Our specialty focus floor teams are organized either geographically or by hospitalist team to enhance teaching, patient care and communication. Although each floor has a subspecialty focus, admissions are typically from a variety of disciplines. House staff work in conjunction with a hospitalist, an intensivist, a specialist or the patient's primary care physician to provide compassionate, evidence-based care.
Our MAHA (Morristown Academic Hospitalist Associates) rotation is one of the most highly-rated experiences of the residency program. Two teams, consisting of one PGY-3 "junior attending" and two interns, work with faculty hospitalists to admit all unassigned patients to the hospital. A third, smaller team of one intern and one PGY-2 resident works with a departmental faculty hospitalist to admit a smaller number of unassigned patients as well. The patient population is both insured and uninsured, and the diversity of pathology is impressive, rivaling many inner-city programs. Teams round at the bedside with the attending daily, and residents are encouraged to develop independence in assessment and management skills. Medical students and pharmacy residents are frequently an integral part of these teams.
Night Float Team
To mimic how attending hospitalist physicians work, we have moved to a team concept for night coverage. A PGY-3 MAHA Resident On Call (MROC) admits patients to the MAHA teams and cross-covers MAHA inpatients. A PGY-2 Medical Admitting Resident (MAR) triages patients from the ED to the appropriate teaching or non-teaching team throughout the hospital. Two PGY-1 Night Float interns cross-cover teaching specialty focus floor patients and assist the MROC with noctural admissions. A "nocturnist" (nocturnal hospitalist) is present for resident support and supervision.
Day Float and Bioskills
The Dayfloat/Bioskills rotation is a two-week rotation in the first year to help Internal Medicine residents develop an understanding of interpretive and procedural skills, which are essential for clinical practice. Additionally, residents will learn principles for effective handoffs in settings where multiple providers are involved and put these principles into practice.
On weekdays, residents will have the opportunity to strengthen their base by working with orthopedic specialists, anesthesiologists and breast specialists, and also by independent study through online resources. They will learn medical procedures such as arthrocentesis and joint injection, interpretation of chest radiography, and effective physician-to-physician communication skills. On weekends, residents will “float” to care for patients on the faculty hospitalist service and practice implementing the procedural skills they have learned.
In our critical care rotation, residents work 12-hour shifts in both the 10-bed medical intensive care unit (MICU) and the 10-bed cardiac care unit (CCU).
The MICU offers interdisciplinary collaboration on many levels. Residents round with a full-time intensivist and work in conjunction with respiratory therapists, pharmacists, and highly-trained nurses. Patients are regularly transferred to Morristown Medical Center by helicopter for tertiary care. The CCU offers similar educational experiences in a cardiac setting, with additional rounds with cardiology fellows to enhance the academic experience. Residents in both units become comfortable doing procedures, presiding at codes, and providing excellent critical care to a variety of very ill patients.
Ambulatory Care Rotation (also known as Organization and Business of Ambulatory Medicine in America)
This rotation was developed to provide residents with skills that will be essential for outpatient general internal medicine practice. Residents will spend clinical sessions at our new outpatient practice center (IMFA-Internal Medicine Faculty Associates), seeing patients with acute and chronic issues, managing test results, and communicating with patients and other health care providers, all under the supervision of attending physicians. Residents will participate in other specialty clinics to provide them with clinical skills to manage specific types of ambulatory patients in fields such as HIV, diabetes, rheumatology, women’s health/gynecology, dermatology, physiatry and cardiology.
Residents will also acquire medical knowledge and skills through online teaching modules. First-year residents will learn about effective management of the opioid-dependent patient, appropriate titration of oral anticoagulants, and commonly seen ophthalmologic and dermatologic conditions.
Senior residents will also develop an appreciation for the organizational and business aspects of outpatient medical practice. They will improve their understanding of how health care is paid for in the United States, be able to describe how to measure and improve patient satisfaction, experience the complexities of coding and billing, and develop an understanding of basic elements of the current health care reform process in the United States. Other modules from a variety of sources are completed during this rotation.
Medical Admitting Resident
Our Medical Admitting Resident (MAR) is a PGY-3 resident who works from 6:00am to 3:00pm Monday through Friday as a triage resident. The MAR evaluates patients in the emergency department and on the floors to assist in determining their placement on a "teaching" or "non-teaching" service, as well as confirming or determining the appropriate level of care. This rotation can also provide an opportunity for senior residents to serve as a general medical consultant for patients on non-medical services such as surgery, gynecology and psychiatry when the consult residents are not in the hospital.
Geriatrics-Palliative Care Block
Our geriatrics-palliative care rotation provides PGY-2 residents with many opportunities to optimize assessment and management skills for this special population. Residents rotate through various sites outside of the hospital that are relevant to the care of the elderly and terminally ill, including assisted living facilities and nursing homes. They will also participate on the palliative care consultation service and learn skills used in end-of-life care, including effective communication with patients and families, and pain and symptom management. Once a week, residents will have a small group case discussion and lecture by our faculty experts in geriatric medicine.
Transitions of Care
Each intern spends two weeks on our new transitions of care rotation. This rotation was designed to optimize residents’ patient education across the variety of health care settings such as inpatient hospital stays, acute rehabilitation facilities, assisted living environments, or home. Residents spend time with visiting nurse services, visit skilled nursing facilities, and practice discharging a complicated patient, as well as following a recently discharged patient in the outpatient environment. Residents access didactic modules and assignments are on our learning portal and are available 24 hours a day, seven days a week. It continues to receive high praise from those who have completed this experience.
PGY-1 and PGY-2 residents directly experience consultative medicine during their training. PGY-1 trainees rotate for two weeks on an intense Diabetes Service, learning how to optimize the management of admitted patients with the diagnosis of diabetes mellitus. PGY-2 trainees have a divided consultative experience; they do two weeks of general Internal Medicine consultative medicine followed by two weeks of consultative psychiatry.
Emergency Medicine (EM)
PGY-3 residents have a four-week rotation in the emergency department, where they optimize the skills needed to go into private practice. This rotation is supervised by full-time EM attendings, and residents are exposed to patients experiencing a spectrum of problems, ranging from simple to life-threatening.
Elective rotations are available in all subspecialty areas and are selected by personal preference and learning needs. Residents may also seek "away electives" with prior approval from the program director. For example, some residents decide to participate in away electives as an "audition" for a program to which they wish to apply for fellowship, while others seek experiences not available locally (tropical medicine, for example). Categorical residents are required to take electives in nephrology and hematology and oncology at some point during their training. During electives, residents work additional half-day clinic sessions.
Throughout their residency, categorical residents maintain a half-day per week office practice assignment at our new outpatient practice, IMFA, where they have the opportunity to build their own panel of patients. Residents are exposed to various pathologies ranging from urgent care center-like problems, to other health ailments across the spectrum of chronic disease management. A wide variety of ancillary services are available, including on-site social workers, nurses and medical assistants. We use an electronic medical record to facilitate management of care across out and inpatient spectra. The emphasis is on chronic disease management, and our diabetes, HIV and rheumatology programs are key in that regard.
Medical Student Rotations
Students at medical schools in the United States are welcome to schedule a visiting elective. Please call our Graduate Medical Education office at 973-971-5316 for more information. Students interested in our program frequently choose electives in one of our subspecialties or even complete a sub-internship with us.
Unfortunately, given the numbers of students on rotation in our hospital, we are unable to offer observerships.