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TRAINING TRACKS | ROTATIONS | DIDACTICS & SCHEDULES | RESEARCH & SERVICE
In each of the training tracks, educational development follows a similar course. However, differences do exist between tracks. Distinguishing features of each track, plus more program highlights, are outlined below:
Internship is an exciting time in which you begin to apply things learned in medical school while simultaneously developing entirely new sets of skills. In the outpatient continuity clinic and on the wards, the intern is the patient's primary physician. This affords an opportunity for you to learn medicine in a hands-on manner through work done in a variety of settings. As the patient's primary physician, the intern has the most in-depth knowledge of the patient and is most closely involved in delivering the high quality of care for which UVa is known.
Categorical Track PGY-1 Rotations
- 9 Inpatient: Medical Intensive Care Unit, Coronary Care Unit, Acute Cardiology, Neurology, 3 months Digestive Health and Hematology-Oncology, and 2 months General Medicine wards
- 3 Non-Ward: Emergency Department, Geriatrics, and an outpatient month at Student Health Internal Medicine or Gynecology Clinic, or the Primary Care Gynecology clinic
Primary Care Track PGY-1 Rotations
- 8 Inpatient: Medical Intensive Care Unit, Coronary Care Unit, Acute Cardiology, Digestive Health, Hematology-Oncology, Neurology, and two months General Medicine wards
- 4 Outpatient/Ambulatory: Rotations are typically spent at a UVa General Medicine community practice clinic, the Emergency Department, Geriatrics, and an additional month at Student Health Internal Medicine or Gynecology clinic, or the Primary Care Gynecology clinic.
Preliminary Track PGY-1 Rotations
- 9 Inpatient: 1-2 months in Medical ICU or Coronary Care Unit, 2-3 months General Medicine wards, 1-2 months Hematology-Oncology or Digestive Health, 1 month Neurology
- 3 Non-Ward: Emergency Department, General Medicine consults, and an outpatient month in an ambulatory internal medicine setting
Clinical Investigator Track PGY-1 Rotations
- 9 Inpatient: Medical Intensive Care Unit, Coronary Care Unit, Acute Cardiology, Digestive Health, Hematology-Oncology, Neurology, and 2-3 months General Medicine wards
- 3 Non-Ward: 1 month Emergency Department, 2 months in an ambulatory setting
Upper level residents are expected to function as leaders of the care team. Second-years see all admissions to the team, participate significantly in inpatient clinical teaching for the interns and medical students, and serve as an advocate for patients' longitudinal care, helping the team to coordinate care with outpatient providers. Residents frequently assume primary care responsibility for patients who lack an identified community physician, thereby optimizing the continuity of care experience.
On inpatient and ambulatory subspecialty services, you receive training from fellows and subspecialty attendings who serve as primary attendings rather than consultants as in most hospital systems. These interactions, and experiences gained through your own teaching role, aide you in clarifying direction for your future career. If fellowship training is your goal, applications will be almost entirely through ERAS. The subspecialty application process begins in earnest in the fall of the second year with regard to obtaining letters of recommendation, etc.
Categorical Track PGY-2 Rotations
- 6 Inpatient: generally 2 months General Medicine, 1 month Medical Intensive Care, and three other ward months (Digestive Health, Acute Cardiology, Hematology-Oncology, and/or Coronary Care Unit)
- 6 Elective: generally a mixture of inpatient consult and subspecialty clinics. A one-month community primary care rotation at one of our UVa affiliated clinics (Charlottesville or rural areas) is required. It is also possible to do community practice, rural health, Navajo, international health, and research rotations.
Primary Care Track PGY-2 Rotations
- 5 Inpatient: combination of General Medicine, Digestive Health, Acute Cardiology, Medical Intensive Care, Hematology-Oncology, and Coronary Care Unit
- 7 Outpatient/Elective:
- 2 consecutive months at Orange Primary Care clinic about 30 minutes north of Charlottesville. This very popular rotation offers great exposure to acute care in a semi-rural primary care practice and lots of opportunity for bedside procedures.
