Internal Medicine Residency

Subspecialty electives are available in all the major medical subspecialties in the inpatient and outpatient settings.  Residents can design their individual course of study by choosing electives to support their chosen career goal.  Residents may take electives in either two weeks or four weeks blocks. In addition to our traditional medical subspecialty electives, residents may rotate in additional electives including:

• Offsite “away” electives: residents may take advantage of rotating at an outside hospital as an audition rotation for fellowship placement or to gain experience in a different setting.
• Research electives: residents may obtain program director approval to use elective time as protected time to complete research projects under the guidance of a research mentor.
• ICU procedures electives: during this elective, residents work under the supervision of our intensivists to become competent at common ICU procedures, including the use of ultrasound.
• Other non-medical specialties including neurology, dermatology, anesthesiology, radiology and psychiatry.

This POCUS curriculum prepares our Overlook Medical Center internal medicine residents to utilize ultrasound to improve diagnostic accuracy, reduce time to diagnosis, improve patient safety, decrease complication rates, and reduce the overall cost of care.

Throughout the residency, POCUS-certified instructors will teach our residents how to utilize POCUS for both diagnostic and procedural purposes. The experience helps develop the necessary fundamental skills to obtain certification after graduation and safely utilize POCUS in their daily practice.

Specifically, in the PGY1 year, residents will receive didactic and hands-on training in procedural POCUS. In the PGY2 and PGY3 years, residents will complete a structured training and evaluation program with opportunities for teaching junior residents.

Ambulatory Medicine is a vital part of the Overlook Medical Center Internal Medicine Residency program. The ambulatory experience provides training for residents in preventive medicine, chronic disease management, urgent ambulatory medicine, telemedicine and post hospitalization follow-up.

What to expect from ambulatory medicine training

Our residents receive their ambulatory medicine training at the Atlantic Medical Group Internal Medicine Residency Practice at Union, which is located about seven miles from Overlook Medical Center. In our X+Y schedule, residents are immersed in ambulatory practice early in residency. Improved continuity allows for longitudinal relationships to form between residents, patients and their ambulatory preceptors.

Ambulatory block rotation highlights

• Practical experience
• Interdisciplinary team approach to patient care with onsite social workers, nurses, medical assistants, nutritionists and a clinical pharmacist
• Ambulatory call learning for PGY2/3 residents 
• Firm practice model, allowing residents on the ambulatory block rotation to provide care for patients whose resident physician is not on the ambulatory block and simulating future medical practices
• EPIC electronic medical record to facilitate the transfer of information across both inpatient and outpatient setting
• Onsite radiology suite and laboratory services
• Ambulatory site participation in the Overlook Diabetes Health Partnership program to personalize health care plans for patients with diabetes, focusing on education and access to care
• Supportive learning opportunities
• On-site faculty preceptors with a ratio of residents to faculty 3:1 or lower
• Dedicated sessions at the Overlook Medical Center preoperative services to learn about medical optimization of the surgical patient
• Online Johns Hopkins Medicine ambulatory curriculum and Yale Office-Based Medicine Curriculum support
• Integrated quality improvement education and projects
• Balanced schedule
• Residents build their continuity panel as there is no inpatient weekday on-call or coverage for other services
• Residents attend four to five continuity sessions in the office as well as other ambulatory care experiences such as specialty sessions for nephrology, cardiology, pulmonary, sports medicine, rheumatology and hematology/oncology
• Half day per week wellness session protects time for self-care

As part of the Internal Medicine Residency, we offer a variety of inpatient rotations — all at Overlook Medical Center. 

Inpatient rotations for internal medicine residents

Our rotations do not require overnight call coverage and employ a night float system.

 Team A (general medical cases)

This team cares for a wide range of general medical cases, including the patients in our intermediate care unit (IMCU). This unit provides a level of care between a general medical floor and an intensive care unit.

• Residents: A senior (PGY2/3) resident and two PGY1 residents
• Supervisor: A hospitalist from the Atlantic Medical Group
• Number of patients: An average census of 16 patients, so the PGY1 resident has no more than eight patients due to the high level of complexity of the medical cases

Team C and Team D (neurological disorders)

Residents on both teams provide care for patients with neurological disorders, including patients in our Level IV Epilepsy Center and the advanced Comprehensive Stroke Center. Residents also gain exposure to perioperative medicine and care for patients on our hip fracture service. Patients on this service have a wide array of inpatient medical diagnoses and are representative of our diverse population, which includes patients from our residency outpatient practice.

• Residents: A senior (PGY2/3) resident and two PGY1 residents per team
• Supervisor: Full-time medicine faculty
• Number of patients: An average census of 16 patients, so each intern cares for a maximum of eight patients

Consult service

The consult resident completes pre-operative evaluations and learns about perioperative management with a special focus on co-management with orthopedic surgery. Our consult service resident is also a member of the Rapid Response Team (RRT). They respond to all RRT calls for hospitalized patients with early signs of deterioration on non-intensive care units. They are also a part of our stroke medical team and receive specialized training in stroke care including the use of the telestroke robot.

