The Department of Internal Medicine offers four types of training programs.
The three-year categorical program emphasizes comprehensive training in Internal Medicine for individuals destined for careers in either academic or community-based General Internal Medicine, and for individuals who will go on to seek sub-specialty fellowship training. Each year the University of Michigan recruits a talented and diverse group of 42 trainees into the categorical program. The training is balanced between inpatient and ambulatory experiences and is broad-based, providing exposure to generalists, hospitalists and a wide variety of sub-specialists. All of the training occurs in an academic environment, under the supervision of University of Michigan faculty members, and exposes the learners to cutting-edge technology and to world-class research.
The schedules and conferences for the Categorical Program are described in detail below.
These trainees alternate three months of Internal Medicine with three months of Pediatrics over the course of four years satisfying board requirements for certification in Internal Medicine and Pediatrics.
Physician Scientist Program
The Department of Internal Medicine is highly committed to the development of academic physicians and physician-scientists. The Physician-Scientist Program is offered as an option for qualified candidates to receive training in the Internal Medicine Program for two years, followed by clinical and research training in a subspecialty fellowship program. All fellowship programs within the Department of Internal Medicine participate in this program and support it enthusiastically.
Candidates for the Physician-Scientist Program are those who are completing their medical school experiences with joint M.D. and Ph.D. degrees. The Department of Internal Medicine is committed to the policies and procedures of the American Board of Internal Medicine's Research Pathway, assuring that individuals will be eligible for board certification in Internal Medicine and in a subspecialty during the training program. During the interview process, applicants to the Physician-Scientist Program will have the opportunity to interact in depth with subspecialty faculty and fellows, with a focus on the individual's research interests and career plans.
Individuals interested in the Physician-Scientist Program are encouraged to review the Physician-Scientist webpage and to contact Subramaniam Pennathur, M.D., Director for the Physician-Scientist Program and Associate Program Director, Internal Medicine, for additional information (firstname.lastname@example.org).
Preliminary Year in Internal Medicine
The Department of Internal Medicine offers a variable number of positions for individuals who require one year of primary training before going on to careers in various other specialties. The Department of Internal Medicine does not offer separate Preliminary Year positions through the match. All of the Preliminary Year positions are recruited as part of 'categorical' programs in those other specialties (Neurology), and the specialty programs are responsible for recruitment and matching of these positions. The curriculum for the preliminary year is developed to provide a tailored experience for the residents, jointly developed by the Internal Medicine program leadership together with the Program Directors for each of the participating specialties.
For the first year of the Categorical Training Program, the first year (internship) is designed to provide a broad experience in Internal Medicine. Each intern could expect 7 - 7.5 months of inpatient experience with 1 month night service, during which time he/she is considered the primary physician for the ward service. We prioritize making Interns the primary order writers, and on giving them the first opportunity for procedures. Throughout the year, each intern maintains a weekly continuity clinic (rescheduled during inpatient months to minimize conflicts while ensuring continuity of care).
A typical HO-I schedule includes:
- One to two months on the General Medicine Services at the University Hospital
- One to two months on the General Medicine Services at the VA Hospital
- Two to three months on the Subspecialty Services at the University Hospital
- One to two months on the Cardiology Services at the University Hospital
- Two to four weeks on the Intensive Care Unit Service at the University Hospital
- One & one half to two months of Subspecialty Electives/Consults (no call)
- One to two months of Ambulatory Clinics (no call)
- One month of night service on ICU or Subspecialty Services
- One month of Vacation
As a second year resident in the program, the house officer develops an expanding role as a consultant and also as a supervisor on most of the inpatient ward services. While on the General Internal Medicine service, the senior resident is responsible for the overall direction and operation of the team. Second-year house officers will also serve as supervising residents on the subspecialty services, the cardiology services and the critical care service. While assigned to these rotations, the resident will have the opportunity to evaluate and manage interesting cases, and he/she will maintain close daily contact with the rounding staff physician from that particular discipline. The greatest proportion of the second year, however, is spent in a combination of subspecialty elective rotations and ambulatory block rotations. During all of these experiences, the resident will continue to manage a panel of continuity patients.
