The Department of Medicine offers six one-year preliminary, one research track, and 20 three-year categorical positions in Internal Medicine. We do not offer observerships of any sort so as to focus our educational effort on our own trainees.
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 inpatient/outpatient services including (Endocrinology, Nephrology, Pulmonary, Rheumatology, Gastroenterology, Cardiology, Infectious Diseases and others).
Inpatient Medical Experiences
During either the one-year preliminary or the three-year Categorical Internal Medicine program, the resident will have diverse 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. One senior (R-2 or R-3 resident) and two interns (R-1 residents). Medical students are assigned to each team, working cooperatively to provide care to patients assigned to the team. Patient care is optimized by the close collaboration between resident teams, pharmacists, social workers, and case managers. At the VA hospital, teams are headed by a VA internist, and manned by one senior resident and two interns.
Our inpatient teams abide by a "hard cap" of 18 patients designed to minimize the revolving door effect seen in other hospital systems.
Ambulatory Care Experiences
At the University of Missouri, our internal medicine residents participate in continuity clinic via the four+one model. This varies from the traditional model of continuity clinic, where residents are pulled from their rotations one-half day per week in order to attend clinic.
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 are 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 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 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. 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 Department at University Hospital 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 percent 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.
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.
Two to three months of elective time each year gives our residents flexibility to pursue their interests. Rotations in Anesthesiology, Adolescent Medicine, Cardiology Consults, Dermatology, Endocrinology, Gastroenterology, Hematology/Medical 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.
Procedures Required for Internal Medicine Certification
The procedures required for certification in internal medicine can be found on the ABIM website. However, there are many opportunities for residents to become proficient in other procedures that are not required by the ABIM such as central lines, arterial lines, endotracheal intubations, paracentesis, thoracentesis, lumbar punctures and chest tubes.
The core curriculum series covers a broad base of medicine and non-medicine topics including clinical, research and administrative/professional areas. Other departments contribute knowledge and skills needed to practice general internal medicine. This is a popular conference often attended by residents of other specialties that may take a variety of formats depending upon the faculty presenter. This series of lectures are intended to deal with the major topics including:
- Quality assessment
- Quality improvement
- Risk management
- Social and economic impact of medical decision
- Preventive medicine
- Medical informatics
- Law and public policy
- Pain management
- End-of-life care
- Principles of managed care
- Substance use disorders
- Sports medicine and school health