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Internal Medicine Residency Tracks
Primary Care Track
(12 positions)
Overview
- This pathway was developed to meet the regional and national need for well-trained general internists practicing primary care. The goal of the primary care track is to train the next generation of general internists to be leaders in academic primary care, health care policy, public health and community practice. Graduates of this program are well-prepared and competitive for chief residencies, postgraduate fellowships, careers in academic general internal medicine and community practice.
- Primary care residents participate together in an immersion block during each year of training. The immersion blocks provide time to explore issues related to primary care practice in depth and are described in greater detail below.
- Primary care residents attend continuity clinic at Harborview’s Adult Medicine Clinic, the University of Washington’s Roosevelt Primary Care Center, or the VA Puget Sound’s General Internal Medicine Clinic.
- Primary care track residents spend 15 of 39 rotations in the ambulatory setting. An additional 7 electives can be spent in either ambulatory or inpatient settings.
- Ambulatory rotations include the 3 immersion blocks, a rural medicine (WWAMI) rotation, and a required block rotation in musculoskeletal medicine.
- Elective ambulatory rotations include HIV medicine,
women’s health, global health, homeless healthcare
and addiction medicine in additional to traditional
rotations in medical subspecialties and non-medical
specialties related to primary care (e.g., dermatology).
The R1 Year
- In the R1 year, primary care residents build basic skills that all internists need regardless of their ultimate career plans.
- The intern year starts with an immersion block. The focus of this block is on a single doctor working to optimize care for a single patient. The goals are to acquire the knowledge and skills necessary to independently manage common outpatient conditions, to develop personal systems of care that allow for efficient and high quality care, and to hone patient interaction skills. The mornings include didactic sessions on the management of common conditions, physical exam, practice management and patient interactions. These sessions are followed by interactive sessions including journal club, chart review and “report.” Interns spend each afternoon at their continuity clinic site building their panel.
- Interns will spend an additional 4 rotations in the ambulatory setting later in the year. These rotations include a course on evidence-based medicine and a course called Patients, Physicians and Society that explores a variety of issues related to health care delivery and policy.
- The remaining 8 rotations are spent in the ED and on inpatient services including ward medicine, ICU, cardiology, neurology and float.
The R2 Year
- In the R2 year, primary care residents cement their inpatient and leadership skills and then turn their focus to ambulatory care training.
- Primary care R2s have 5 inpatient rotations including ward medicine, CCU, ED and float.
- The immersion block occurs in the fall. The focus of this block is on the doctor as a member of a care team working to optimize the health of a panel of patients. The goals are to continue to build medical knowledge and skills relevant to primary care practice, to understand how clinic processes impact quality of care, and to use data to analyze and improve care for a panel of patients. Morning sessions include didactic sessions, quality improvement seminar (including designing and initiating a QI project), videotape review, journal club, chart review and report. Residents spend each afternoon in their clinic or doing home visits to panel patients.
- All residents do a rotation in musculoskeletal medicine and have the option of electing a rural medicine rotation in the WWAMI region. Other elective ambulatory rotations are as noted above in the overview.
The R3 Year
- In the R3 year, primary care residents have the opportunity to address individual needs and interests and to pursue individual goals. Accordingly more than half of the rotations this year are elective.
- Primary care R3s have 4 inpatient rotations including ward medicine, ICU, CCU and float.
- The immersion block is in mid-winter. The focus of this block is on the doctor as a part of the health care delivery system working to optimize the health of a community. Residents will perform a community health assessment and intervention and will have time to complete their QI projects. There will also be time for other scholarly pursuits including creating new didactic elements for the immersion block curriculum. Afternoons will be spent in continuity clinic, at community based clinics and in doing home visits to panel patients.
- The 7 elective rotations may include medical subspecialty and community based rotations in Seattle, an international rotation, and rural rotations in the WWAMI region.
Seattle/Boise Categorical Track
(10 positions)
Overview
The Seattle/Boise Categorical Track is similar to the Seattle
Categorical Track, except that the R2 year is spent in Boise,
Idaho. During the R2 year, the program is based at the Veterans Affairs
Medical Center, Boise, a major teaching hospital of the University of
Washington.
R1 Year
- The R1 year is the same as the Seattle Categorical Track.
R2 Year
- Residents spend their second year at the Boise
Veterans Affairs Medical Center in Boise, Idaho.
- Boise R2s spend six months on general medicine.
- Morning activities consist of inpatient work rounds, morning
report to the Chief of Medicine, and educational conferences.
- Two half-days are spent in clinic, where residents develop their
own outpatient practice.
- Night call is approximately every fifth night.
- The remainder of the year is divided into two months of electives,
one month of community medicine, one month of clinic block, and one month of critical care medicine.
- Elective rotations available include: infectious diseases, dermatology,
gastroenterology, endocrinology, hematology, oncology, rheumatology,
pulmonary diseases, hypertension, nephrology, cardiology, geriatric
medicine, neurology, psychiatry, orthopedics, anesthesiology, radiology,
and radiation oncology.
