Residents in the Department of Internal Medicine rotate through the University of Michigan Medical Center, the Veterans Affairs Medical Center , and numerous community-based General Medicine and subspecialty practices. Together, these settings provide the trainee with exposure to a diversity of patients and their diseases.

The University of Michigan Medical Center

Consistently rated by the US News and World Report as one of the top hospitals in the United States , this world-class facility, housed in a modern facility that opened in 1986, serves as a referral center for the entire state of Michigan and the upper Midwest of the United States . The institution attracts a broad and diverse patient population, which together with state of the art technology, computerized medical information systems, and strong ancillary support services creates an outstanding learning environment. The Department of Internal Medicine has over 1000 admissions to its service each month. The inpatient operations are designed to maximize exposure to the expertise of our faculty, on the part of the patients as well as the learners.

Department of Veterans Affairs Medical Center (VAMC)

Located just 0.5 miles from the University of Michigan Medical Center, the VAMC is a major referral institution within the Veterans Health Agency. It is responsible for providing primary, secondary and tertiary care to veterans residing in the lower peninsula of Michigan and also Northwestern Ohio . A new clinical addition, which houses the intensive care units, a new medical procedures unit, and all general medicine and ambulatory specialty clinics, opened in May of 1999. Over 2,700 patients are admitted annually to the Medicine service. All of the attending staff physicians are full-time faculty members of the University of Michigan Medical School, with full representation of all subspecialties.

Clinical Experiences

Inpatient Experiences

General Comments and Sample 3-year Schedule

Residents rotate through a variety of inpatient services at the University Hospital and the VA Medical Center.

At the University Hospital , the rotations are designed to match the expertise of our faculty to the presenting complaint of the individual patient. The VA hospital inpatient services help to provide a broad general medicine experience including ICU patients. Together the experiences provide excellent clinical and teaching exposure.

At the Univeristy, Subspecialty, Generalist, Hospitalist, and Critical Care services have been created to provide a balanced experience for the residents and early exposure to subspeciality attending staff in the major medical specialties. Each service has a faculty director who is responsible for the coordinated clinical and educational activities for that service. An updated curriculum of goals and objectives, along with material from conferences such as slide shows and important journal articles is available on a web-based platform available from any computer in the hospital. Throughout their course of training residents are exposed to both generalists and specialists as supervising attending physicians, who are selected based upon teaching evaluations. All of our inpatient attendings serve as both the inpatient care supervising physician and the teaching attending. There are no private attendings. Our inpatient services both care for the general medicine needs of the surrounding community and serve as a tertiary referral center.

Sample Categorical 3-year Schedule

Inpatient Service Configurations

Following is the current configuration of inpatient services in our residency program:

University Hospital

There are four General Internal Medicine services, each with one senior resident, and two interns. These services admit general medicine cases as well as a wide variety of endocrine, renal, rheumatology, and infectious disease patients.

There are three different subspecialty services - Pulmonary, Gastroenterology, and Hematology/Oncology. Two senior residents, and four interns staff each subspecialty service which is staffed by leading experts in these specialties.

The Hospitalist service is staffed by four senior residents and staffed with hospitalist attendings. They care for both general medicine and subspecialty patients, accepting admissions after other services cap and between midnight and 7 a.m. The senior residents cap at five new admits. This service provides a broad patient care experience and exposure to attendings in the rapidly growing field of hospital medicine.

Four Cardiology services each have one senior resident, and two interns. The cardiology services follow patients admitted to the CCU or to the telemetry floor.

The Critical Care Medicine service consists of four house officer teams, each with one senior resident and one intern. The CCMU is a closed intensive care unit. The teams rotate in-house call every fourth night and cap at six new admissions.

VA Hospital

The general medicine service consists of 4 teams each with one attending, one senior (3rd or 4th year) resident and two interns. They follow patients both on the general floors and in the intensive care unit which is staffed by faculty from the division of Pulmonary and Critical Care.

The VAMC has an active geriatric inpatient unit, staffed by a faculty member from the division of Geriatric Medicine. Two senior residents rotate monthly on the VA Geriatrics Services, taking phone call from home.

Call Structure

All inpatient services take call no more frequently than every fourth night. On general medicine, cardiology, subspecialty services and at the VA, services admit as a team during the day, and with the assistance of senior float residents at night. Day float residents assist with the teams' post-call duties. The Hospitalist and Intensive Care services have internal coverage. A time cap of midnight and an admission number cap exist for interns and senior residents on all services. All interns and residents are scheduled at least four days off each month.

Non-resident Covered Services

In addition to the resident services, there are several non-resident services that help to reduce resident workload. At the University Hospital there is a large hospitalist service service run by faculty and physician assistants that manages a census of 60 patients (about 25% of the total inpatient medicine census) without resident involvement. In addition bone marrow transplant, chemotherapy and post-cardiac procedure patients are cared for by non-resident services.

Computers and Technological Innovation

At both the VAMC and University Hospital , a state of the art computerized medical record allows quick and easy access to patient care data (including all documentation) both on and off-site. The system at the University incorporates sign-out functions and allows for easy generation of a discharge summary thereby eliminating the need for dictating charts in the inpatient setting. Computer order entry has been in place at the VAMC for several years and a new state of the art order entry system will be implemented at the University Hospital in 2007-08. To help facilitate patient care, all interns are issued wireless-internet ready laptops to be used during their intern year. In addition there is ready access to computer terminals on all units at the University and VAMC.

Clinical and Ancillary Support

Ancillary support is excellent at both hospitals. The University Hospital has 24 hour phlebotomy and IV services along with the full array of radiology and other support services. The VA hospital also has regular IV and phlebotomy support. All radiology studies, including CT scans and MRIs are now completely digital (filmless) at both hospitals.

Subspecialty Electives

Residents rotate monthly through the consult services for each of the individual medical subspecialties as part of elective rotations. The elective rotation for each of the subspecialties is coordinated to include scheduled time in the outpatient clinic, combined with daily rounds on the consult service. The aim of these rotations is provide focused exposure to subspecialty medicine (including outpatient clinics as described in the outpatient clinical experience section) which is vitally important in helping residents make informed career choices. Every effort is made to provide early exposure to those residents interested in particular specialties. These rotations also allow all residents to learn the important role of medical consultant to both medical and surgical teams – something that is equally relevant to residents pursuing generalist or specialist careers.