Internal Medicine Residency Curriculum

The educational goals of the Internal Medicine Residency Program are centered around the six ACGME competencies:

1. Patient care
2. Medical knowledge
3. Interpersonal and communication skills
4. Systems-based practice
5. Professionalism
6. Practice-based learning and improvement

The Internal Medicine Residency Program offers exceptional learning opportunities in a vast array of clinical settings, including outpatient and in-patient experience. We have dedicated teaching faculty and supportive staff who strive to ensure all of our residents have the best experience possible.

The program is currently using a “4+1” block schedule in order to provide the most experience possible. Each two to four week-long in-patient, ICU, or elective subspecialty rotation block will be followed by one week of protected internal medicine (IM) clinic time where residents can provide continuity of care to their patient panel and act as a genuine primary care provider.

Clinical Experience

Outpatient IM Clinic: Certified as a medical home, residents provide primary care service along with staff including nurse, medical assistant, St. Louis College of Pharmacy/PharmD, pharmacy residents/students and pharmacy technician, social service specialist, office manager, and administrative leadership. Phlebotomy is performed in the clinic by our nurse(s) and/or medical assistant.

Outpatient IM Ambulatory Care: In addition to rotating with community based primary care physicians, interns, and residents also rotate with specialist physicians (allergy & immunology, wound care, ENT, gynecology/women’s health, and vascular surgery) to enhance their primary care skill set.

In-patient Service: Residents on the inpatient service are directly supervised by an academic hospitalist and serve as the physician(s) for their patients on a multidisciplinary team. The team consists of physicians, nurses, clinical pharmacists, allied health professionals including case management, specialized therapy services, and medical/pharmacy students. Residents personally interact with multiple consultants to provide high value patient-centered care.

Resident teams are led by a PGY-2/PGY-3 and have one to two interns and medical students.

In addition to caring for hospitalized patients, residents can build their experience caring for high acuity patients in the Step-Down Care / Transitional Care Unit, assessing and managing patients in hyperglycemic crises or respiratory failure requiring noninvasive ventilation.

PGY-2's and PGY-3's can build autonomy and diagnostic acumen running the triage service, a unique admission rotation that allows for control of the admission workflow as well as the opportunity to evaluate and treat rare medical cases.

Our program also has a fully staffed night float with nocturnist supervision, allowing residents to gain the opportunity to explore the career of nocturnist medicine and rapidly build confidence in admitting patients.

Critical Care Medicine: Residents on the critical care service are directly supervised by an academic intensivist and serve as the physician(s) for their patients on a multidisciplinary team. The team consists of physicians, nurses, ICU clinical pharmacists, allied health professionals including specialized therapy services, and medical/pharmacy students. Point of Care Ultrasound (POCUS) is highly utilized and integrated into the ICU curriculum. As on the inpatient rotation, residents interact with multiple consultants in the ICU.

Subspecialty Medicine: PGY-2/PGY-3 rotations include experiences in cardiology, gastroenterology, pulmonology, nephrology, hematology/oncology, infectious diseases, rheumatology, palliative care, endocrinology, dermatology, neurology, emergency medicine, and psychiatry. These experiences vary in length and location (inpatient/outpatient) per academic year.

Specialty Exposure: Residents have the opportunity to experience an additional wide range of specialties to broaden the scope of their future internal medicine practice. Available rotations include chemical dependency medicine, dermatology, wound care, podiatry, ENT, gynecology/women’s health, and vascular surgery. Our internal medicine program is strongly involved in sponsoring institutions plan of care and protocol development.

Educational Noon Conferences

Protected time for education is provided from Noon to 1 PM, Monday through Friday, and consists of the following:

Intern Case Report: Interns prepare and lead a case discussion that emphasizes clinical reasoning and diagnosis under the guidance of a senior/chief resident. These discussions are held once a week during noon conference periodically throughout the year.

Educational Lecture: Consists of organized core curriculum lectures presented by teaching faculty in general internal medicine, as well as subspecialty medicine. In addition to this, residents are also educated by allied health professionals including pharmacy, specialized therapy services, social services and case management. Professional development and wellness conferences are held once a month.

Death Review: Interns and/or residents are assigned to review an inpatient mortality on the teaching teams, and lead a discussion on potential safety events, root cause analysis and system factors under the supervision of teaching faculty.

Grand Rounds: In addition to live-streaming grand rounds from Saint Louis University, we have guest speakers from across the country speak on various topics as related to internal medicine.

Resident Grand Rounds: PGY-3's are guided by core faculty on preparing and presenting a one-hour scientific conference on a topic of their choosing. Attendees include hospital physicians and staff, core faculty, residents, and other healthcare professionals.

Journal Club: Residents present and discuss journal articles once a month during noon conference as part of their education in critical appraisal of scientific literature, including case-control studies, cohort studies, randomized controlled trials, and meta-analyses.

Other Conference Topics: Noon conferences also include Medical Knowledge Self-Assessment Program (MKSAP) sessions, Doctor’s Dilemma, recorded ACP lectures, State of the Program updates, Ombudsman professional development series.

Scholarly Activity and Research Opportunities

In addition to providing an excellent education at the bedside and in the clinic, the IM residency program requires all residents to be actively involved in activities related to scholarly activity.

Scholarly activities include quality improvement projects, grand rounds, abstract submissions, poster presentations, clinical vignettes, case reports, and article submissions under the supervision of faculty. All scholarly activities must be approved by the program director.

The program is committed to engage all learners in expanding their skills by embracing research/quality improvement initiatives as part of the tools in medicine to enhance patient care. Some projects may be simpler than others; some research projects may require Institutional Review Board (IRB) approval.

Yearly, the program participates in the ACP MO Chapter Poster competition. Winners of the MO Chapter Poster competition are eligible to present at the national ACP conference.

Patient Safety and Quality Improvement/ High Value Care: All residents are responsible to formulate a small-scale quality improvement project on an annual basis, usually using the PDSA (Plan, Do, Study, Act) cycle and A3 problem solving. The IM clinic and inpatient services offers great opportunities to identify gaps and serve as a solid base for a project.

Abstract Writing/ Case Report/Clinical Vignettes: Residents can elect to write an abstract, case report or case series under the guidance of a faculty member and publish in a PubMed-indexed journal, subject to approval. Clinical vignettes are case reports that are presented at the local ACP chapter.