Baylor University Medical Center
Internal Medicine Residency
Our patient spectrum is very broad; residents evaluate and treat both "routine" and unusual problems every day. The formal didactic schedule includes attending rounds, grand rounds, morning report, clinicopathologic conferences, and daily subspecialty conferences. Attending physicians and lecturers are reviewed regularly to ensure outstanding scholarship and expert presentations. The work schedule is designed so that each resident is given the time to regularly attend the didactic sessions.
We accept 11 internal medicine residents each year. Nine categorical internal medicine residents will receive at least three years of training at BUMC. These residents become general internists or pursue postgraduate fellowship education in a subspecialty of internal medicine. Two preliminary internal medicine residents will train one year in internal medicine in preparation for subspecialty training in such fields such as neurology, dermatology, ER medicine, anesthesiology, or radiology.
During the first year, internal medicine residents (both categorical and preliminary) spend six to seven months on general inpatient medicine rotations. The balance of the year includes two months of coronary care unit experience, one month in the emergency room, and two months in elective rotations. Three weeks of vacation are provided during the first year.
All residents are expected to attend a series of conferences, which include internal medicine grand rounds every Tuesday morning, internal medicine subspecialty conferences Monday through Friday at noon, and a chief's conference every Friday at noon. These specialty conferences include a monthly mortality and morbidity conference and a journal club.
The second-year internal medicine residents have four general medicine inpatient months, six to seven months of subspecialty rotations or electives, one month of outpatient internal medicine (Baylor Medical Center at Waxahachie), and one month in the CCU. Second-year residents receive three weeks of vacation and may attend an approved medical conference that is supported by a stipend. Residents are expected to attend the same series of conferences as the first-year residents and, in addition, the supervising residents attend morning report.
During inpatient medicine rotations, residents meet with the chief of medicine for a breakfast morning report. New admissions are presented, differential diagnoses and treatment plans discussed, and advice offered. Morning report is an educational and enjoyable way to start the day and provides the on-call residents an opportunity to decompress and describe cases to their colleagues.
Third-year residents spend two or three months supervising general inpatient teams, eight to nine months on electives, and one month devoted to research study and manuscript preparation. Third-year residents have three weeks of vacation and attend an approved medical conference that is supported by a stipend. Residents are expected to attend the same series of conferences as the first-year residents and, in addition, the supervising residents attend morning report.
General Medicine Rotations
The inpatient general internal medicine service is staffed by five teams. Each team includes one supervising resident (PGY-2 or PGY-3), two first-year residents (PGY-1), and one or two University of Texas Health Science Center junior medical students. Teams take call every fifth day and spend the night in the hospital. Comfortable private call rooms are provided for each on-call resident and student. Each team leaves the hospital between noon and 1 p.m. on the day following call. Each member of the team receives at least one 24-hour period of time off each seven days.
The internal medicine team responds to all cardiac arrest “codes” and assumes primary responsibility during resuscitation attempts. Monday through Friday, a “code call” team is assigned to respond from 8 a.m. until 5 p.m. The daily on-call team takes over this responsibility after 5 p.m. on weekdays and on weekends.
Each PGY-1 resident is responsible for the care of five to 10 patients at any given time. They perform initial evaluations, design treatment plans, write all orders, and act as each patient’s principal physician during the hospital stay. PGY-1 residents, under close supervision of PGY-2 or PGY-3 residents and an attending physician, perform invasive procedures, including lumbar punctures, thoracenteses, paracenteses, central line placements, Swan-Ganz catheter placements, arterial cannulations, bone marrow aspirations and biopsies, joint aspirations, and injections.
A “teaching attending” physician is assigned to each general medicine inpatient service and rounds with the team. New admissions are presented, differential diagnoses and treatments discussed, and pertinent physical findings demonstrated. The teaching attending also functions as the medical attending physician for patients admitted from the outpatient clinical service. In addition, residents confer with the attendings of private patients on a daily basis.
Residents provide care to a wide spectrum of patients. Admission guidelines prevent overexposure to a narrow range of disease processes or diagnoses.
BUMC does not utilize separate ICU teams (with the exception of the CCU - see below). Each medicine team provides care to ICU patients as well as those on regular floors. When a patient on the medicine service requires transfer from a private room to the ICU, the same team continues to oversee that patient`s care. Similarly, the team follows patients from the ICU back to the floor. This continuity of care enhances patient outcomes, patient satisfaction and the overall educational experience.
Each PGY-1 medicine resident has two one-month CCU rotations. The CCU team includes three PGY-1 residents and one PGY-2 resident. The CCU rotation provides our residents with a broad exposure to acute and chronic cardiac diseases. A cardiologist is assigned to the CCU rounds each day with the residents. Daily conferences cover the range of cardiology topics. When patients transfer from the CCU to a step-down facility or private rooms, the CCU interns continue to provide follow-up care to these patients. Again, every effort is made to ensure the continuity of care. Night call during the CCU rotation is taken every fourth night.
The residents on call leave the hospital between noon and 1 p.m. the day following call. All residents receive at least one 24-hour period of time off each seven days.
During the one-month emergency room rotation, PGY-1 residents care for a wide variety of emergency cases. General internal medicine, trauma, pediatric, and obstetrics/gynecology patients are evaluated, treated and triaged. Board-certified emergency room physicians supervise, educate and guide the trainees.
In the ER, residents work three consecutive days from 7 a.m. to 7 p.m., then three consecutive nights, from 7 p.m. to 7 a.m. and then have three days off. The cycle repeats every nine days.
Each resident is assigned to the BUMC outpatient clinic for one-half day each week. Residents are the primary healthcare providers for this group of patients. Residents are supervised by general internists, who are always present in the clinic, and consult with subspecialists, who are always available on a prn basis. Patients may be referred to BUMC’s specialty clinics (e.g. surgery, gynecology, etc.) for specific problems. Categorical residents follow the same group of patients through three years of training to establish continuity of care and to observe the evolution of patients and disease processes over time. BUMC’s outpatient clinic facilities were built in 1996, and each resident is assigned his/her own private exam room.
Categorical residents spend one month during their second year in a BUMC-affiliated outpatient practice in Waxahachie, Texas. This office site provides residents the opportunity to experience the practice of internal medicine in a more rural community hospital setting. In addition, most subspecialties offer outpatient rotation options. Cardiology, gastroenterology, endocrinology, rheumatology, and dermatology may be taken entirely as outpatient rotations. Other subspecialty rotations include large outpatient components.
Didactic sessions are a regularly scheduled component of each resident’s day. Daily conferences at noon integrate the theoretical, scientific and practical aspects of internal medicine. Discussions emphasize salient points of diagnosis and therapy, as well as the financial, social, and ethical implications of medical decisions. Lunch is provided so our residents can nourish their bodies simultaneously with their brains.
Internal medicine grand rounds every Tuesday morning at 8 a.m. cover a wide spectrum of timely topics. Once each month, internal medicine residents present either an “unknown” case in a CPC format (the cases are discussed by a member of the medical staff, the pathologist presents the answer, and the resident then gives a brief review of the disorder) or present a series of brief clinical vignettes.
Chief’s conference is scheduled each Friday and once each month residents present “potpourri”—a series of interesting cases.