnostic, cohort and case control studies.) Residents should meet with their mentors at least one month prior to their presentation, so that they can guide them in the article selection, analysis and discussion of the article. Residents present the journal club to the rest of the program (who should previously read the article) in the presence of their mentors and there is a discussion at the end of the presentation.

Morbidity & Mortality Conference

Quality Improvement Conference focuses on adverse outcomes and medical errors. Cases are presented anonymously so that discussions are open and cordial. The goal is to provide a supportive atmosphere where residents (and attendings) can improve their skills in self-assessment and practice improvement.

Subspecialty Conferences

Each subspecialty division offers a number of weekly conferences focusing on clinical cases, clinical research and basic science research. A yearly Research Day Conference highlights the research projects and accomplishments of faculty, fellows, and residents.