Following are key aspects of our internal medicine residency training program:
To promote housestaff education, a number of required conferences are scheduled during the work week. These include Noon Conferences, our Thursday Academic Half Day for all residents, as well as Morbidity and Mortality Conference sessions and Medicine Grand Rounds held weekly at each hospital. Residents on the inpatient service also participate in bedside attending rounds. Each institution is staffed using a teacher/hospitalist attending model, whereby each team is managed by one attending.
While in training, call schedules vary by institution. At B-UMCT, "code pager duty" is every fifth day on the General Medicine Wards. While on CCU, call is every fifth night with a senior resident in-house and dedicated to assisting interns assigned to call. ICU call is variable, occurring every 4th or 6th night. At SAVAHCS long call is every third day. Interns and residents are assigned several weeks in the course of the year where they may be called in for "jeopardy" in the event that a colleague suffers an illness or other personal or family emergency. There is no 24-hour call for interns.
Our ambulatory training provides the opportunity for residents to establish long-term therapeutic relationships with their patients. Categorical residents participate in continuity clinics throughout all three (3) years of their residency. Clinic sites include the main University Campus, South Campus, VA hospital, and a private practice. We restructured our program during the 2014-15 academic year to optimize the outpatient experience. In our 4+1 system, residents participate in various rotations for four (4) weeks followed by one (1) full week of clinic. Residents only see clinic patients during their clinic weeks. There are no scheduled continuity clinics during wards, ICU, or elective rotations. During clinic weeks, each resident will be assigned to five (5) half-day clinic periods. Each resident will follow their individualized clinic schedule throughout the academic year. During clinic weeks, when a resident is not in a clinic to see patients, they have the opportunity to complete patient care tasks, work on quality improvement projects, or participate in an extra subspecialty clinic half-day. Residents may establish an extra subspecialty clinic half-day with a mentor and participate in this extra subspecialty during every continuity clinic week. All clinics are supervised by attending physicians who offer their guidance and assist with patient management. For additional learning, we use the John Hopkins clinic curriculum, which allows residents to work through question-based didactic modules pertinent to outpatient medicine. During their second year, residents also participate in an additional one month of community-based outpatient medicine where they work one-on-one with an experienced private practice internist. In this setting, residents not only gain further experience in outpatient medicine, but also gain exposure to practical issues of billing, coding, and clinic management.
Elective experiences are designed to allow residents to customize their training in accordance with their career plans. Elective options are varied and flexible ranging from Internal Medicine subspecialties to Radiology, Pathology, Orthopedics and Palliative Care. Unique opportunities are available with the Indian Health Services Cardiology and Rheumatology trips which visit multiple sites on the Navajo and Hopi Nations in the Four Corners Area of Northern Arizona. In addition, many residents elect to pursue research opportunities.
During any year, residents may elect to do formal research projects with a faculty mentor, ranging from bench to clinical research. Many residents have published abstracts and papers as well as received grant support. All of our residents compete in the American College of Physicians (ACP) Clinical Vignette Competition for the ACP Arizona Chapter Scientific Meeting and are encouraged to submit clinical and research abstracts for this meeting.
In all three years of training, an emphasis is placed on the team approach to patient care. At each level, residents are encouraged to learn and teach the important aspects of clinical evaluation and the pathophysiology of disease processes. With each year of additional training, greater responsibility for patient care and teaching of other team members is given. The third-year resident will experience critical care, medical consultation, community based private practice, ward medicine, electives and continuity clinic. By the completion of the third year, residents are expected to be competent and independent in inpatient and outpatient medicine.
Our residents have been fortunate to enter the fellowships and practices of their choice. Recent graduates have entered fellowships at our own institution as well as the Banner – University Medical Center Phoenix, Cleveland Clinic, Johns Hopkins, Mayo Clinic, Yale, Stanford University, Brown University, Harvard University, Rush-Presbyterian, the University of North Carolina, University of Alabama, University of Cincinnati, University of Virginia, University of Wisconsin, UT Houston, UT San Antonio, Loma Linda University, UC-San Diego, Tufts University, Duke, Tulane, Wake Forest, Washington University, UCLA and USC.