We offer 5 one-year preliminary and 18 three-year categorical residency program in Internal Medicine.
The General Internal Medicine wards and the Ambulatory Care Clinics represent the key portions of the resident's experiences during the three year residency. These experiences are augmented by rotations through subspecialty medicine clinics (Endocrinology, Nephrology, Pulmonary, Rheumatology and others.) and inpatient/outpatient consultation services (Gastroenterology, Cardiology, Infectious Diseases), and diversifying experiences in office gynecology, otolaryngology and orthopedics (sports medicine).
Inpatient Medical Experiences
During either the one-year preliminary or the three-year Categorical Internal Medicine program, the resident will have rich experiences at both of our affiliated teaching hospitals:
Care is provided by teams led by attending faculty. At the University Hospital, inpatient attendings are full-time academic hospitalists. There are six Medicine Ward teams at the University Hospital. One senior (R-2 or R-3 resident) and one or two interns (R-1 residents) and medical students are assigned to each team, working cooperatively to provide care to patients assigned to the team. On University Hospital rotations, residents take in-house call every sixth day, and receive one or two short call admissions on non-call days, and no admissions on the post-call day. At the VA hospital, teams are headed by a VA internist, and manned by one senior resident and two interns. The VA Medicine Ward service includes three teams, and the interns alternate long and short call every 3 days with a Night Float system taking admissions from 7 p.m. to 7 a.m.
With the existing team structure, team census averages 8-10 patients, and there are usually 6-8 admissions to the Long Call team during a 24 hour period.
Ambulatory Care Experiences
- At the University of Missouri, our internal medicine residents participate in continuity clinic through a new, innovative model for clinic training called Four-One. In the traditional model of continuity clinic, residents are pulled from their rotations one-half day per week in order to attend clinic. We found that this is extremely difficult for residents given their obligations to both the clinic and their inpatient rotations. Moreover, this was disruptive to inpatient duties and didactics and the clinic was disjointed as residents were only present in clinic four hours per week.
- In the Four-One model, residents have four weeks of a given rotation that is followed by one week of continuity clinic. When one is in clinic, there are no other responsibilities except for clinic. When on a non-continuity clinic rotation, there are no continuity clinic duties. Residents will now be able to solely focus on their four week rotation without interruption from clinic and likewise, they will be able to solely focus on the outpatient continuity clinic during the one week of clinic.
- The Internal Medicine RRC now requires that internal medicine residents have 130 clinic sessions during their three years of residency. This requirement is easily satisfied in the Four-One model.
- The Harry S Truman Veterans Hospital and Clinics and the Fairview General Internal Medicine clinic are the two settings in which residents may have their continuity clinic. Residents serve as the primary care physicians for their patients and continuity of care is also provided by the General Internal Medicine Attending Faculty who supervise the residents.
- When a resident is in clinic, he or she will have six one-half day sessions of clinic in which to see patients. Two half-days a week are reserved for ambulatory didactics and quality improvement learning. We utilize the Yale Office-Based Curriculum as a backbone of our didactics. Residents have no other responsibilities during these two half-days, so they are able to totally focus on learning. In addition, residents are given two half-days of unassigned time which can be utilized in a variety of ways, including academic endeavors, but also a time to attend to personal matters.
- The Emergency Center of the University Hospitals and Clinics is the only Level I trauma facility in Mid-Missouri.
- Residents evaluate and treat patients with medical and surgical emergencies, under the supervision of 100% Emergency Medicine residency-trained and board certified faculty.
- Residents rotate through the Medical Intensive Care Unit and the Coronary Intensive Care Unit at the University Hospital, and the Medicine Intensive Care Unit at the Harry S. Truman Veteran's Administration Hospital.
- Residents are on call during these rotations every third night and have four assigned days off per month.
- The ICUs work on a team model with residents free to go home post call when their work is completed from their night of call, after team sign-out rounds.
Long Term Care & Geriatrics
- Training currently occurs at the Geriatrics (GEM) unit at the Harry S Truman Memorial Veterans Hospital; additional training experiences in local Ambulatory Clinics and long-term care facilities are being planned.
- Residents gain experience in hospice, nursing home, and subacute care.
- At the Fairview Clinic, a board certified Geriatrician is available for an elective rotation as well.
Training in Medical Oncology occurs on the Ellis Fischel inpatient service at University Hospital and Clinics, and in ambulatory care at the Ellis Fischel Cancer Center, a member hospital of University Hospitals and Clinics.
Other Required Training Experiences (Selectives)
At least one two- week block of each of the following rotations helps the resident build a skill set useful for the general internist in private practice:
- Medical Ophthalmology
- Orthopedics (Sports Medicine)
- General Medicine consultation service
Two to three months of elective time each year gives our residents flexibility to pursue their interests. Rotations in Anesthesiology, Adolescent Medicine, Cardiology Consults, Cardiology Graphics, Dermatology, Endocrinology, Gastroenterology, Hematology/Oncology, Infectious Diseases, Medical Ophthalmology, Nephrology, Pathology, Physical Medicine and Rehabilitation, Psychiatry, Pulmonary Disease, Radiology, and Rheumatology are popular clinical electives. If so inclined, the resident may also select one four-week Research block per academic year, under the tutelage of a faculty research mentor.
Examples of Yearly Rotations
The training year is composed of thirteen four-week blocks. Below is a sample schedule:
|4 wk block||Year 1||Year 2||Year 3|
|1||Inpatient Wards||Inpatient Wards||Gen Med Consults|
|4||Vacation Outpatient||Cardiology Graphics||Emergency Room|
|7||Inpatient Wards||Inpatient Wards||Inpatient Wards|
|9||Infectious Diseases||Inpatient Ward||GYN|
|13||Night Float||Inpatient Wards||GM Clinic/Vacation|
It is not uncommon for a particular resident's education program to deviate from the sample schedule above in order to satisfy his/her special interests. The training program is continuously evolving to comply with the education guidelines outlined by the Accreditation Council of Graduate Medical Education and the changing health care environment.
Responsibility and Call Schedule
Residents are on call for an average of eight to nine 4-week blocks during their first year of training, usually four to seven times a month. During the remainder of their residency, residents are on call an average of 12 blocks.
Interns have direct responsibility for the care of patients and are given autonomy consistent with their abilities. Support is provided by senior residents, fellows, and faculty to ensure high-quality patient care and educational guidance.
Training in the second and third year provides progressive experience and responsibility in general and subspecialty medicine.
Procedures Required for Internal Medicine Certification
The procedures required for certification in internal medicine can be found on the ABIM website.