Department of Medicine
Case Department of Medicine Internal Medicine
Residency Program 2007-2008
Frequently Asked Questions
Hospitals
How many clinical training sites are there?
How much time do housestaff
spend at the two sites?
Do you have non-housestaff
covered services?
Do you have hospitalist
services?
How are the ancillary services at the VA?
Schedules
Are
your rotations based on months or blocks?
What
is the standard breakdown of rotations?
What
is the approach to work hour reform at the Case IM residency?
What
changes have you made to support duty hour reform?
How does continuity clinic work?
Internship
How
many admissions can I get when I am on call?
After Graduation
How do your residents do in obtaining fellowships?
What do most of the residents do after
residency?
Admission
What
criteria are used to select housestaff?
How many PGY1 positions are available?
What
are the unique aspects of the Internal Medicine Residency at Case?
Outside of Work
Do you have residency retreats?
Are there housestaff
social events?
Education/Rotations
On the inpatient service, do you have
subspecialty teams?
How many people are on a team?
What is the conference curriculum?
Is
there a required Ambulatory rotation?
Are there required Neurology and Geriatric services?
Research/Mentoring
Is there a “scholarly requirement”?
How do I find a research mentor?
Are international experiences available?
Q: How do your residents do in obtaining
fellowships?
A: Overall the residents do extremely well. Last year 100% of PGY2s applying for fellowships successfully matched.
Q: How many clinical training site are
there?
A: Two, University Hospital Case Medical Center (UHCMC), which is a large tertiary academic hospital located on the east side of Cleveland and is the primary teaching affiliate for Case Western Reserve University, and the Cleveland Veterans Administration Hospital (CVAH), which is located one mile across University Circle [http://www.universitycircle.org/content/] from UHCMC.
Q: How much time do housestaff spend at the
two sites?
A: Housestaff spend approximately 2/3s of their time at UHCMC and 1/3 at CVAH.
Q: Are your rotations based on months or
blocks?
A: We use a block schedule- a block is 4 weeks. The interns schedule is based upon 13 blocks. A block schedule makes the switch days standard and facilitates days off and weekend coverage.
Q: What is the standard breakdown of
rotations?
A:
Categorical Intern Preliminary Intern
Wards 6 blocks 7 blocks
Elective 1 ½ 2 ½
Clinical Skills ½
ICU 2 1 ½
Neurology ½
Ambulatory 1 1
Vacation 1 1
Urgent Care ½
Junior Resident
Vacation 1 block
Elective 2 ½ (½ elective
jeopardy)
Ambulatory 1
Geriatrics ½
Wards 2 ½
Urgent care 1 ½
ICU 1
½
VA
Cardiology 1
ER ½
Nightfloat 1
Senior Resident
Vacation 1 block
Elective 3 ½
Med
Consult/SAR 1
Ambulatory 1
ICU 1 ½
Urgent care 2
Wards 3
Q: What is the Clinical Skills Block?
A: All categorical interns spend two weeks on the Clinical Skills block, which focuses on developing procedural competency, proficiency at resuscitation, and honing physician exam skills.
Q: What criteria are used to select
housestaff?
A: We look for applicants with a commitment to learning and professionalism, who value teamwork, and who have academic potential.
A: The current PGY1 salary is $41,850. (
Q: How many PGY1 positions are
available?
A: We have 26 Categorical positions, 4 Med-Peds, 8 Prelim, 2 IM-Genetics, 2 Research Pathway and 2 International Health.
Q: On the inpatient service, do you have
subspecialty teams?
A: We have a mixture of general medicine and subspecialty teams. At CVAH there are four general medicine teams, a Cardiology team and a MICU team. At UHCMC there are two general medicine teams, and five subspecialty teams (hematology/oncology, pulmonary, renal, cardiac and infectious diseases). There are also separate CICU and MICU teams.
Q: How many people are on a team?
