The General Internal Medicine Track

Peggy B. Hasley, M.D., M.H.Sc.

General Internal Medicine for the 21st Century

Current political and economic conditions are setting the stage for significant growth in the need for general internists. The Institute of Medicine has placed greater emphasis on health care that is patient-centered, safe, timely and evidence-based. As a result there has been dramatic change in the training of the general internist and an explosion of hospitalist medicine as a sub-specialty within general internal medicine. General internists are now taking broader roles and there are diverse opportunities for generalists which will likely increase in the future.

Graduates of the General Internal Medicine Track will be able to pursue any of the following career paths:

1. The primary care physician principally working in the ambulatory setting responsible for diagnosis of complex disorders, chronic disease management and prevention.
2. The hospitalist physician responsible for acute care of the complex patient with an emphasis on patient safety and quality.
3. A combination primary care/hospitalist physician who maintains expertise in both acute and chronic care of the complex patient.
4. The academic general internist with a focus on a career as a clinician educator or a clinician investigator in health services.

The mission of the General Internal Medicine (GIM) Track is to train residents so that they become highly competent internists who function effectively in the health care system for the 21st century. The GIM track offers flexibility in curriculum design to accommodate the variety of roles that GIM physicians are assuming in the health care system.

To accomplish this mission residents work closely with general internal medicine faculty mentors who assist in the design and implementation of an individualized curriculum with a balance of inpatient and outpatient activities that directly relate to their individual career goals. Residents may choose to join this track at the end of their first year of their residency. By the middle of the second year, residents choose an area of concentration in one of the four career directions above. Residents have the option to choose among a broad selection of special electives that have been developed in ambulatory and hospitalist medicine.

Goals

By completion of the Generalist Track, residents will be:

• Experienced in general internal medicine that is patient-centered, efficient and evidence-based
• Master diagnosticians and educators of physical diagnosis
• Partners in continuous healing relationships with patients
• Understand leadership of multi-disciplinary health care teams
• Experienced in information technology and other patient care systems
• Skilled in procedures
• Champions of quality and patient safety
• Practiced in environments that are designed for modern chronic disease management approaches

Meet the Faculty

Special Features

1. Unique Schedule of Clinical Rotations
   • Enhanced ambulatory care and hospitalist experiences. Comparative Schedule
2. Practice-Partnership Model
   • 1:1 mentored relationship with faculty internist expert in ambulatory or hospitalist medicine
   • For the Primary Care/Ambulatory Pathway: Longitudinal care of private patients in comprehensive general internal medicine
3. Core Curriculum of General Internal Medicine
   • Conferences, workshops, and small group experiences
   • Track Day Noon Time Conference
   • Pre-clinic Conference
   • Ambulatory Morning Report
   • Hospitalist Morning Report
   • Quarterly Conferences with Senior Master Educator
4. Focus on Mastery of Clinical Skills
   • Extensive opportunities for evaluation and longitudinal management of complex patients
   • Advanced training in physical diagnosis skills
   • Substantial training in procedures
   • Leadership training as leaders of multi-disciplinary teams
5. An Individualized Approach to Career Development
   • Exciting menu of electives in ambulatory, hospitalist, sub-specialty and research options
   • Dedicated mentor in general internal medicine
   • Research mentor within area of interest
   • Access to over 100 general medicine faculty advisors and multiple additional sub-specialty faculty advisors
   • Mentored senior project in research, curriculum development, or health care delivery
6. Option for Comprehensive Training in Research

   As one of the nation’s leading academic research centers, the University of Pittsburgh has undertaken an initiative that has resulted in the formation of the Clinical and Translational Science Institute (CTSI). The CTSI’s primary focus is to develop, nurture, and support a cadre of clinical and translational scientists by building on the university’s existing clinical research training programs. Residents participating in the General Internal Medicine Track will have the opportunity to work with scientists who have extensive experience in the translational sciences to meet their research training objectives.

7. Health Policy Curriculum:

   The General Internal Medicine and Global Health Tracks (GIM/GH) have combined forces to sponsor and develop a curriculum in health policy. This consortium is comprised of faculty and residents who have worked together to bring the current health care debate into the residency.

   • First, a two hour session on health policy didactics and discussion of hot topics takes place during the intern ambulatory block. It is developed and delivered by residents. Topics covered are: History of Health Care in USA, Medicare/ Medicaid, Current Organization of US Health Care and Current Issues in US Health Care.
   • A two year curriculum of 8 lectures and debates is presented during the noon time conference series for interns and residents. Topics in this series include: Health Care and Politics, Physician Reimbursement, Health Care Costs, and Big Pharma and Influence.
   • This year the Resident/Faculty Health Policy Journal Club has been launched. This monthly meeting serves to help residents and faculty to stay abreast of health policy publications in the medical and lay press. Our first Journal Club included a discussion of the Atul Gawande article: The Cost Conundrum published in the New Yorker Magazine June 2009. This Journal club will serve to increase the knowledge base of this complex literature and provide a forum for the exchange of ideas.
   • The GIM/GH Consortium is currently working to provide a reference list of Health Policy fast facts that can be transmitted to all interested residents on a weekly basis so that they can remain current on developments from government and academia.

General Internal Medicine Track – Ambulatory Elective Rotations

Advanced Physical Diagnosis/Master Educator – developed for generalist track residents this seminar series teaches education techniques in advanced physical diagnosis.

Alternative and Complementary Medicine - offered at Shadyside center for Complementary Medicine. Includes exposure to acupuncture.

Community Health Care – with a focus on the private practice model

Consultative Medicine – inpatient and out-patient general medicine consultation that includes peri-operative assessment and post-operative care.