A typical HO-II schedule includes:
- Three to four ward rotations (a combination of either subspecialty services at the University Hospital, General Medicine services at the VA and University Hospital, the Cardiology service, or the Critical Care services)
- Three to four months on subspecialty elective rotations (combined consult and outpatient clinic experiences, no call)
- One to two months of Ambulatory Block rotations (no call)
- Four - eight weeks of combined Night Float/Hospitalist service
- Two weeks in the Emergency Department
- One month of Vacation (taken as two 2-week blocks)
Much like the second-year schedule, the third year is tailored to the individual interest of the resident, with continued opportunities to serve as a consultant, supervisor of ward rotations, and an expanded role as teacher. In addition, there is increased flexibility to accommodate requests for protected time to conduct research or pursue off-site electives. The continuity clinic is maintained one-half day each week.
A typical HO-III schedule includes:
- Three inpatient ward rotations (a combination of either subspecialty services at the University Hospital, General Medicine services at either the University Hospital or the VA, the Cardiology service, or the Critical Care services)
- Four to five months on subspecialty or other elective rotations (no call)
- One to two months on an Ambulatory Block rotation (no call)
- One month of Research (no call)
- One month of combined Night Float/Hospitalist service
- Two weeks in the Emergency Department
- One month of Vacation (taken as two two-week blocks)
A core curriculum has been developed and maintained for each rotation. These documents, developed to provide learning objectives and teaching ideas, are not only distributed to all residents and teaching attendings each month, but are also available in a Web-based format that can be accessed from any computer terminal in the hospital. As a supplement to the daily teaching activities for the individual services, which occur both as bedside rounding and didactic sessions, there are also a number of regular core teaching conferences scheduled on a regular basis for all residents.
In addition to the structured teaching activities outlined below, the Chair and Program Directors meet regularly with the Housestaff in an effort to both seek feedback and to provide updates regarding proposed improvements to the educational environment. There are scheduled individual class meetings and combined lunches for housestaff on a quarterly basis. Also there is a very active House Officer Council composed of class representatives, which meets monthly with the Program leadership to discuss new initiatives.
Departmental Grand Rounds
Grand Rounds is conducted weekly, each Friday at noon. This conference features state-of-the-art lectures on topics relevant to Internal Medicine, with a focus on recent scientific advances. Visiting professors account for approximately 20 percent of all speakers.
Morning report is conducted daily, Monday through Friday, at 10:30 a.m. at the University Hospital, and separately at 10:30 a.m. daily at the VA Hospital. The chief medical resident directs several case-based discussions as presented by second and third year residents assigned to ward rotations and subspecialty electives. Also present is one faculty discussant from one of the subspecialties to help provide expertise, and either the Chair, Program Director or one of the Associate Program Directors.
Two times weekly, a faculty lecture is presented during lunch with topics chosen from a core curriculum developed by the Program leadership.
Because interns are not required to attend the daily morning report, once weekly there is an interns-only session conducted in case-based format by the Chief Resident along with a faculty discussant. During the first two months of the year, a second weekly session called the "Intern Boot Camp" covers the initial mangement of common problems.
Ambulatory Morning Report
Each morning there is a separate one-hour session conducted for all residents assigned to ambulatory block rotations. The focus is to present case-based discussions of primary care and primary care-related topics.
During the second half of the year, a separate once weekly session focuses on review of content and test taking strategies for the ABIM Board Certification Examination. All classes are invited and encouraged to attend.
On a regular basis, recent articles from major medical journals are discussed in detail under the direction of the chief medical residents and one of the Program Directors.
In addition to these teaching conferences, the Chair and Program Directors meet monthly with the House Officer Council to discuss the training program and optimize the educational environment. The Council is made up of representatives nominated by each House Officer class as well as the Med/Peds Program. Each year, a number of suggestions brought forward by House Officers are implemented into the program.