Internal Medicine Residency Program Structure

The Department of Medicine at St. Elizabeth's Medical Center is proud to offer ACGME-accredited training in two categories: categorical and preliminary. The internship year is similar for both Categorical and Preliminary interns except that preliminary interns do not have a scheduled outpatient continuity clinic. The program offers 16 categorical and eight preliminary positions annually.

The internal medicine residency training at St. Elizabeth's Medical Center is a comprehensive clinical experience encompassing several educational opportunities located at St. Elizabeth's Medical Center's Boston campus. We follow a “4+2” block model where every third two-week block is ambulatory followed by four weeks of a mixture of other rotations (inpatient and elective) which then repeats throughout the three years.

PGY-1 (Categorial and Preliminary)

Rotation	Approximate Number of Weeks
Medical Wards	8 to 12
Day Float	2 to 4
Night Float	4 to 6
ICU/CCU	8 to 10
Cardiology Wards	2 to 4
Emergency Medicine	2 to 4
Ambulatory	16 to 18
Elective	4 to 6
Vacation	4 (3 Weeks + 5 Personal Days)

PGY-2

Rotation	Approximate Number of Weeks
Medical Wards	6 to 8
Day Float	2 to 4
Night Float	6 to 8
ICU/CCU	6 to 8
Cardiology Wards	2 to 4
Ambulatory	16 to 18
Elective	8 to 10
Vacation	4 (3 Weeks + 5 Personal Days)

PGY-3

Rotation	Approximate Number of Weeks
Medical Wards	4 to 6
ICU/CCU	6 to 8
Cardiology Wards	2 to 4
Emergency Medicine	2 to 4
Geriatrics at the VA	2
Neurology Consult	2
Medicine Consult	2 to 4
Ambulatory	16 to 18
Elective	8 to 10
Vacation	4 (3 Weeks + 5 Personal Days)

Summary of Rotations

The internal medicine residency training at St. Elizabeth's Medical Center is a comprehensive clinical experience encompassing several educational opportunities located at St. Elizabeth's Medical Center’s Boston campus.

General Medicine, Cardiology Wards, Day Float, and Night Float

Our General Medicine ward experience is divided into teams devoted to taking care of general medicine patients. Each team rounds with a dedicated supervising teaching hospitalist.

Day float is a separate team that is dedicated to admitting patients during the day, allowing the General Medicine ward teams to have uninterrupted bedside teaching rounds. The experience acquired during the day float rotation helps improve admitting skills, critical thinking, and efficiency.

Cardiology team rounds daily on cardiology patients with a dedicated cardiology faculty and a cardiology fellow. Most of the cardiology patients are geographically located primarily on one floor.

The Night Float team operates as two “mini-teams,” each consisting of an intern and a supervising resident. Their primary role is to admit medical and cardiology patients overnight, and cross-cover the general medicine and cardiology patients for acute issues.

ICU

Our ICU team is collectively responsible for caring for both medical and cardiovascular patients - the ICU team rounds separately with both the pulmonary/critical care and cardiology faculty and fellows. The team consists of two PGY-3 residents, two PGY-2 residents, and five PGY-1 residents. ICU team members rotate through day and night shifts thus eliminating 24 hour-long shifts.

Our ICU is a state-of-the-art 28-bed multidisciplinary unit. As a tertiary referral center, the ICU team is constantly exposed to many critically-ill patients with diverse pathology. The team gets firsthand experience responding to rapid responses and codes and managing very complex cases including those with rare diagnoses.

An advanced practice providers team is available during the nights to assist the residents with procedures and admissions.

