GME Internal Medicine Curriculum

• Inpatient Wards: A traditional academic rounding team composed of a senior resident (PGY-2 or 3) and an Intern (PGY-1). We welcome medical students on the team and have students rounding with us most blocks. This rotation provides training in hospital medicine from our board-certified academic hospitalist staff. Residents will be tasked with conducting comprehensive patient care, from admission to discharge. This includes placing orders, developing treatment plans, updating families, and working on disposition planning.
  

• Medical-ICU: A fast-paced environment in which residents are tasked with assessing and caring for critically ill patients alongside Critical Care fellows and attendings. As a tertiary referral center for a large hospital network, our CCM rotation provides exposure to complex cases sure to stimulate intellectual discussion and growth. Residents conduct complex care discussions with patients, families, and consultants daily.

• Cardiovascular ICU: Our residents work on a team composed of a Senior Resident (PGY-2 or 3), an Intern (PGY-1), a Critical Care Fellow and Critical Care attending during this rotation. Cases include STEMI, pre- and post-operative CABG patients, TAVR, vascular patients, and many more. During this rotation, the team is led by a Critical Care Attending, with interdisciplinary care from consulting cardiothoracic surgery, vascular surgery, and cardiology services. Residents will also be exposed to the care of patients undergoing both VV and VA Extracorporeal Membrane Oxygenation (ECMO). Similar expectations for family communication and patient care are upheld as with our Medical-ICU rotation.

• Emergency Medicine: Each intern will have one block of emergency medicine incorporated into their schedule. They work with board certified emergency medicine physicians to assess, stabilize, and triage patients as they present to the emergency department. As a Level 1 trauma, burn, STEMI, and stroke center, this rotation ensures quality training in the management of conditions along the entire spectrum of acuity.
   

Additional notes:

• Residents work an in-house hospital “long shift” until 6 p.m. approximately Q4 days on their Inpatient Ward blocks. Senior residents are immediately available to supervise interns.
• There are two 2-week blocks of night float annually.
• No more than 80 hours per week is spent on patient care duties.
• Residents have at least one full day out of seven free of patient care and responsibilities.

One week per outpatient blocks (1 week every 8 weeks), residents care for their panel of patients in JFK clinic. Each resident is responsible for managing their patients’ health care issues including preventive care, chronic disease management and acute illnesses under the guidance of dedicated clinic teaching Faculty. The clinic incorporates opportunities to work closely with clinical nursing staff, social work, dieticians, and a clinical pharmacist all while having the opportunity to get 1:1 teaching from attending physicians. Tuesday mornings are dedicated to our Academic Half Day curriculum while Wednesday and Thursday afternoons are used for didactic sessions, POCUS and administrative tasks.

Every other month, on their outpatient block, residents will rotate through JFK ambulatory clinic, a variety of subspecialty clinics or through a variety of consult or surgical services. See below for ambulatory clinic details and examples of elective rotations.

• Subspecialty clinics: Endocrinology, Rheumatology, Musculoskeletal, Gastroenterology, Hepatology, Neurology, Ophthalmology, Wound Care.

• Special Care Services: Podiatry, Hospice, Palliative Care, Point of Care Ultrasound (POCUS), Procedural (combined Hospitalist and Interventional Radiology).

• OBGYN-clinic: Interns spend 2 weeks of GYN clinic in which procedures such as pap-smears and pelvic exams will be performed in addition to learning to care for common Gynecologic conditions and assure appropriate preventative care is provided.

• Mercy Virtual: As one of the first virtual care centers in the country, Mercy offers residents an opportunity to train in a state-of-the art virtual care center a short distance from Mercy Hospital’s main campus. This rotation exposes residents to cutting edge virtual care technology and provides training in the delivery of patient care in the virtual space. Responsibilities include admitting patients from the emergency department, providing cross cover to admitted patients, participation in virtual monitoring programs such as v-Glucose, v-Sepsis, and v-Stroke. (See Mercy Virtual section for further details). This is a 4-week elective rotation conducted within the PGY-2, or 3 years.

