Curriculum & Rotation Descriptions

Brown University and the School of Medicine have been leaders in educational reform and the development of a competency-based educational curriculum. Our program is a logical extension of that educational philosophy. We are able to build on our considerable strengths to offer our residents the finest training in Internal Medicine. The Categorical and Preliminary Internal Medicine Residency at Brown Medical School provides training at three sites: The Miriam Hospital of Rhode Island, Rhode Island Hospital, and the VA Medical Center. By offering a multi-institutional training program, we can provide our residents with several distinct, diverse populations of patients, training environments, and complementary institutional cultures. Together these institutions represent an array of faculty that, in its depth and breadth, offers residents an exceptional opportunity for education and professional growth. The curriculum provides comprehensive training in outpatient and inpatient internal medicine, medical and non-medical subspecialties, emergency medicine, critical care medicine, community-based experiences and elective rotations. Residents may also design curricular variations which meet their individual goals for training. The following document reviews some selected rotations for your information:

General Medicine Wards

The General Medicine Wards rotation serves as the cornerstone for interns and residents to develop their skill for the management of hospitalized patients. At all three hospitals, teaching and supervision of housestaff is provided by both generalist and sub-specialty full-time faculty as well as a small, select group of community-based faculty, all with demonstrated dedication to their roles as clinical educators. On all ward rotations except the subspecialty ward services, interns and residents admit patients until late in the evening on every fourth day, and then go home overnight while covered by the in house Night Float team. On the subspecialty ward services (Hematology/Oncology, Nephrology, Geriatrics, and Primary Care Medicine) there is no late call, and teams admit patients until the afternoon and return home daily. The disease spectrum, ethnic and socioeconomic diversity, and accessibility to outstanding faculty make these rotations a critical educational experience for medical housestaff at Brown. Our residents typically spend four (PGY1 - intern), three (PGY2), and three (PGY3) months respectively during their residency on the General Medical Wards, approximately equally divided between The Miriam and Rhode Island Hospitals. They will spend one month each in their PGY-1 and PGY-2 years at the Providence VA Medical Center. These experiences allow the residents to develop their skills in inpatient medicine, seeing a wide variety of problems, in a position of direct responsibility. They will learn how to enhance their skills as bedside teachers by virtue of their responsibility for the education of more junior residents, Brown University medical students (years two, three, and four) and each other.

Night Float Team

Housestaff at all three years are assigned to a month of Night Float rotation where they will work as a team to care for patients on the teaching services. Intern night floats are responsible for the cross coverage care of patients already on the teaching service and are supervised by the senior resident on the night float team. The PGY-2 night float is responsible for admitting patients overnight to the Teaching Service. The senior resident night float is responsible for supervising the intern night floats in the care of their patients, ensuring that the "on-call" admitting teams complete their clinical tasks and leave the hospital in compliance with ACGME Duty Hour Guidelines and providing overnight medical consultation for non-Internal Medicine services. The senior night float resident is also responsible for reviewing the Intern Night Float Curriculum with the interns so as to provide the educational underpinning of their work. A web-based electronic sign-out system which automatically updates itself in real time with the Lifespan Clinical Information & Pharmacy Systems (lab results and medication lists) assures accurate and efficient sign-out among teams and night floats.

Day Float

The Day Float rotation provides coverage of residents on the wards who are assigned to their continuity clinic and community-based site on a particular day. The day float resident "steps into the shoes" of the usual resident assigned to the team and is responsible for all of the activities of that resident including the supervision of interns. This assures that interns are not left without resident supervision and that residents are able to attend their continuity clinics while fully relieved of their inpatient responsibilities.

Critical Care/Coronary Care Rotations

Rotations in the Coronary Care Unit and/or Medical Intensive Care Unit are assigned as depicted in the sample schedule. In each of these units, interns and residents are assigned to be on-call overnight every third to fourth night. Dedicated on-site faculty conduct combined management and teaching rounds as well as educational conferences. The CCU was recently moved to the newly completed bridge building and boasts a dedicated procedure area, catheterization facilities directly below the unit, and state of the art communication and work facilities. All of the units utilize the latest electronic medical record and clinical data systems.

Emergency Medicine

PGY-2 and PGY-3 residents are assigned to rotations in the Emergency Department at either Rhode Island Hospital or The Miriam Hospital. A brand new state of the art Emergency Department was completed in 2005 and is a state-of-the-art facility. Orders, laboratory testing, xrays and medical records are completed online in a building that is comfortable for patients, physicians and nurses. PGY-3 residents also rotate in the Emergency Department in the role of Medical Admitting Resident where they participate in early diagnosis and triage decision making for patients admitted to the medical services and critical care units.