Emergency Medicine, Neurology and Medical Consults, and Geriatrics

• Emergency Medicine: Residents rotate in the emergency department during their PGY-1 and PGY-3 years. The emergency department is staffed by emergency department physicians 24 hours a day. Each emergency medicine rotation consists of approximately six eight-hour shifts over the course of a week for two to four weeks.
• Neurology: PGY-3 residents rotate on the inpatient neurology consult service, which also includes a psychiatry resident and medical students. The team rounds with a dedicated neurologist and is expected to attend weekly neuroradiology conferences while on the rotation to bolster their experience in the field.
• Medical Consults: PGY-3 residents rotate on the inpatient medical consult service. PGY-3 residents evaluate all inpatient medical consults and round with a hospitalist. Moreover, they carry the code pager, being the frontline providers to respond to, and lead, rapid responses and codes. Additional responsibilities during this rotation include reviewing and presenting cases at the weekly Department of Medicine End-of-Life Review sessions and attending biweekly Infection Control and Patient Triage and Safety Team meetings.
• Geriatric Rotation: Our PGY 3 curriculum includes 2 weeks of Geriatrics rotation at Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA. This facility is one of the Geriatric Research, Education, and Clinical Centers (GRECC) that focus on aging. The rotation allows them to gain experience in the best practices in caring for older adults. Residents share the skills gained during this rotation with their teams at SEMC to improve the care for our geriatric population.

Ambulatory Block

Through our 4+2 block system, two dedicated consecutive weeks of every six weeks will be spent in an ambulatory outpatient setting.

• Continuity Clinic: During the ambulatory block, all categorical residents and interns spend two full days or four half-days per week in their continuity clinic conducted in a primary care office. Each resident is assigned to a primary care clinic preceptor and works closely with that attending physician for three years. The focus is on learning how to manage a broad array of illnesses in an outpatient setting and the most important aspects of primary care, including chronic disease management and preventive care. This opportunity allows the residents to develop a continuous, therapeutic relationship with a panel of general internal medicine patients during the period of their training.
• Subspecialty Clinics: During the ambulatory block, all residents and interns spend the remaining half-days in various internal medicine subspecialty and other specialty ambulatory areas. Clinical experiences are available in Cardiology, Endocrinology, Gastroenterology, Hematology/Oncology, Infectious Diseases, Nephrology, Neurology, Pain Management, Pulmonary (including Sleep Medicine), Rheumatology, Radiation Oncology, Addiction Medicine, as well as in Physical Rehabilitation and Sports Medicine. Recently, we have expanded these clinics to include Dermatology, Urology, and Palliative Care Medicine. We are in the process of expanding this experience further to include additional subspecialties.
• Academic and Administrative Time: During the ambulatory week, all residents get three half-days that are used for academic and administrative duties. Monday mornings are designated for Physician Education and Assessment Center (PEAC) modules (see Conferences) with the outpatient Associate Program Director. Friday afternoons are designated as Administrative half-days during which one hour is dedicated to our Quality Improvement (QI) curriculum and the remainder of time is provided for the residents to complete any outstanding medical documentation and/or residency-related administrative duties. A study half-day allows residents to independently study, complete assigned educational modules (see Academic Enrichment Program), prepare for an upcoming presentation, or conduct research or quality improvement activities.

Electives

• On-Site Electives: We offer elective rotations in Cardiology, Endocrinology, Gastroenterology, Infectious Diseases, Nephrology, Pulmonary Medicine, Critical care and Procedures, Rheumatology, Neurology, Addiction Medicine, Palliative Care, Addiction Medicine, Hematology/Oncology, and Emergency Medicine. We have recently begun to offer Psychiatry elective for interested residents.
• Off-Site Electives: Residents may wish to do one off-site clinical elective of their choice (up to four weeks in duration) during their second or third year of residency training with the approval of the program director.

Other Opportunities

• Research: PGY-2 and PGY-3 residents with a well-conceived research plan and a designated faculty mentor can use one elective block to pursue a research project instead of their clinical away elective.
• Mock Code Blue Sessions: Code blue training is provided during noon conference sessions by chief medical residents during ambulatory weeks. These are coordinated in collaboration with the Electrophysiology team. Emphasis is given to improving resident comfort as code leaders.