- Primary care seminars during clinic block and geriatric medicine
provide a comprehensive curriculum which includes directed readings,
case discussions, role playing, and problem-solving activities.
- During electives, residents continue to attend their own medicine
continuity clinics. There is no night call during these rotations.
- Residents work with interns from two University of Washington-sponsored
training programs based in Boise. Other trainees with whom residents
interact include the R4 chief resident(s) and post-doctoral research
fellows in pulmonary/critical care medicine. Residents also supervise
University of Washington third- and fourth-year medical students assigned
to Boise.
R3 Year
- Residents return to Seattle for their R3 year.
- R3s spend four months on inpatient medicine rotations (general medicine,
oncology, cardiology, ICU), one month in the Harborview emergency department,
and the remainder of the year on elective rotations.
- Electives may include medical subspecialty and community-based rotations
in Seattle and rural medicine rotations in the WWAMI region.
- Electives may include infectious diseases, gastroenterology,
nephrology, hepatology, endocrinology, rheumatology, medical genetics,
dermatology, pulmonary medicine, general medicine consults, rural
medicine, ambulatory medicine, gerontology, emergency medicine,
neurology, hematology/oncology, cardiology, women's health, adolescent
medicine, pediatric emergency medicine, occupational medicine,
or a research project.
- R3s attend a general medicine clinic one-half day a week throughout
the year, with the opportunity to assume care once again of many of
the patients they followed as R1s in the clinic.
Seattle Categorical Track
(30 positions)
Overview
The Seattle Categorical Track provides broad training in
general internal medicine and medical subspecialties in both the inpatient
and outpatient settings. Most residents in this program pursue academic
careers in general internal medicine or medical subspecialties. Residents
may choose research electives in their R2 and R3 years.
R1 Year
- Heavy emphasis is placed on the care of patients with complex medical
illnesses. The entire year is spent in direct care of patients under
the guidance of internal medicine R2s, R3s, and attending physicians.
- Three months are spent on general medicine inpatient rotations.
- Two months are spent on ambulatory medicine.
- Two months are spent on critical care medicine.
- One month is spent on each of the following rotations: cardiovascular
medicine, medical oncology, a neurology inpatient service, a gerontology
service, and the emergency room.
- R1s attend a weekly general internal medicine continuity clinic.
R2 Year
- Three months are spent on inpatient medicine rotations that include
caring for patients on general medicine wards, and two months are spent
on coronary and intensive care units.
- R2s have a two-month full-time ambulatory medicine rotation with
experiences in general medicine as well as specialties that are primarily
outpatient-based, such as rheumatology, dermatology, and endocrinology.
- Residents may choose to have this rotation either in Seattle
at their continuity site or at teaching sites in central Washington,
Wyoming, Montana, or Alaska which have been developed as part of
the WWAMI program.
- One month is spent in the emergency room and three months on elective
rotations.
- Electives may include infectious diseases, gastroenterology,
nephrology, endocrinology, rheumatology, medical genetics, dermatology,
pulmonary medicine, general medicine consults, rural medicine at
a WWAMI site, ambulatory medicine,
gerontology, emergency medicine, neurology, hematology/oncology,
cardiology, women's health, adolescent medicine, pediatric emergency
medicine, occupational medicine, or a research project.
- All residents attend a weekly general medicine continuity clinic.
R3 year
- Residents spend about two-thirds of the year on consultative subspecialty
rotations.
- Subspecialties available include infectious diseases, gastroenterology,
nephrology, hepatology, endocrinology, rheumatology, medical genetics,
dermatology, pulmonary medicine, general medicine consults, rural
medicine at a WWAMI site, ambulatory
medicine, gerontology, emergency medicine, neurology, hematology/oncology,
cardiology, women's health, adolescent medicine, pediatric emergency
medicine, occupational medicine, or a research project.
- Residents may also elect to spend one or two months doing research,
choose general medicine consultation or rural medicine electives or
a two-month full-time ambulatory medicine rotation to include additional
outpatient subspecialties (in Seattle or at WWAMI sites)
to those undertaken in the R2 year.
- R3s spend four months on inpatient services (general medicine, oncology,
cardiology) and in the ICU/CCU.
- R3s attend a weekly general medicine continuity clinic.
Preliminary Internal Medicine
Track
(8 positions)
Overview
The preliminary track provides a year of broad clinical experience
for individuals who wish exposure to internal medicine before entering
a residency training program in another discipline.
- Eight positions are available to all applicants seeking a one-year
internal medicine training experience.
- Residents in the preliminary track will spend four months
on general medicine inpatient rotations, and one month of critical care
medicine.
- One month is spent on emergency medicine, neurology, cardiology and medicine consultation.
- Preliminary interns also have three elective months which include medical
subspecialties and some additional choices (neurology, anesthesia,
radiation/oncology, etc.)
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