Internal Medicine Residency Program Curriculum Overview
Our Internal medicine curriculum provides general medical care and subspecialty experiences to residents through a mix of primary and tertiary care patients. The curriculum and rotation schedule are designed to give you the flexibility necessary to meet your educational needs. Each teaching team is overseen by one teaching attending who reviews patient care each day with the resident team. Each team is also layered with senior resident supervision. You will note graduated levels of responsibility through your training and a team designed to help support medical decision-making around patient care.
Throughout your three years of training, residents will build and follow a panel of patients seen at Valley Health Partners Lehigh Valley Physicians Practice at Lehigh Valley Hospital–17th Street. This is a core part of your learning experience and a one-week dedicated rotation that residents rotate through every fifth week in our 4+1 rotation model. Additional outpatient experience is gained at our private practice faculty group LVPG Internal Medicine 3080 Hamilton Boulevard. The core faculty dedicated to these sites provide the foundation to your training experience.
Training in all the major internal medicine subspecialties is required during the three-year residency. Subspecialty rotations include:
Critical care medicine
Hospice and Palliative Medicine
Elective rotations include anesthesiology, dermatology, ENT, family medicine, forensic pathology, general surgery, nutrition, ob/gyn, ophthalmology, physiatry and physical medicine, radiology, radiation oncology, sports medicine, street medicine, and toxicology. In addition, residents may participate in away electives as approved by the program director.
Hospital Medicine Services
There are four resident-covered hospital medicine services, termed ECLS A, ECLS B, HMS-I and HMS-J. Our Exemplary Care and Learning Site (ECLS) is a dedicated 30-bed unit where every patient is covered by one of two teaching teams: ECLS A or ECLS B. The attendings, residents, interns and students are dedicated to the care of the patients on this floor alone. They thereby own the quality metrics of this unit and build collaborative relationships with nursing colleagues, case managers and support staff on this floor. It affords a unique opportunity to understand systems-based practice. This unit is covered by Attending Physicians from our core faculty team based at LVPG Internal Medicine 3080 Hamilton Boulevard. These faculty members offer a unique perspective as they practice both in the inpatient and the ambulatory settings.
In addition, our Hospital Medicine team staffs two services, HMS-I and HMS-J. These Attendings are traditional Hospitalists from our Department of Hospital Medicine and follow a more traditional model of dedicated practice toward hospital-based care alone, with 7-days-on / 7-days-off schedules. They follow patients from admission in the emergency room to wherever they land in the hospital (low-level units, med-surg space, etc.). It offers a great contrast to our ECLS rotation and allows learners a more in depth understanding of the drivers of quality in hospital-based care. What’s more, our HMS-I rotation is modeled to be a General Medicine Junior Attending rotation where a senior resident is able to work one-on-one alongside a hospitalist and simulate attending practice. Throughout residency, each resident will be scheduled to rotate within different services so as to experience all the different types of inpatient practices available.
The Exemplary Care and Learning Site
The concept of an Exemplary Care and Learning Site (ECLS) was born out of the Institute for Healthcare Improvement’s Health Professions Educational Collaborative. Since its beginning, the collaborative has sought to pioneer ways to teach residents about quality and process improvement. The idea behind the ECLS is to have the site function as a clinical microsystem that incorporates the three aims of improved patient care, improved education and improved system performance. Goals of the ECLS are to help medical (and other) professional students/residents learn about the improvement of health care, help foster faculty development, and allow collaboration to speed educational change. In addition to LVHN, several institutions have developed their own ECLS programs, including Dartmouth, University of Missouri, University of Minnesota and the Mayo Clinic.
Construction of our Kasych Pavillion and the establishment of geographic admitting for tis floor allowed the ECLS concept become a reality at LVHN. In addition to an improved educational focus, a major goal of the ECLS is involvement of the learners in quality improvement efforts. Efforts have focused on inpatient glucose control of patients on the ECLS. Such efforts include weekly didactics and collaborative rounds focusing on the nuances of inpatient glucose control. Not only have we shown an improvement in medical knowledge, we have seen a dramatic improvement in patient care that has led to over $1 million in cost savings in its first year of operation.
Additionally, we have seen improvements in care in other units on which the internal medicine residents rotate. Our data illustrate that experience on the ECLS allows residents to better care for patients throughout the network. Floor data is posted weekly on the floor, and residents are provided with individual feedback on the care they are providing to patients. We also delivered content around an infectious disease module on the ECLS to better streamline and reinforce evidence-based guidelines for certain infectious disease.
Ambulatory Clinic Model
The ambulatory curriculum and continuity clinic experience capitalizes on the strengths of our progressive 4:1 schedule. We have restructured how residents provide care to patients in the continuity clinic through this model. Every fifth week, a cohort of residents rotates through our ambulatory practice for one-week rotations. It affords dedicated blocks to the practice of primary care.
We have a core group of faculty dedicated to this continuity clinic site: Valley Health Partners Lehigh Valley Physicians Practice (LVPP) in Allentown, Pennsylvania. This dedicated group of primary care faculty act as the primary preceptors of residents in the continuity clinic while also seeing their own patients alongside the residents. This model has improved patient care, continuity of care, and continuity of learning for the residents.
A novel ambulatory curriculum has been developed for the residency in this context as well. This curriculum consists of regular didactics that are primary care based with a focus on healthcare maintenance, preventive medicine and practice management (billing and coding). Sessions are also devoted to quality and process improvement around population health initiatives for the community we serve. These sessions are facilitated by the core teaching attendings based at the site.
In short, we have established a true team approach to primary care. With this renewed focus on the team model for patient care and designated weeks in continuity clinic, residents have spearheaded numerous quality and process improvements at LVPP. Residents learn to live the art of continuous quality improvement and develop skills that will help them be successful in primary care. Our goal is to maintain a residency ambulatory site that efficiently and effectively provides medical care to an underserved population while at the same time provides a meaningful educational platform for learners.