Rochester General Hospital has been providing training to Internal Medicine Residents for over 50 years. We strive to balance rigorous inpatient and ambulatory training with expectations of independent thought and a sense of ownership in patient care. Our training program benefits from a large full-time faculty, many of whom hold faculty appointments at the University of Rochester, and its primary care physicians, many of whom trained at Rochester General when it offered a primary care residency. Medical students from the University of Rochester come to Rochester General for their 3rd year medicine clerkships, their subinternships and subspecialty electives, and their presence enhances the hospital’s academic atmosphere.
Rochester General Hospital, a 528 bed community hospital with one of the busiest emergency departments in New York State, provides primary care to its local neighborhoods and tertiary care to surrounding communities. The hospital has been named one of the top 100 best cardiac centers in the country eight times. It has affiliations in oncology with Roswell Park, one of the nation’s major cancer centers, in cardiac care with the Cleveland Clinic, and with the Rochester Institute of Technology.
Ambulatory Education & “Majors”
As we were once a primary care program, we have a long history of educating residents in ambulatory settings. Our curriculum is organized in a ‘4+1’ block structure: 4 weeks of Core residency rotations (electives, inpatient general medicine, ICU, etc.), are followed by a 1 week Ambulatory block, and the sequence repeats throughout the year. During the 4-week portion of the schedule (i.e. when on floors/ elective/ ICU rotations) there are no ambulatory sessions. Similarly, during the 1-week ambulatory block there are no inpatient responsibilities. Separation of inpatient and outpatient rotations frees residents to concentrate on the task at hand without distraction from competing responsibilities.
Every fifth week throughout the three years of residency is devoted to ambulatory education. During that week, residents see patients in their own hospital-based practice, participate in the care of private patients of community-based primary care physicians, and ambulatory patients in a subspecialty practice of their choosing (an innovation, we call “majors”) . The majors are in six-month blocks, and though intended to enrich any resident’s ambulatory experience, it is especially helpful for those residents considering a fellowship. We like to believe that involvement in a major will convey a distinct advantage in helping a resident clarify a focus of interest if a fellowship is to be pursued, and it also provides an opportunity for mentoring by a faculty member in the resident’s chosen specialty . Residents interested in a primary care career may choose a major in a primary care practice, increasing their already rich exposure to primary care medicine. Career decisions are made after more exposure, and letters of recommendation are based on more than just a short month elective. Thus far the "majors" option has been enormously popular.
As the hospital does not sponsor fellowship programs, inpatient education at Rochester General Hospital offers residents an unusual degree of direct access to highly experienced and well-published faculty, and an opportunity for progressive clinical growth and autonomy as the residency progresses. Their confidence in managing complex and critical illness is immediately recognized when our residents take “away electives” at University Hospitals, and their success in these rotations has helped graduates who seek fellowship training to thrive at academic centers. Two of our recent graduates are now on the faculty of Harvard’s Massachussetts General Hospital
Housestaff do all of their rotations in hospital medicine, including intensive care, at Rochester General Hospital. Hospital-based teams are made up of one upper level house officer (R2 or R3), and one R1. Your team is often joined by one or two medical students from the University of Rochester or other medical schools. Long call is approximately once every 5 days when you stay until 8 pm to sign out to the night float. Weekend call is once/twice every month on floors "Night float" teams admit patients and provide cross-coverage, so there is no overnight in-house call for inpatient teams. Housestaff on all inpatient teams leave after they have completed their clinical and educational responsibilities for the day. The average work week is 65-70 hours
Rochester General Hospital has full-time faculty in all of the medical subspecialties. All senior residents are required to complete an rotation on the inpatient Cardiology consultation service. Other subspecialty rotations are elective, and can be taken in all three years of the residency. Many rotations, such as Allergy/Immunology/Rheumatology, Outpatient Cardiology and Endocrinology are almost exclusively office-based. Other rotations, such as Hematology/Oncology, Gastroenterology, and Pulmonary offer choices of office-based or combined office-based/inpatient experiences. Electives are also available in, community-based HIV care, home-based geriatric care, and evidence-based medicine.
In addition to Rochester-based electives, every house officer is eligible for at least one four-week "off-site" elective during the R2 or R3 year. You will continue to receive salary, benefits, and malpractice coverage during approved off-site electives.