• Residents: One senior (PGY 2/3) resident
• Supervisor: One of our full-time medicine faculty
• Number of patients: An average census of 10 patients

Medical Intensive Care Unit (MICU)

The MICU team treats a full range of cardiac, pulmonary, renal, endocrine and infectious as well as toxic or metabolic cases. Residents become proficient in many procedures including central venous and arterial line placement, thoracentesis and ventilator management.

• Residents: Three senior (PGY2/3) residents and three PGY1 residents
• Supervisor: Attending physicians who are board certified in pulmonary-critical care or cardiology
• Number of patients: An average census of 20 patients from both the MICU and the cardiac care unit (CCU)

Medical admitting rotation

This rotation gives our residents the opportunity to triage, evaluate and admit the sickest and most complex cases. Residents are the primary liaison for the Department of Medicine on all patients admitted from the Emergency Department to the Medical Intensive Care Unit (MICU) or transfers from other services to the MICU. All potential admissions to the MICU are evaluated and discussed collaboratively with both the Emergency Department attending and the ICU attending to determine the appropriate level of care and management.

• Residents: PGY2/3 residents who work six days per week
• Supervisor: Board-certified intensivists
• Number of patients: Varies

Night medicine (night float)

The night float team provides cross coverage for patients admitted to our service, receiving sign out from the day teams at 8:30pm and covering until 7:00am. During this rotation, residents improve triage, clinical reasoning and management skills.

• Residents: One PGY2 and one PGY1 resident
• Supervisor: Medicine faculty
• Number of patients: Varies

As part of the Internal Medicine Residency at Overlook Medical Center, we deliver our educational curriculum in a variety of modalities, including daily lectures, bedside attending rounds, chair rounds and critical care rounds. Lecture presentations happen in person as well as via a virtual platform to all our residents and rotating students. 

Learn what to expect from our educational conferences.

Academic half-day conference

The academic half day takes place on Thursdays from 1:00pm to 4:00pm. It’s designed to be protected academic time for didactic and case-based educational sessions. Hospitalists and medicine faculty cover the inpatient teams’ admissions, consults and nursing pages. Topics include general internal medicine, the medical subspecialties and interdisciplinary topics.

Attending rounds

Attending rounds occur each day on all inpatient services. We see most patients at bedside with review of the history, physical and management plans. Hospital pharmacists are an integral part of the team and provide support in selecting the most appropriate drug therapy and dose monitoring. Of note, our daily rounds in the Intermediate Care Unit (IMCU) involve an interdisciplinary approach with nursing, intensivists, hospitalists and pharmacists present.

Afternoon conference

• We hold an afternoon conference twice per week at 1:00pm. Monday afternoons are reserved for our chair of medicine rounds where a resident presents a case to our department chair. We emphasize pathophysiology, prevention of diagnostic error and management. 
• Tuesday afternoons are reserved for our Journal Club with a focus on critical appraisal of the medical literature and practical applications to patient care. 
• Once a month, the program director or associate program director hosts a “Feedback Friday” session to hear from the residents and to give programmatic and institutional updates.

Morning report and critical care advantage (CCA)

These sessions occur on alternate Wednesday mornings at 7:30am. During morning report, residents and general medicine faculty meet to discuss an overnight or recent admission to the inpatient service. Our night float team presents the case, and the discussion includes generating differential diagnoses, improving clinical reasoning, evaluation and management, and making cost-effective decisions.

The CCA lecture series focuses on critical care topics. A senior resident leads the session, with active participation from our intensivists and pharmacy staff. Interns and residents participate in active skill-building exercises to augment their ability to recognize and manage critically ill patients.

Board Review

Core faculty and subspecialty attendings lead board review sessions throughout the year. The instruction provided is focused, relevant and includes test taking strategies and tips. We use a variety of question banks including Medical Knowledge Self-Assessment Program (MKSAP) and the American College of Physicians (ACP) board review resources.

All residents are encouraged to participate in scholarly activity during their time at the Overlook Medical Center Residency Program. The program provides the support for scholarly work as defined by the ACGME in the following manner:

• All residents acquire skills in the critical appraisal of medical literature through their participation in Journal Club
• All residents receive training in Quality Improvement and Patient Safety with the support of Institute for Health Care Improvement (IHI) Open School modules
• All residents complete a QI project which is presented at Grand Rounds at the end of the academic year with the expectation that an abstract of the project be submitted for publication
• All residents present a Patient Safety Event Review at Grand Rounds with emphasis on completing a root cause analysis, lessons learned and a plan to improve
• All residents have access to Atlantic Health System online resources for didactic topics on the principle of research design, statistics, IRB approval process, etc
• Research curriculum with workshop focusing on the publication of manuscripts and case reports
• Updated dashboard of ongoing clinical projects to assist residents in choosing a research mentor and project
• Financial support for travel, lodging for residents to present scholarly work at regional and national meetings.

Residents frequently present their work at local, regional and national meetings. Our very own Atlantic Health Research Symposium is a popular venue for our residents to showcase their work.  This annual event features poster and oral presentation submissions from all departments and professions within Atlantic Health System. The most highly rated abstract submissions are selected for oral presentation or a poster-judged competition.