- 5 months Electives generally divided between inpatient consult services and outpatient specialty clinics. It is also possible to do community practice, rural health, Navajo, international health, and research rotations.
Clinical Investigator Track PGY-2 Rotations
- 7-8 Inpatient
- 4-5 Outpatient/Ambulatory
Third-year residents set the tempo for the educational excellence that is a defining characteristic of our program. Many take on important extracurricular activities that contribute to the constant evolution necessary to maintain a progressive academic medicine program. Some recent examples: publication of a comprehensive intern/ward medicine survival guide and pocket reference; serving as resident medical directors and board members for the Charlottesville Free Clinic; lunch time lectures for new interns on clinical approach to common cross-cover issues; aiding in the "Teaching to Teach" symposium for rising second year residents; and helping to design the "Elements of Research" lecture series provided to residents early in their second year.
Categorical Track PGY-3 Rotations
- 5 Inpatient: combination of General Medicine, Digestive Health, Acute Cardiology, Hematology-Oncology, and Coronary Care Unit
- 7 Electives: Ideal time to do rotations internationally or at our affiliated Indian Health Service sites in Arizona. Many residents do a research month during this time.
Primary Care Track PGY-3 Rotations
- 4 Inpatient: combination of General Medicine, Digestive Health, Acute Cardiology, Medical Intensive Care, and either Hematology-Oncology or Coronary Care Unit
- 7 Electives: Ideal time to do rotations internationally or at our affiliated Indian Health Service site in Arizona. Many residents do a research month during this time.
- 1 Rural Health: at Central Virginia Community Health Center, a nationally recognized health center staffed by UVa Faculty serving the rural poor of neighboring Buckingham county.
Clinical Investigator Track PGY-3 Rotations
- 3 Inpatient
- 1 Outpatient/Ambulatory
- 8 Research & Master's Degree coursework months:
Fall semester - 17 credit hours
Spring semester - 9 credit hours + Thesis 5 credit hours
Complete and defend thesis
Clinical components that are common to the Categorical, Primary Care, Med-Psych and Fast Track curricula include:
- A 3-year outpatient continuity experience in University Medical Associates, our nationally recognized faculty-resident practice. Primary Care track residents work together in an outpatient firm, under the preceptorship of the track director, Dr. Wolf.
- Ambulatory electives in all outpatient internal medicine subspecialties, sports medicine, orthopedics, dermatology, adolescent medicine/student health, women’s health, ophthalmology, palliative care, and the Charlottesville Free Clinic.
- Ample opportunities for national and international rotations, with established rotations on the Eastern Shore of Virginia, the Navajo Reservation in Arizona, Latin America, and Africa.
- A comprehensive 3-year ambulatory curriculum, covering core primary care clinical topics, systems- and practice-based learning, advanced physical diagnosis, advanced interviewing skills, and office procedures.
- Opportunities to conduct research projects under the mentorship of nationally recognized general internists and geriatricians. Areas of expertise include medical errors and patient safety, cancer screening, care of the underserved, chronic illness care, geriatrics, and palliative care.
These areas are described more fully below:
Continuity Clinic
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Housestaff in the Categorical and Primary Care Tracks provide comprehensive, ongoing care to a Panel of Primary Care Patients in our university-based general medicine clinic, University Medical Associates (UMA). The clinic resides in a newly renovated and dedicated space with computers in each exam room and an electronic prescribing system. Interns have clinic one half-day per week and residents see patients one half-day per week when on inpatient rotations and twice per week when on elective rotations. |
The Firm System: Housestaff are assigned at the beginning of the PGY-1 year to an outpatient "firm" at UMA. This consists of a General Internal Medicine faculty mentor/firm director, a firm nurse, and approximately six residents who follow their patients over the span of their three-year residency. This team approach yields optimal patient care while facilitating the development of a mentoring relationship with a primary care faculty role model. With a base of 8,000 patients and 25,000 annual visits, diverse opportunities are provided for long-term patient management and continuity of care. Clinics do not occur on call days or post-call days.