Cross-Cultural Experience - in Chinle, Arizona at the Indian Health Service.

Cardiology – Residents chose from a list of specialty clinics within cardiology including electrophysiology, heart failure and pulmonary hypertension clinics

Dermatology for the Internist – only available to the Generalist Track

Endocrinology – residents work with endocrinologists to develop skills in the outpatient management of diabetes, thyroid disorders and other topics in endocrinology

Geriatric medicine – residents work in outpatient clinics with geriatric faculty with attention to issues related to frailty, dementia, incontinence and the complex care of the geriatric patient

Gastroenterology/ Hepatology – residents work with gastroenterologists in the care of inflammatory bowel disease, the evaluation of abdominal pain, the care of functional bowel disorders, and the evaluation and treatment of chronic liver disease.

Hematology-Oncology – outpatient care of the oncology patient

HIV Clinic – residents work with general medicine and infectious disease attendings while providing primary and advanced care for patients with AIDS

Musculoskeletal Month – developed exclusively for the generalist track, includes caring for patients in orthopedics, physical medicine and rehabilitation and sports medicine rotations.

Neurology – This 2 week rotation focuses on movement disorders, headaches, vertigo and general outpatient neurology

Ophthalmology for the Internist – this rotation allows residents to experience outpatient non-operative issues of the eye

Private Practice - Elective with Kaiser Permanente in Boulder Colorado

Psychiatry for the Internist – residents care for ambulatory psychiatric patients under the supervision of faculty psychiatrists

Pulmonary Medicine – residents care for chronic ambulatory pulmonary issues

Renal medicine – residents work with renal faculty caring for outpatients with chronic renal insufficiency. An added elective allows residents to develop particular expertise in the care of the renal transplant recipient.

Rural Medicine – residents have the opportunity to work at an office practice in a rural setting of Fayette County Pennsylvania.

Rheumatology – residents care for rheumatologic issues such as osteoarthritis and rheumatoid arthritis

Women’s Health – residents rotate with general medicine faculty who have special expertise in women’s health. Emphasis is placed on the acquisition of skills in gynecology

General Internal Medicine Track – Hospitalist Elective Rotations

Hospital Medicine – The hospital medicine rotation is a 1-month rotation spent under the direct supervision of a hospitalist attending physician. Residents learn to function independently in an environment that reproduces the responsibilities of hospitalists. The rotation schedule is a typical hospital medicine schedule that allows residents to develop the skills required in today’s shift work environment, such as hand offs and time management. Residents work with physician extenders and are required to learn elements of billing and coding. Daily didactics are offered on topics that are not usually covered in general medicine ward rotations.

Medicine Consults – The medicine consult rotation provides residents with the skills required to offer effective medicine consultation and peri-operative management. The rotation exposes residents to concepts of co-management with surgical and non-medical services. The curriculum includes important evidence based guidelines and landmark articles.

Palliative Care – Palliative Care education is an essential part of the training of future hospitalists. Under the guidance of experienced palliative care attendings, residents acquire the knowledge, skills and attitudes needed to provide compassionate, technically proficient, culturally appropriate care to patients with life threatening illness and their family members. Residents make up part of a multidisciplinary palliative care team.

Procedure Service – Residents are supervised in the performance of most common procedures at the bedside. Residents are taught indications, contraindications, complication management and techniques of obtaining complete informed consent. Residents are then trained to teach junior residents and medical students.

Critical Care Elective – With over 2000 interventions each year, UPMC is a leader in rapid response teams. During this rotation residents work with critical care faculty and learn to rapidly assess and manage critically deteriorating patients.

Geriatric Inpatient Elective – This rotation provides residents with exposure to the common problems in caring for the elderly including poly-pharmacy, delirium, dementia, falls and reduced mobility.

Acute Inpatient Stroke Elective – In many centers hospitalists are required to manage patients with acute stroke. Residents have the option to choose a 2 – 4 week rotation on this service where they become familiar with the assessment treatment and prevention of stroke.

Patient Safety Elective – During this 2 week elective, residents participate in multiple patient safety committees to help them better understand the hospital patient safety effort. Residents attend a variety of meetings related to code review, risk management, adverse drug reactions, anticoagulation and other topics. Residents evaluate and present a case of a patient who suffered a medical error and develop a plan to prevent a similar event in the future.

Hospital Administration Elective – This 2 week elective allows residents to spend time with different hospital administrators to understand the hospital system and different roles that administrative positions entail. Residents rotate with business, nursing and physician administrators.

Transitional Care Elective – This 2 week elective allows residents to visit different types of long term care facilities including skilled nursing facilities, acute rehab units, personal care facilities and nursing homes.

Generalist Track – Other Ambulatory Elective Experiences

Adolescent Medicine – residents care for adolescent patients under the supervision of general medicine faculty with expertise in this field.

Health Care for the Homeless – Set at the Birmingham clinic staffed by general internal medicine faculty

Obesity Clinic (Willow Program) – This group care model allows residents to care for patients who are working as a team to lose weight.

Practice Management Seminar – Residents attend a one day seminar addressing practice topics including : Making Career Decisions, Finding and Evaluating Practice Opportunities, Negotiating a Fair Employment Agreement, Building a Successful Practice, Starting and Running a Practice

Procedures Clinic – exposes residents to common procedures in the generalists ambulatory practice

Quality Improvement Project – residents are assisted in the performance of root cause analysis and quality improvement project.

Sport’s Medicine – residents work with sports medicine faculty to assess and treat sports related pain and functional impairment

Walk-In and Urgent Office Care – residents join general medicine faculty in their walk-in and urgent care clinic

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