Residencia en Medicina Interna

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Baylor Scott & White Medical Center - Templo

There is no formal call schedule. Instead, we work by "shifts."

Admissions for the day team are from 7 a.m. to 5 p.m. daily. Day team is comprised of one upper level resident and two to three interns.

Night team takes admissions from 5 p.m. to 7 a.m. and is comprised of one upper level resident and one intern.

We have four ward teams: A, B, C and D. The C team is a third-year only hospitalist rotation. A, B and C teams are responsible for beds on one floor of the hospital (geographic localization). D team is a general hospital wards team (not geographically localized).

• A=14 beds/patients for which they are responsible
• B=14 beds/patients for which they are responsible
• C=10/beds/patients for which they are responsible
• D=14 beds/patients for which they are responsible

Our teams perform admissions throughout their shifts. If they have no discharges and beds are full, they will have no admissions for that shift.

Night float call system and admissions work the same as above, and they admit to all open beds to the teaching floor after 5 p.m.

Olin E. Teague Veterans Hospital

Three teaching teams consist of one attending physician, one upper-level resident and two to three interns. Team cap is 16 patients with re-admissions not counting for cap.

Each team can receive five admissions within a 24-hour period. Up to two can be from the night prior.

Day team admits from 7 a.m. to 5 p.m. Teams rotate order for admissions daily.

Interns are never responsible for more than 10 patients at any given time; typically, they have eight or fewer.

Conferences

Morning report

Morning report has many different formats. This 30-minute session varies between case presentations from teaching teams lead by faculty staff, M&M reports, intern case reports and wellness conferences. For case presentations, the presenting intern/resident is responsible for communicating the case ahead of time to the staff scheduled for morning report at least 48 hours in advance.

As part of our initiative to develop residents as teachers, resident-led morning reports with staff supervision are strongly encouraged. Interns are responsible for providing a two- to three-slide PowerPoint presentation specific to the core topic of the case during the last five minutes of the case-based morning report. A schedule outlining the specific dates during which the teaching teams will be presenting morning report is provided.

Noon conference

General Internal Medicine noon conferences will cover the core medicine topics in an 18-month designed curriculum. Each topic will ideally be discussed twice during the course of internal medicine residency. Tuesday’s noon conferences will vary between third year resident Capstone projects and the Lifestyle Medicine curriculum.

Additionally, 12 conferences throughout the year will be dedicated to the wellness curriculum. Throughout the year, there will be occasional noon conferences during Mondays and Wednesdays for communication curriculum. This curriculum is designed to enhance emotional intelligence and give residents the tools on how to approach difficult conversations.

In general, a third of all conferences will take place at the VA.

Medicine grand rounds

The Chairman of Medicine organizes these conferences, and guest speakers and local senior staff are invited to discuss advances in the many fields of medicine. Additionally, third-year residents will present their Capstone projects intermittently during grand rounds.

Capstone Project

The Capstone Project now replaces the traditional CPC. This project is designed to allow the resident to provide key updates on certain assigned topics. As an effort to make the project integrated and collaborative, our outpatient providers are given an open based question survey inquiring which aspects of the assigned topic they have questions about. The elicited inquiries are then used to create objectives for the resident to answer during their presentation.

The project will consist of an assigned mentor, topic and case with known diagnosis to the third-year resident. The topic is assigned four weeks in advance to the resident. The resident is expected to discuss the objectives, pathophysiology, and evidence-based medicine as it relates to the case as well as any pertinent radiographic and pathologic findings. We strongly encourage inviting members of other departments, such as radiology and pathology, to discuss the specialized aspects of the case. It is the residents' responsibility to meet regularly with their assigned mentor to review the case presentation.

Attendance policy for conference

All residents are expected to attend morning report and noon conference, as well as grand rounds. A minimum of 70 percent conference attendance, which is re-assessed on a bimonthly basis, is required for PGY-2 and PGY-3 residents to be eligible for moonlighting.

Residents are required to attend their respective academic half days. During the weeks residents have their academic half days, they are encouraged, but not expected to, attend regularly scheduled morning report and noon conference.