A: Most of our teams are one resident and two interns- and for the first 4 blocks we put two residents on these teams to help with the additional supervision needed for new interns, acting interns, etc. Three of our subspecialty teams (renal, heme-onc, cardiology) are 2 resident, 4 intern teams.
Q: How many admissions can I get when I am
on call?
A: Interns are allowed to get five patients on call, including nightfloat admissions and ICU transfers. Interns are not allowed to follow more than 10 patients and will get fewer admissions if they are at their cap. Interns take overnight call but do not take new admissions after 11 pm. Several years ago our program had a reputation among housestaff applicants as being work-intensive for interns; we have made significant changes since then and our schedule and workload is comparable to other top academic programs regionally and nationally.
A: Our subspecialty wards do not have short call. Our General Medicine wards have one short call per four-day admitting cycle which is limited to nightfloats and ICU transfers. There is no short call on clinic days.
Q: What is the approach to work hour reform
at the Case IM residency?
A: We have tried to use a team approach that minimizes the amount of handoffs. In general, our ward residents do not take overnight call and are available to assist in getting interns out when they take overnight call and follow-up on patient care when the post call intern is gone.
Q: What changes have you made to support
duty hour reform?
A: We have limited the total number of
patients interns can care for and the number of admissions, and have
continually expanded the number of non-teaching services. We have changed the structure of several of
our teams, adding members and eliminating all Q3 overnight call. We have added nightfloats at both UHCMC
and CVAH.
Q: Is there a nightfloat system?
A: We have a nightfloat system at both UHCMC and CVAH. The nightfloat rotation if for PGY2s. They admit patients after 11 pm (or earlier if the interns cap) and supervise the on call interns overnight (allowing the ward residents to leave). Interns take overnight call on the wards but do not admit past 11 pm and do not do any nightfloat time.
A: Typically, on inpatient rotations housestaff get one Saturday, one Sunday and one “Golden Weekend” per 4-week block. Non-ward rotations have additional weekend days off.
Q: Do you have non-housestaff covered
services?
A: We have continually expanded our non-teaching services in order to decrease the housestaff work load and keep the focus on education on the housestaff team. At UHCMC we have non-teaching services in cardiology, oncology and general medicine, and we are starting a general medicine non –teaching service at the CVAH.
Q: Do you have hospitalist services?
A: At UHCMC our academic hospitalist attend on our general medicine teams, and we have non-teaching hospitalist services. This year we have established a non-teaching hospitalist service at CVAH.
A: At UHCMC we have about 1/3 tertiary or
quaternary referral patients; 1/3 come from an underserved urban population;
and 1/3 community based internal medicine. The patient population at CVAH is
both primary care and tertiary care, and comes from the greater
Q: How are the ancillary services at the
VA?
A: The ancillary services have improved
significantly over the years. There are
phlebotomy "rounds" 8 times daily to ensure that pt's can get their
lab
draws throughout the day, and IV therapists also available during the day to
place IV lines. After midnight, the IV therapist is also available to do
blood draws (blood cultures, etc.) Nurses in the ICU and telemetry floor do
all admission ECGs, and all nurses will do ECGs for acute clinical changes
in patients (i.e., chest pain).
Q: What is the conference curriculum?
A: We have a resident conference every day at noon with food at both UHCMC and CVAH. One noon each week we have a Morbidity and Mortality Conference (done separately at the VA). Once a week there is Grand Rounds, which is ‘live’ at UHCMC and is broadcast to the VA. Three days a week there are resident noon conferences, which include an annual curriculum and focuses on case-based, interactive teaching. In the beginning of the year some of the noon conferences are “Intern Boot Camp,” with the focus on knowledge and skills needed for beginning interns. There is morning report three mornings a week for residents and one morning a week for interns (with the residents carrying the interns’ pagers). All the subspecialty divisions have their own clinical conferences, grand rounds and research conferences. Residents are encouraged to attend when they are on those services or based upon their interest.
