Internal Medicine Residency

Block schedule

Block schedule follows 4:1 rotation where 4 weeks of Inpatient/Subspeciality is interspersed with 1 week of Ambulatory continuity Clinic.

PGY-1

• Internal Medicine – inpatient 16 weeks
• Night Float – 4 weeks
• Nephrology – 4 weeks
• Critical Care – 4 weeks
• Emergency Medicine – 4 weeks
• Cardiology – 4 weeks
• Individualized Education Experience – 4 weeks
• Continuity Clinic – outpatient 10 weeks

PGY-2

• Internal Medicine – inpatient 12 weeks
• Night Float – 4 weeks
• Endocrinology – 4 weeks
• Gastroenterology – 4 weeks
• Infectious Disease – 4 weeks
• Critical Care – 4 weeks
• Pulmonary Disease – 4 weeks
• Individualized Education Experience – 4 weeks
• Continuity Clinic – outpatient 10 weeks

PGY-3

• Internal Medicine – inpatient 12 weeks
• Night Float – 4 weeks
• Geriatric Medicine – 4 weeks
• Neurology – 4 weeks
• Rheumatology – 4 weeks
• Hematology / Oncology – 4 weeks
• Critical Care – 4 weeks
• Individualized Education Experience* – 16 weeks
• Continuity Clinic – outpatient 10 weeks

*Rotation can be modified to include 16 weeks of individualized education experience

Individualized education experience

Residents have Individualized Education Experience blocks in each year and have the option to choose any of the previous rotations.

In addition, the following electives are also offered:

• Cuidado de Apoyo y Cuidados Paliativos
• Advanced Heart Failure/LVAD
• Transplant service (Hepatology and Nephrology)
• Patient safety and quality
• Dermatología
• Pathology
• Research Block

Rotations

A resident's schedule is based on a 4 + 1 model where every 4 weeks of an inpatient or subspecialty rotation is followed by 1 week of the continuity clinic.

Core rotations:

Inpatient general medicine rotation (floor rotation)

Team Structure: Each inpatient general medicine team has a senior resident (PGY2 or PGY 3), and two PGY 1s. An attending physician is assigned to each general medicine inpatient service who rounds with the team daily. A team is on call every 5 days.

Each PGY-1 resident is responsible for the care of an average of 8 patients. PGY-1 residents perform initial evaluations, design treatment plans, write all orders and act as each patient’s principal physician during the hospital stay.

Baylor Scott & White All Saints Medical Center – Fort Worth, located near downtown Fort Worth, is an award-winning full-service hospital dedicated to providing for the health care needs of the Fort Worth community. The medical center is a recognized leader in the areas of complex heart and vascular surgical care, oncology and head and neck surgical services, comprehensive women’s services, and transplant surgery. Our hospital utilizes EPIC EMR for patient care.

Our high acuity and diverse patient population uniquely positions our inpatient general medicine service to provide advanced exposure to a broad range of pathology extending from common community based acute and chronic problems to advanced liver disease, heart disease, opportunistic infectious pathology in immunosuppressed patients, transplant related pathology, and others.

Teamwork and leadership are the theme of inpatient rotations. Resident teams under the supervision of their attending lead multidisciplinary huddles where they interact with various disciplines of inpatient services including, care management, social services, physical medicine, pharmacy, nutrition and chaplain, and other services that provide direct care to patients.

Night float

Residents participate in 4 weeks of night float rotation every year and provide night coverage to inpatient services, cross cover calls, and overnight admission.
Night Float team consist of both senior residents (PGY 2 or PGY 3) and PGY 1.

Critical care rotation

Residents perform 4 weeks of critical care rotations each year of residency. This rotation provides broad exposure to both medical and surgical patients ranging from acute and chronic community-based diseases to complex cardiac, transplant, and ECMO patient management.
Residents round daily with attending intensivist. Residents also perform various procedures and participate as part of the critical response team within the hospital during their rotation.

Ambulatory clinic rotation

Residents participate in an ambulatory clinic rotation at Fort Worth Institute of Medical Sciences, a resident run continuity clinic.
Residents are assigned their own panel of patients and follow them through three years of residency as their primary care physician under the supervision of an ambulatory attending physician.

Each year residents spend 10 dedicated weeks in the continuity clinic and complete 50 half day sessions, totaling 150 sessions during the 36 months of training. Predictive scheduling using the 4 + 1 model help to facilitate the scheduling of residents and patients to maximize the development of on-going relationships with a panel of patients.
Residents are also required to complete John Hopkins Ambulatory Care Modules® during their ambulatory clinic rotation.

Point of care ultrasound

Residents go through one year longitudinal POCUS curriculum during their second year. Residents dedicate 10 half days (4 hour sessions) during their ambulatory week and go over POCUS curriculum with faculty. Residents will get training on basic cardiac, abdominal, thoracic, DVT, skin/soft tissue POCUS.

Average day on floor rotation (PGY 1)

• 6:45 AM: Arrival to hospital
• 6:45AM - 7:00 AM: Hand off from Night Team at Residents lounge
• 7:00 AM - 7:45 AM: Morning Report- Protected learning time
• 7:45AM - 9:00 AM: Pre-rounds on patients
• 9:00 AM - 12:00 PM: Multi-disciplinary huddles and Attending Rounds on floors
• 12:00PM- 1:00 PM: Noon Conference – Protected learning time
• 1:00 PM- 6:00 PM: Patient follow up and Notes; Admissions on Call Days
• 7:00 PM: Hand off to Night Team 

Non-call days: Complete work and sign out to cross cover person.

Conferences

Morning case report

• Residents present cases for discussion, dissect through differentials along with work up and management.
• Faculty is present to facilitate discussion

Noon conference (daily lunch and learn conference)

• Mondays - Core internal medicine topics
• Tuesdays - Grand rounds, journal club, morbidity and mortality conference, patient safety and quality updates
• Wednesday - Board review series
• Thursday - System based practice series, resident wellness sessions
• Friday - Core internal medicine topics

Investigación

“We believe scholarly activity is essential to clinical training in Internal Medicine. The opportunity to participate in research, scholarly writing, quality improvement, and medical education greatly enhances the clinical learning environment and inspires a deeper knowledge of the clinical and basic sciences as well as the practice of Medicine. Our culture of collaboration and teamwork creates an ideal atmosphere for residents to work alongside faculty mentors and participate in projects that are relevant to their interests and aspirations in clinical practice.

"By exploring ways to improve the quality of care and outcomes for patients through asking challenging questions, our residents will develop skills in critical thinking that they will carry forward throughout their career. Our goal is to not only provide the resources and environment for an outstanding clinical training experience, but also a framework for residents to achieve a greater understanding of Internal Medicine, contribute to advancement in the field, and develop new approaches to benefit our patients.” - Dr Stevan Gonzalez, Core Faculty

• Residents are required to do at least one Research and one Patient safety and Quality projects during their residency.
• Program will support the cost for resident presenting a project at a Conference.
• Residents are required to complete CITI program training.
• BSW Research Institute will support residents in developing research projects, getting IRB approval and conduct research activities. 

BSW Research Institute (BSWRI)

BSW Research Institute provides the critical infrastructure and operational resources needed to both safely and effectively conduct research across a broad range of specialty areas.

BSWRI by the numbers

• Staffing more than 600 employees, including scientists, laboratory assistants, research nurses, clinical research assistants and research coordinators
• Utilizing more than 200,000 square feet of research space
• Conducting more than 2,000 active research protocols, spanning more than 60 medical specialties

Serving more than 800,000 people at medical centers across our healthcare system