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Internal Medicine Residency Program

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Program features

Educational Innovation Project

The Aurora Health Care Internal Medicine Residency Program is one of 21 elite programs in the country which was recently selected by the Accreditation Council for Graduate Medical Education to participate in the national Educational Innovation Project (EIP).

This project allows each program the freedom to develop innovative approaches to education of internal medicine residents with far more freedom than the current accreditation guidelines permit. The ultimate goal is to assess whether improved educational outcomes lead to improved patient care outcomes. Each participating program has been given a 10-year accreditation cycle and will report data at national meetings.

There are 4 major goals relating to the Aurora Health Care EIP program:

Goal 1: Apprenticeship experiences
Three new month-long rotations have been integrated into the PG-1 year:

• Each resident spends a month on an inpatient unit working directly under one of the faculty hospitalists on a 1-to-1-basis. Cardiac and pulmonary ausculating skills are taught and assessed as part of this experience.
• A 2nd month is spent in the ambulatory setting working directly with one of the fulltime general medicine faculty. The curriculum emphasizes blood pressure, lipid and diabetic management. Video review sessions using trigger tapes and actual encounters form the basis for teaching and assessing doctor-patient communication skills.
• The 3rd month is designed to develop resident appreciation of the key role nurses and social workers play in delivering quality patient care. The resident focuses on available resources both within the hospital and outside the hospital setting related to patient care and discharge planning. Residents get the chance to view area shelters as well as nursing home facilities. The hypothesis is that after these 3 apprenticeship months the interns' system-based learning and efficiency will be greatly enhanced.

Goal 2: The Resident Report Card
Each resident is provided with his/her own “clinical report card.” This allows the resident to assess both inpatient and outpatient data relating to clinical performance and patient care outcomes compared to national standards and institutional guidelines. This allows each resident to design individual interventions to improve their performance-based practice.

Goal 3: Competency-Based Learning
This is a long term project in which a specific curriculum for each of the required patient care venues is defined. These will include inpatient medicine, subspecialty medicine, critical care, emergency medicine and continuity ambulatory care. Each resident will require 24-30 months to complete this curriculum. A resident who has demonstrated competency in all of the above will then be able to proceed to the final phase of their training, the Individual Learning Plan.

Goal 4: Individual Learning Plan
A resident completing the core requirements will be allowed to tailor their remaining training to those experiences the resident feels would best benefit their own career needs and interests. Each resident will work with a faculty mentor during this phase.

Informatics

One of the unique aspects of the Internal Medicine Residency at Aurora Health Care is the emphasis on clinically relevant medical informatics.

The computer-based curriculum focuses on communication, information and clinical data. Residents and faculty are linked via Lotus Notes to help house staff and faculty communicate on a daily basis. Residents have free access to databases, literature searches and full text references on computers located throughout the patient care units, house staff lounge and clinics.

All transcriptions and lab data on inpatients and outpatients are accessible via the system-wide electronic record. Internal Medicine residents have access to the hospital mainframe and patients' clinical data via PC.

The Continuity Clinic

The primary care experience is central to internal medicine training. A resident begins their continuity clinic in the fall of the first year. Each clinic functions like a "mini" group practice, consisting of a teaching attending and 3-4 residents. Clinic teams stay together for 3 years.

Clinic sessions are preceded by a pre-clinic conference during which a variety of ambulatory topics are discussed and quality care projects pursued. Over 1/3 of the residents have chosen to have their ambulatory base outside of the hospital-based clinic in private office practices and clinics with specializing populations.

An important component of the primary care experience is the development of doctor/patient communication skills. Each resident participates in a retreat at the beginning of their residency to focus on this essential quality of patient care. This is followed by extensive use of video reviews throughout the training years for improving these acquired skills.

During the 2nd and 3rd year, residents may elect a 2nd clinic when not on-service. This may be either a 2nd primary care clinic or subspecialty clinic of choice.

Inpatient services

There are 4 inpatient general medicine services at Aurora Sinai and St. Luke's. On the Aurora Sinai campus, each team is led by a faculty member from either the hospitalist program or the general medicine division. These are smaller services with 1 senior resident, 1 junior resident and 1 University of Wisconsin medical student. All team members and faculty participate in Morning Report. Teaching rounds are predominately held at the bedside on the Aurora Sinai campus. Teams do not stay overnight when on call but rather leave at 10 p.m. Calls are taken from home by the 1st year resident with the backing of the senior resident, attending and in-house emergency coverage team.

On the St. Luke's campus, there are 4 general medicine teams each having a senior resident, 2 junior residents, and 1-2 medical students. Each team has their own generalist or subspecialist assigned as teaching attending. Call on this rotation is overnight and every 4th night.

Scholarly activity

All residents engage in scholarly activity during their residency. This may take the form of basic or clinical research, topic review, chart audits or clinical vignettes. All residents present their work at national, regional or local meetings.

Conferences

Conferences are held every noon from Monday through Friday on both the Aurora Sinai and St. Luke's campuses. Core topics are video-teleconferenced to residents at each campus.

Basic and clinical research

Basic and clinical research programs are promoted at Aurora Health Care as an important aspect of the hospital's commitment to provide an excellent academic environment for health care delivery and training.

By having access to clinical and basic researchers within the program, opportunities are available for house staff to pursue the study of selected patients in great depth. For those desiring an academic career, or simply wishing to experience the excitement and challenge of research, residency training can include elective research rotations.