Our educational style is based on adult learning theory and philosophy. In the adult learning tradition, the learner takes an active role in learning. This means that our residents get to make a lot of decisions . It also means that we expect them to be active learners. Upper level housestaff (R2s and R3s) share teaching responsibility with faculty in many conferences, including senior report, attending rounds, and professor’s rounds. We expect housestaff to prepare cases, critically review relevant literature, and take an active teaching role in these conferences. This participatory style has been shown to improve learning and retention, and to prepare learners for lifelong learning. We strongly believe in it. The sessions are usually case-based, interactive, and provide an intellectually rigorous and clinically useful approach to patient care.
Boot Camp and Simulations - PGY1s are introduced to Internal Medicine during their first six weeks of residency with an innovative curriculum that we call “boot camp”. The first-year resident class is divided into three groups, each rotating for two weeks on either general medicine floors, the resident outpatient practice or the intensive care unit. During boot camp,, residents receive instruction on the electronic medical record, system-based practice in the three clinical areas, and didactic sessions on basic skills. In addition, residents participate in inter-disciplinary simulations at a state-of-the-art simulation center, at the nearby nursing school of St John Fisher College. In these video-taped sessions, residents learn to work collaboratively with nurses, pharmacists, and respiratory therapists who participate in the simulations, and they master clinical skills that will serve them well during the remainder of their residency. Interdisciplinary seminars after each of these simulations, address issues of teamwork and cultural competency as well as clinical knowledge. Monthly simulation sessions continue throughout the residency, emphasizing resuscitation and teamwork skills.
Intern Report - All PGY1's on floor teams and a Chief Resident meet for forty-five minutes four to five times weekly to discuss a case. Residents develop their skills in case presentation and clinical reasoning and they are introduced to some of the concepts of Evidence-Based Medicine that are developed more rigorously, later in residency in Senior Resident Report.
Senior Resident Report and Evidence Based Medicine - Four to five times weekly, for one hour, all PGY2's and PGY3's on inpatient floor teams meet with a Chief Resident and faculty member to present a case-generated question to the group. While addressing issues of diagnosis, prognosis and therapy during Senior Report, residents learn to formulate concise, focused searchable clinical questions related to the presented case. They then search the existing literature for the best available evidence, critically appraise the evidence they find, and apply their appraisal to the patient question and to their clinical practice. Senior report serves as a seminar in Evidence-based medicine, and residents use this time to review classic articles on the subject in the “Users Guides to the Medical Literature” series, published in JAMA. For residents interested in pursing the more advance aspects of EBM, an elective is offered in which participants develop the course content based on interest and educational need. In recent years, residents have improved their appraisal skills in the areas of decision analysis, practice guidelines, economic analysis, and disease probability.
Ambulatory Report – During each ambulatory week, residents meet with the ambulatory chief resident to present a problem case. The format is similar in format to that of Senior Resident Report and Intern Report, except that the focus is on clinical problems faced in ambulatory practice.
Attending Rounds – Residents meet with their attending daily during their general medicine floor rotations. In addition to discussions of evidence-based management decisions, these rounds emphasize history and physical examination skills.
MICU Sign-Off Teaching Rounds – During ICU rotations, residents on the departing overnight team and residents arriving for the day shift meet with their critical care attending physician for a two hour teaching session, with discussions ranging from individual patient management decisions, transitions of care skills, bedside teaching, clinical guidelines, and discussions of pathophysiology.
Professor's Rounds - Every Friday afternoon at noon conference, a PGY1 and senior resident present a case to a senior faculty member who leads a highly interactive session in which all housestaff ask hypothesis-driven questions and contribute to the differential diagnosis. The session is concluded with a 15 to 20 minute presentation by the senior residentwho serves as the “world’s expert” on the patient’s condition. .
Noon Conferences - Residents on inpatient floor teams, ambulatory rotations and electives attend the Noon Conference Series, which is held five days of the week. Typically headed by a specialist in the field being covered, these case-based, interactive sessions encompass the major subspecialties of internal medicine, including primary care and hospital medicine.
Grand Rounds - Every Thursday morning from 8:30-9:30AM the Department of Medicine holds Grand Rounds. These sessions, which are attended by residents, students, and attending physicians, are presented in a variety of formats, including topic reviews, and case-based conferences, and they are an opportunity to hear from an outstanding array of visiting professors.