Q: Is there a required Ambulatory rotation?
A: There is a minimum of one block per year. During this rotation there is no overnight call inpatient responsibility. There is a conference every day at 8 am, subspecialty clinics in the morning and ambulatory electives in the afternoon. One morning a week is devoted to an Evidenced Based Medicine curriculum, and one afternoon a week to a Quality Improvement curriculum and project. Residents interested in primary care can do additional ambulatory blocks and can tailor their experience based upon their career goals.
Q: Are there required Neurology and
Geriatric services?
A: Yes, interns spend two weeks on Neurology consults and PGY2 residents have a two-week outpatient Geriatric experience.
Q: How does continuity clinic work?
A: All housestaff have a ½ day continuity clinic per week. Clinic is held on the same day each week to ensure continuity with the preceptor. Clinic is cancelled for post call interns. Housestaff have clinic at UHCMC and CVAH and have the option of choosing one of several community sites. The faculty to resident ratio is 1:3 or 1:4.
Q: Is there a research pathway?
A: Yes, we participate in the ABIM research pathway and support a year of research for residents who want to pursue this option. There are a large number of well-funded, research-intensive faculty in the Department of Medicine.
Q: Is there a “scholarly requirement”?
A: All Senior residents are required to give a scholarly seminar as part of noon conference. The majority or residents do research, many presenting at national meetings. Resident research is not a requirement, but the majority of our residents are involved in research projects.
Q: Are there research electives?
A: Residents can use some or all of their elective time throughout their training to pursue research projects. As above, we also participate in the ABIM research pathway.
Q: How do I find a research mentor?
A: There are a large number of faculty supported by NIH grants and other external funding who provide mentorship. Interns meet with the Chair of the Department early in the intern year to discuss career counseling, and meet with one of the programs directors twice a year. Interactions during these meetings, as well as less formal interactions with Chief Residents and peers provide guidance for selecting research mentors.
Q: Is there a mentoring program?
A: All housestaff are assigned to one of the four program directors to being the mentoring process, and then obtain mentors based upon career choice.
Q: Are international experiences available?
A: Case
A: Most residents live within a mile or two
of the hospital in Cleveland or one of the inner ring suburbs (
Q: Do you have residency retreats?
A: We have three major retreats- at the end of the year we meet off site with all the categorical interns to talk about the skill set needed to be a successful resident and teacher. We have an offsite retreat for the rising PGY3s, with the focus on system issues and the leadership role of a PGY3. Mid-year we have an evening retreat for current interns to discuss how the year is going and get their feedback on the training program.
Q: Are there housestaff social events?
A: Our residents organize housestaff social events on an ad hoc basis during the year with financial support from the residency. The Department of Medicine organizes a Holiday Party in December, and a graduation dinner in the spring. Families and friends are invited to the graduation dinner, which also features awards and a skit spoofing the hospitals and faculty (primarily the program directors…………).
A: Lunch is served at noon conferences. At UHCMC residents have swipe cards for on call meals, and at CVAH food is provided for on call residents.
Q: What do most of the residents do after
residency?
A: Lists of graduating residents are available on our web site (www.casemedicine.com). A large portion of our residents go on to subspecialty fellowships (and are successful in obtaining spots at competitive fellowships), but we support and encourage diverse career paths.
Q: What is the relationship between UHCMC,
CVAH,
A: UHCMC is the primary academic affiliate
of Case Western and is part of a large, regional health care system that along
with the Cleveland Clinic affiliated system account for about 80% of healthcare
in
Q: What are the unique aspects of the
Internal Medicine Residency at Case?
A: When asked this question, we usually cite our clinical and academic breadth and depth combined with a collegial, supportive atmosphere. When we ask our residents, they say housestaff camaraderie – in the setting of a large academic program. We are proud of our diverse and close-knit housestaff and collegiality among the housestaff and between the housestaff and faculty.