Academic half day

As part of the 4+1 curriculum, our residents are divided in to cohorts that share the same week in clinic. Cohorts will gather every Wednesday during their clinic week for the academic half day. These meetings rely on a team-based learning framework and are built on the spirit of open discussion. The four hours are dedicated to didactic and interactive lectures. Topics include ambulatory conference series, EPIC/workflow issues, and physical exam techniques. The last one-hour of the half day consists of Journal Club, during which clinic staff members lead didactic sessions as well as lead discussions. There are a total of 10 academic half days per cohort.

Specialty exposure

Our goal is to provide ample opportunity for comprehensive exposure to any of the medical subspecialties of the department of medicine through rotations in intensive care medicine, inpatient consultative services, and outpatient experiences.

Additional elective rotations are available each year and residents are encouraged and welcomed to take advantage of this time to broaden their exposure to the subspecialties available. Each subspecialty listed has inpatient and outpatient opportunities available.

Cardiología

Inpatient and outpatient opportunities including:

• Advanced heart failure inpatient service
• Invasive cardiology - cardiac catheterization, PTCA, TAVR
• Procedimientos de electrofisiología
• Echo diagnostics
• Rehabilitación cardiaca
• Outpatient continuity clinic

Medicina de cuidados intensivos y pulmonares

Outpatient opportunities include:

• Sleep medicine clinic
• Invasive pulmonary medicine
• Right heart catheterization
• Thoracentesis
• Bronchoscopy
• Continuity clinic
• Hipertensión pulmonar
• COPD
• Asma
• Fibrosis quística
• Alpha 1 antitrypsin disease

Gastroenterología

Gastroenterology provides several inpatient and outpatient opportunities. If a more procedure oriented experience is desired, residents can spend more time in the endoscopy suite or assisting with paracenteses. Outpatient clinic and hepatology clinic experiences are also available and give residents the opportunity to participate with initial and follow-up evaluations of new patients with primary gastrointestinal and liver problems.

Hematology and medical oncology

Our hematology and oncology department offers residents both inpatient consult and primary services as well as outpatient continuity clinic. Many of our providers are subspecialized within the field, and residents may rotate with a provider of their choice if they are interested in a specific disease.

Enfermedades infecciosas

Infectious diseases is an active consult service. Residents have the opportunity to see and discuss a wide range of adult infectious disease problems both on the inpatient and clinic side. Clinic offers the opportunity to learn more about HIV medicine as well as management of chronic complicated infections.

Endocrinología

Our endocrinology department operates ambulatory management of diabetes, thyroid and hypertension. Additionally, this department maintains an active inpatient consultation service. Residents are scheduled to be on this service during their ambulatory care week. Additionally, they are given the opportunity to rotate through on elective time as well.

Nefrología

The nephrology department provides an active inpatient consultation service as well as ambulatory care opportunities. This service provides a chance for residents to learn more about the challenges unique to the population with end stage renal disease as well as the science of dialysis. Fluid, electrolyte and acid base disturbance management are additionally inherent to this service.

Reumatología

The rheumatology experience is best served as a combination of inpatient consults and outpatient care. Residents are exposed to a broad range of rheumatic and connective tissue disorders. They are also given the opportunity to learn several procedures such as arthrocentesis and joint fluid analysis. Weekly case conference takes place within the department.

Investigación

The Residency Review Committee, the accrediting body for internal medicine residency programs, requires all internal medicine residents to participate in scholarly activities. All residents are expected to participate in a scholarly activity by the completion of their residency.

Examples of acceptable projects include:

• Presentation of clinical vignette poster
• Quality improvement projects
• Oral podium presentation
• Publicaciones

Research activities must be presented in one of these formats to fulfill the scholarly activity requirement. Baylor Scott & White Academic Research Development offers several courses ranging from approach to critical appraisal of literature to IRB approval through their Research Development and Scholarly series. All residents are encouraged to both publish their work and present at national and local meetings.

We have also identified a group of faculty mentors who are willing to assist residents with scholarly activities during their training. We feel this is an excellent way for faculty and residents to work together in scholarly activity.