Senior Medicine Consultation Rotation

All senior residents will spend one month on the General Medicine Consultation rotation. This rotation provides senior residents with the opportunity to act as general medical consultants to non-medical services such as surgery, orthopedics, and neurology. Half of the month is spent based at Women and Infant's Hospital, which is also located on the Rhode Island Hospital Campus. At Women and Infant's, residents provide medical consultation as part of the Division of Obstetric Medicine where they participate in the care of obstetric and gynecology patients with medical illness and symptoms. This is a unique and valuable experience grounded in a highly structured curriculum and syllabus, which is reviewed by the obstetric medicine faculty with all senior residents.

Neurology

All Categorical and General Internal Medicine/Primary Care interns rotate on the Neurology service. This is a combined inpatient and consultative service where interns are on-call until late in the evening every fourth to fifth night. A Night Float intern covers all neurology patients overnight. A dedicated Neurology faculty and residency provides the educational framework in which our interns care for patients with neurologic illness. A conference series and specific instruction on neurologic examination is carried out over the course of the month. We are fortunate in that many of our neurology residents are graduates of our Preliminary Internal Medicine Residency Program therefore forming a close alliance between our two departments.

Ambulatory Block Rotations

Ambulatory Curriculum

The ambulatory curriculum consists of seminars, conferences, and rotations which address three major areas in ambulatory medicine:

• The diagnosis and management of important general medicine problems (e.g. hypertension, headache, dyslipidemias)
• Common non-medical disciplines (e.g. office gynecology, orthopaedics, ear, nose throat)
• Non-clinical topics including statistics, ethics, critical appraisal of the literature, medical informatics, and the behavioral sciences.

Categorical Ambulatory Block

All Categorical Residents participate in a three-month ambulatory block rotation in which they are scheduled for one month per year. During the intern year, the Ambulatory Block rotation for Categorical residents is a month on the Geriatric service. In years two and three, Ambulatory Block consists of a series of didactic and clinical experiences in Internal Medicine and related fields. Content areas such as clinical teaching seminars, clinical epidemiology, evidence-based medicine, medical ethics, professional development, behavioral medicine, and others round out the experience for residents. Clinical rotations in dermatology, Rheumatology, ENT, Allergy and Immunology also provide a well-rounded exposure to specific ambulatory topics. An ECG Course is run by our cardiology faculty during the PGY-2 Ambulatory Block Rotation. An airway management/intubation skills program is also integrated into the PGY-1 year.

Ambulatory Electives

Ambulatory electives can be chosen from a wide variety of fields in an equally wide variety of settings and include: office gynecology, allergy, geriatrics, physical and rehabilitation medicine, adolescent medicine, ophthalmology, ear, nose, throat, office orthopedics, dermatology, and the traditional medical subspecialties.

Continuity Clinics

Every resident has a primary weekly continuity clinic at The Miriam, the Providence VAMC, or Rhode Island Hospital for the three years of their training. The resident is responsible for the longitudinal care of a panel of patients throughout the duration of their training. Additionally, each second and third year resident has a weekly continuity site at a different location offering another patient population and care setting. Under careful faculty supervision, the resident will develop an in-depth knowledge base in ambulatory medicine. Preceptors whose sole responsibilities are the supervision and teaching of housestaff are assigned to these clinics with a ratio of one preceptor to four residents. A daily ambulatory medicine curriculum topic is presented as part of a two-year ambulatory medicine curriculum. These presentations are case-based, interactive, and linked to an online syllabus with attached references.

Community Based Sites

During the Junior and Senior years, residents spend an additional one-half day per week in another site, designed to complement their longitudinal clinics at the Miriam or Rhode Island Hospital and broaden the residents' ambulatory exposure. Faculty volunteers are carefully selected for this effort based upon their interests and teaching ability. Residents and community based faculty are carefully paired in a one-on-one relationship based on resident interests. Training sites include private offices around Providence and nearby communities, Providence Ambulatory Health Center Network (a nationally recognized consortium of neighborhood health centers), the VA Firm clinics, Brown Student Health Services, as well as selected subspecialty office practices.

Electives

Elective rotations, available locally, nationally or internationally, allow a resident to develop a program tailored to his or her individual interests and to gain experience in problems not commonly managed in the hospital environment. (See special programs and research opportunities.) Electives at Brown are offered in an integrated manner allowing residents to rotate through any of the Brown University affiliated hospitals and/or offices of affiliated physicians. Thus, residents have a wide variety of opportunities with the chance to benefit from the strengths of any of the individual institutions and programs affiliated with the University.