Overview

The Emory University Internal Medicine Residency Program strives to train highly competent internists and leaders in medicine, regardless of ultimate career pathways. Internal Medicine encompasses 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 derived from humanistic and professional values.

Residents are trained through direct patient care activities, both inpatient and outpatient, balanced with didactic instruction and education. The curriculum is structured such that a minimum of one-third of the training time is spent in ambulatory sites and a minimum of one-third of the time in inpatient sites.

Over the 36 months of training, each resident spends at least 1/2 day each week is spent in a continuity clinic managing a panel of general internal medicine patients under the direct supervision of Internal Medicine faculty.

A major strength of the Emory program is the diversity of clinical exposure. During their three years of training, residents will rotate through four affiliated hospitals and have the opportunity to rotate through the Wesley Woods Geriatric Center.

Library and Literature Appraisal Skills:

To facilitate patient care and resident education, residents have ready access to an on-site library, a computerized literature search system, and electronic medical database at each site, at all times. PGY-1 residents receive an in-depth orientation on the use of library services by trained librarians, followed by close contact with librarians throughout the 3 years of training. A Medical Librarian is present at resident report sessions and assists residents with literature searches related to the case discussions.

Geriatrics

Residents receive formal didactic instruction in geriatric medicine by ABMS-certified geriatricians as part of the core curriculum and have clinical experience in geriatric medicine. These experiences can occur at one or more specifically designated geriatric inpatient units, geriatric consultation services, long-term care facilities, geriatric ambulatory clinics, and/or home-care settings. Some residents will be assigned to a month-long block of time at the Wesley Woods Geriatric Hospital, while others rotate through the outpatient geriatric clinics during the ambulatory block months.

Emergency Medicine

Internal medicine residents assigned to emergency medicine will have first-contact responsibility for a sufficient number of unselected patients to meet the educational needs of the residents. Triage by other physicians prior to this contact will not occur. Internal medicine residents are assigned to emergency medicine for a total of 4 to 6 weeks of direct experience in blocks of 2 weeks. During emergency medicine assignments, continuous duty will not exceed 12 hours. Residents have direct patient responsibility, including participation in diagnosis, management, and admission decisions across the broad spectrum of medical, surgical, and psychiatric illnesses, such that the residents learn how to determine which patients require hospitalization. Internal medicine residents assigned to emergency medicine rotations are supervised on site by qualified faculty members, and timely, on-site consultations from other specialties are available.

Consultative experience

Residents have a structured clinical experience to act, under supervision, as consultants to physicians in other specialties. The consultative experience occurs in both the inpatient and outpatient rotations. During inpatient general medicine months, residents have the opportunity to serve as general medical consultants to the non-medicine specialties, and are directly supervised by the medical attending. While on the subspecialty rotations, residents serve as subspecialty consultants to medicine and non-medicine specialties and are directly supervised by the subspecialty attending. Residents receive formal training on how to serve in the consultative role as part of the core curriculum and during each of the general medicine and consult months.

During the ambulatory block months, residents are assigned to the pre-operative clinics where they provide medicine consultation to the surgical services and receive formal training on pre-operative medicine.

Inpatient Medicine/Subspecialty Experience

Residents spend a minimum of 12 months on inpatient rotations. There are 9 to 10 months of inpatient internal medicine teaching service assignments in the first year, 5 to 6 months of inpatient internal medicine teaching service assignments during the second year, and 7 to 8 during the third year of training.

The typical resident has 9 to 10 months of inpatient general internal medicine teaching service assignments over the 3 years of training (4-5 months occur in the first year).

On these rotations, the resident writes all orders for patients under the team's care, with appropriate supervision by the attending physician. In those unusual circumstances when an attending physician or subspecialty resident writes an order on a resident's patient, the attending or subspecialty resident must communicate his or her action to the resident in a timely manner. There is a resident on-call schedule and detailed check-out and check-in procedures, so residents learn to work in teams and effectively transmit necessary clinical information to ensure safe and proper care of patients. The on-call system includes a plan for backup to ensure that patient care is not compromised during or following assigned periods of duty.

Clinical experience in each of the subspecialties of internal medicine occurs in both the inpatient and ambulatory settings. Residents can be assigned to a dedicated rotation in the specialties and the curriculum must be designed to ensure that each resident has sufficient clinical exposure to the diagnostic and therapeutic methods of each of the recognized internal medicine subspecialties.

Critical Care

Residents are assigned to critical care rotations for approximately 4 months during their training. The total required critical care experience will not exceed 6 months in 3 years of training. However, when elective experience occurs in the critical care unit, it cannot result in more than a total of 8 months of critical care in 3 years of training for any resident.

All critical care training occurs in critical care units that are directed by ABMS certified critical care specialists, and all coronary intensive care unit training occurs in critical care units that are directed by ABIM-certified cardiologists.

Timely and appropriate consultations are available from other internal medicine subspecialists and specialists from other disciplines.