• Consult Services: Pulmonology, Cardiology, Gastroenterology, Neurology (Stroke-call), Infectious Disease, Urology. 

• Daily: formal didactic noon conferences.
• Twice a week: inpatient case conferences
• Weekly: Medical grand rounds
• Academic Half Days: imbedded in JFK clinic weeks and covers topics including communication seminars, substance use disorder management, POCUS training, study skills, billing and coding and much more!
• Residents as teachers: weekly during ambulatory blocks with a focus on preparing residents to be effective teachers, communicators and team leaders.

View Internal Medicine sample schedules.

Point-of-care ultrasound (POCUS) use complements the traditional history and physical examination to improve diagnostic accuracy and patient satisfaction. Because we believe that POCUS will become an essential skillset for Internal Medicine physicians in the near future, our Residency has fully integrated POCUS into the curriculum. Core POCUS education is offered throughout the year (activities listed below) and Residents are encouraged to become POCUS certified.

• All PGY-1 Residents receive a focused cardiac and pulmonary ultrasound workshop (bootcamp) during the first month of residency
• Every Resident receives an ultrasound account to build their educational image portfolio
• A variety of POCUS topics are offered during the POCUS half day in the form of a mini workshop with a 1:3 faculty to resident ratio. Sample topics include
  • Simulated scanning sessions with Simbionix Ultrasound Mentor
  • Didactic series in cardiac, pulmonary, abdominal, DVT POCUS
  • Dedicated simulation sessions with standardized patient scanning
  • Scanning for Deep vein thrombosis 
  • Interactive POCUS image review
  • Ultrasound guided procedures
• Scheduled noon conference covering POCUS topics and cases
• Recurring ultrasound "Gel" rounds for inpatient teams with a POCUS Faculty providing real-time bedside mentorship
• All Resident POCUS images are reviewed by Faculty and feedback is given for each study
• Personalized mentorship with 1:1 bedside scanning 
• Interesting cases and teaching topics are posted and discussed within the Residency social media website
• Participation in POCUS related QI and research projects
• PGY-2 and PGY-3 residents working towards POCUS competency and certification have an option to rotate through a POCUS Elective or Procedure Elective to refine their POCUS knowledge, teaching, scanning and procedural skills

Mercy’s Internal Medicine Residency Program has a rich history of training excellent physicians who go on to have great careers in Primary Care, serving diverse communities in the St. Louis area and beyond. As we continue to look for ways to help our residents develop the skills necessary to transition seamlessly from residency to practice, we will offer a two-year Primary Care Track curriculum tailored to preparing residents pursuing a career in ambulatory medicine. First year residents interested in pursuing the Primary Care Track should reach out to the Program Coordinator and Program Director prior to submitting schedule requests for their second year.

Curriculum Highlights

Residents will have additional time in the primary care setting in place of one of their regularly scheduled inpatient rotations during both their PGY-2 and PGY-3 years. If a resident is planning on staying on with Mercy Primary Care, every effort will be made to arrange a rotation for that resident in the practice location they will be joining to allow added opportunity for them to become accustomed with their future partners and clinic staff while deepening their knowledge of chronic disease management.

Ambulatory Psychiatry

Residents in the Primary Care Track will have a longitudinal experience built within their continuity weeks where they will have the opportunity to evaluate and manage patients with a variety of psychiatric diseases.

Virtual Substance Use Disorder Clinic

Residents will spend half days at Mercy’s state of the art Virtual Care Center where they will gain experience in evaluating patients with Substance Use Disorders and, under guidance of an Addiction Medicine specialist, assess and adjust treatment plans.

Transition to Practice

Created to be a longitudinal learning experience in the PGY-3 year, residents will have additional exposure to  topics like working with APPs, ambulatory billing and coding, understanding individual quality metrics and how to use them to improve clinical practice, and many more!

Additional Electives and Rotations:

• Outpatient Cardiology
• Weight Management
• Musculoskeletal Diseases and Ambulatory Procedures
• Community-Based Health
• Clinical Dermatology