Primary care at UMA also involves an array of health care resources including full-time clinical pharmacists, nurse practitioners, diabetes educators, a nutritionist and a social worker. A daily outpatient morning report and afternoon teaching conference are integrated into the UMA training experience. Practice Management sessions involving such issues as quality improvement, billing, and "practice profiling" are a core component of the UMA experience.
Home Visit Program
As part of training at UMA, interns and residents participate in an innovative home visit program in which they visit their patients at their place of residence in conjunction with their firm team. This highly popular program affords an opportunity to examine patients' quality-of-life factors in a way not possible in the ward or clinic setting.
Ambulatory Curriculum
Our faculty has developed an innovative, graduated program in systems-based practice, practice-based learning, communication and professionalism competencies. Over the three years, in the fall and spring elective periods, residents participate in two dozen interactive seminars and projects to acquire and practice these new skills under the direction of selected general medicine faculty. Teaching examples come from residents' daily practice in the acute and chronic illness settings and methods include simulations, chart audits, video clips, role plays and group projects. Residents develop learning portfolios to chart their progress. This curriculum reflects the values, interests and roles of general and subspecialty internal medicine physicians whether in practice or academia.
Special Ambulatory Electives
Migrant Health Eastern Shore: This one-month rotation on the rural eastern shore of Virginia offers an opportunity to provide primary care to a rural underserved cross-cultural population of local residents and migrant farm workers – working in the clinic, on the migrant farm worker camps and on the tiny island of Tangier (reached by boat or small plane). This is a rich environment for learning about public health and cross-cultural/international health.
Indian Health Service: A one-month rotation at one of our affilitated Navajo Reservation sites offers an opportunity to provide primary care to underserved Native Americans and to learn the tenets of cross-cultural medicine and population-based health. Residents are supervised by a UVa Internal Medicine program graduate.
International: Residents have been supported in overseas rotations in Kenya, Uganda, Brazil and India and are encouraged to develop unique experiences that help them meet their goals for future practice and enhance cross cultural training in the residency program.
Subspecialty Electives
Residents gain excellent clinical training in all Internal Medicine subspecialties during elective rotations that are mainly at our University-based specialty clinics. Supervision is by nationally respected faculty who evaluate patients presenting from a wide referral base and with common and rare illnesses. Community-based subspecialty sites are also available for those interested in exposure to nontertiary care settings. Elective rotations are also available in Dermatology, Sports Medicine, Musculoskeletal Disorders, Radiology, Toxicology and other subspecialties.
Advisory Support System
Intern Support Groups: The first year of residency training can be stressful for even the most prepared house officer. Small groups run by members of the General Medical Faculty meet early in September to discuss the rigors, frustrations and fears inherent in the life of an intern. Sharing with housestaff and faculty – all of whom have had similar feelings and experiences – aids in establishing bonds between residents and makes an otherwise rigorous year a learning experience among colleagues.
Committee on Residency Education (CORE): Department faculty have a major interest in hoursestaff development and education. The CORE supervisory board includes the Program Director, six to eight key Clinical Faculty, the Chief Residents, and an additional resident representative. CORE faculty members are assigned incoming housestaff and serve as their mentor, advisor and link to the department structure. Members meet with housestaff at least every six months to review their performance, discuss all aspects of training and provide career planning advice. This 1:1 relationship continues through all years of training and fosters a smooth transition from medical school to residency and then on to a fellowship or career practice.
Core faculty members also facilitate assignment of faculty subspecialty and research mentors to assist housestaff in meeting their career and educational goals.
Department Retreat
| Each year, all the department interns and residents leave the hospital for a day for an educational retreat. (Clinical services are covered by IM fellows and faculty). In the setting of local camps or lodges, housestaff and CORE members discuss the program and identify strengths and weaknesses, and suggestions for improvement. Team building challenges like ropes courses provide a fun way to evaluate the Department's goals. |
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