General Principles

Program Goals and Objectives

The ACGME defines Internal Medicine as the discipline encompassing the study and practice of health promotion, disease prevention, diagnosis, care, and treatment of men and women from adolescence to old age, during health and all stages of illness. Intrinsic to the discipline are scientific knowledge, the scientific method of problem solving, evidence-based decision making, a commitment to lifelong learning, and an attitude of caring that is derived from humanistic and professional values.

Our program's overall educational goal is to provide a learning environment which fosters the growth of young physicians into highly competent generalist physicians, across the six areas defined by the ACGME: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice. Upon completion of our program, residents are confident internists, ready to pursue all the vast opportunities that internal medicine provides in today’s world, including academic general internal medicine, primary care practice, hospitalist medicine and subspecialty academic fellowships.

Unity’s educational program is built around the following conceptual framework:

• Patient-Based Learning
• Active Learning
• Learner-Based Learning
• Evidence-Based Medicine

Patient-Based Learning
Residency is essentially a patient-based learning experience. The key to an excellent program is proper balance of service versus education: one that allows each patient admission to become a learning opportunity. Duty hours regulations are strictly followed, and resident teams are right-sized to provide the optimal learning experience. Attending Rounds focus on patient –based teaching, whether they take place on the General Medical Services, the subspecialty consult services, or the Intensive Care Unit. Chief Residents and faculty conduct intense case-based morning reports for both interns and senior residents.

Active Learning
Although we have an outstanding array of didactic sessions and conferences, we realize that residents learn the most from their minute-to-minute experiences on the wards and in the clinics, while taking active responsibility for their patients’ care. Senior residents are expected to lead discussions during Attending Rounds, and all interns and students are given opportunities to educate the group. Many of our Noon Conferences are small group formats, designed to encourage maximum interaction between residents and faculty. Residents also are expected to teach in the large group as well, as each categorical resident prepares four case conferences, one Clinicopathologic Conference (CPC), and one Evidence-Based Medicine (EBM) conference during the 3 years of training. During many of the 3rd year electives, residents are given the opportunity to present cases at City-Wide Subspecialty conferences.

Learner-Based Learning
Each of our residents is unique, so the training he/she receives must be individualized. Learner-based learning is an educational method that identifies the individual's strengths and weaknesses to tailor the educational program and to incorporate the interests of the resident in the context of his/her long-term career plans. The faculty are actively involved in all rotations so that a comprehensive evaluation of these strengths and weaknesses may be performed. At the end of each rotation, the resident reviews his/her performance with the faculty preceptor, and the information gathered is placed in the resident's permanent file. Every six months, each resident meets with the Program Director to discuss his/her performance, evaluations, scholarly activity, quality improvement, and career planning. In addition, the ABIM In-Training Examination is offered each year of a resident's term; this provides quantitative information regarding the resident's medical knowledge and offers insights on the resident's performance when compared with other trainees in internal medicine throughout the country.

Evidence-Based Medicine
As medicine advances and new scientific discoveries unfold, a practicing physician must have at his/her disposal methods to evaluate those advances. EBM, at its core, provides a physician with a most important skill: to critically appraise what he/she read and what he/she hears. As part of this competency, we expect residents to formulate questions as they arise during patient care, and to seek evidence from the literature to support their decisions. This is essential to the life-long learning that is central to any physician’s career and is the concept that unifies the program’s structural elements of patient-based learning, active learning, and learner based learning.

As part of our bi-weekly EBM conference series, residents gain first-hand experience in analyzing peer-reviewed journals from the current medical literature. The first of the two conferences is a small group-based session, designed to enhance resident-attending interaction and the EBM concepts to the entire group of residents and faculty. For the second conference, we require each resident to make an EBM presentation during his/her PGY2 year.

Information Technology

Unity Health System has committed to provide state-of-the-art information technology to enhance residency education and to facilitate access to clinical information. Residents have online access to extensive educational resources for both point-of care information, as well as scholarly activity. Trainees also use an electronic medical record for their outpatient clinic, which is available both on and offsite. The inpatient computer system provides access to all labs, dictations, scanned medical records, and radiologic reports and images (PACS) from any internet-connected computer. Computerized Physician Order Entry (CPOE) is currently in development and is expected to be online in the 2009 academic year.

Conferences

The Department of Medicine sponsors several conference series as part of the educational curriculum for both housestaff and attending physicians. These include the following:

• Noon Conferences - This series includes topics in general and subspecialty medicines. The non-medical specialties also provide didactic lectures. Lectures in Orthopaedic Surgery, Neurosurgery, Podiatry, Dermatology, Ophthalmology, and Radiology are all provided during the Noon Conference series. Additionally, quality assurance, medical ethics, practice management, medical legal issues, physician impairment, and resident stress are discussed.
  
• Grand Rounds - Held every Tuesday, this is an opportunity for both residents and attendings to hear discussions on state-of-the-art subjects. Each month, a Grand Rounds session is dedicated to Morbidity and Mortality. This is a multi-disciplinary conference in which the case of a complicated patient is presented for open discussion.
  
• Cancer Conferences - Unity Hospital is a cancer teaching hospital, as designated by the American College of Surgeons. As part of our accreditation, we provide a bi-weekly multi-disciplinary, patient-centered cancer conference that serves as an excellent opportunity for residents to learn how to provide state-of-the-art management of oncologic disorders.
  
• Case Conferences and CPCs - Second and third year residents are assigned to present four case conferences and one CPC by the time they graduate. These are some of the most interesting conferences we have at Unity Health System. They provide residents with an opportunity to present an interesting case, delve into the literature, and hone their presentation skills.

Scholarly Activity

We also actively encourage residents to pursue academic projects. Past academic projects include: Case studies that are presented at Grand Rounds; case reports; small retrospective studies; and prospective, diagnostic, and interventional studies. Many of our residents submit projects that result in national or regional recognition. Over the past five years, Unity residents have presented their work at National ACP, SGIM, and AMA meetings, as well as national and international subspecialty society meetings (See Academic Activity for recent academic work and publications by our residents and faculty).