Our curriculum has been designed to equip residents to be competent and confident physicians. Residents will be allowed to sit for the allopathic Internal Medicine (ABIM) and osteopathic Internal Medicine (AOBIM) boards (DO’s only).
The curriculum emphasizes focused learning in inpatient and outpatient settings. Residents on inpatient general internal medicine and intensive care unit rotations do not have any outpatient responsibilities so they can focus on the care of their inpatients. Residents rotate with a core of teaching attendings on the wards and in continuity clinic. Teaching attendings take residents to the bedside and engage patients, family and nursing staff to provide patient-centered care. In the continuity clinic, residents participate in team-based care with medical assistants, nurse practitioners, nurses and IM faculty.
The ambulatory experience is enhanced by two general internal medicine ambulatory blocks each academic year, when residents spend time in continuity clinic as well as other ambulatory settings for the block. This allows residents to experience all aspects of ambulatory care, including acute illness visits, routine continuity visits, chronic disease management visits with patients, post-hospital discharge visits and primary care specialty visits. Residents are precepted in continuity clinic by Internal Medicine (IM) faculty at Academic Internal Medicine Partners, a newly constructed ambulatory facility across the street from GMC-Lawrenceville. Through collaboration with the Atlanta VA Medical Center residents see patients at the Lawrenceville VA Community Based Outpatient Clinic during the ambulatory block to gain experience in the health care of veterans. In addition, the ambulatory block resident provides general medical care for patients under treatment for tuberculosis at the Gwinnett-Rockdale-Newton Public Health Preventative Health Clinic in Lawrenceville. Each of these experiences is also available for additional block long elective experiences in general internal medicine.
Residents have a dedicated educational block (“academic half day”), during which they participate in both didactic and interactive educational sessions. During academic half day, activities include team-based learning activities, board review, quality improvement and patient safety curriculum, and skills development using task trainers for bedside procedures. Once weekly, Internal Medicine residents join other residents and staff for Interdisciplinary Grand Rounds and Primary Care Grand Rounds (sponsored by the Internal Medicine and Family Medicine departments) focusing on topics of interest to primary care physicians both in training and in practice. Every morning, senior residents and night float interns participate in morning report, while interns participate in a weekly intern report, which focuses on clinical decision making and management of patients admitted to the hospital.
Skills Development Block
As one of our most innovative rotations, the skills development block is a dedicated month in block 7 of intern year that aims to enhance physical exam skills, medical knowledge and clinical decision making. The rotation takes interns through a variety of learning methods, including simulation, didactic lecture, intensive ambulatory experience, game-based review and resident-led teaching. Residents also go through a team-building retreat and intensive osteopathic principles and practice review. Topics covered during the block are based on a needs assessment determined by rotation feedback, in-training exams, and directly observed needs by faculty.
Simulation is one of the most important innovations in medical education in recent times. Gwinnett Medical Center has embraced simulation-based training in its residency programs and throughout the hospital. We have a growing and robust simulation center with cutting edge technology including multiple hi-fidelity simulators, a cardiopulmonary physical exam simulator, and procedural task trainers for central line placement, thoracentesis, paracentesis, lumbar puncture and knee/shoulder injections.
Internal Medicine residents also receive individual licenses for online instructional modules for point of care diagnostic ultrasound with the ability to practice on both real ultrasound and an ultrasound that simulates common pathologies.
Simulation sessions are held weekly on the ambulatory rotation, monthly in academic half day, and at various times in the year including intern orientation and the Skills Development Block. Internal medicine faculty focus the simulations on individual deficiencies to be able to make the most out of simulation training.
Resident as Teacher
Residents have multiple opportunities to grow as educators throughout their training. During inpatient general medicine wards and cardiology service, residents will supervise 3rd and 4th year medical students. Senior residents also serve as team leaders and managers of the inpatient team, supervising interns in Internal Medicine and Transitional Year programs.
Retreats are held on a semi-annual basis that focus on team building, leadership, and teaching methods to improve skills as a team managers and educators.
Residents have ample exposure to geriatrics during their residency training. Each resident will complete a geriatrics rotation, where they rotate on the long-term care service at the Gwinnett Extended Care Center, located at Gwinnett Medical Center-Lawrenceville, caring for nursing home patients on the teaching long-term care service. In addition, they also run the geriatrics trauma consultation service, under the supervision of a board certified geriatrician, to provide multidisciplinary team care for elderly patients who are admitted on the trauma service.
Medical knowledge is constantly evolving and to assist residents in keeping up with reading and self-assessment, the program provides several web-accessible curricula and question banks specifically for Internal Medicine residents. Residents have paid access to Challenger, a large online question bank and reference material for topics in internal medicine and NEJM Knowledge+, an interactive board review platform. Online access to the Physician Education and Assessment Center’s Internal Medicine Ambulatory Care Curriculum provides focused ambulatory education for residents to complete during their outpatient rotations. In addition, residents may use CME funds for access to any other board review programming of their choosing, such as the American College of Physicians MKSAP program.
Residents in the osteopathic track have multiple longitudinal opportunities to grow as osteopathic practitioners. Osteopathic residents have Osteopathic Manipulative Medicine (OMM) clinic and teaching once weekly during the ambulatory block. They have opportunity to perform OMM during inpatient and outpatient patient visits under the supervision of osteopathic trained faculty. With our osteopathic affiliate, Philadelphia College of Osteopathic Medicine – Georgia Campus right around the corner, residents also benefit from the teaching and mentorship of osteopathic physicians who are board certified in OMM/Neuromuscular Medicine. In addition to small group review sessions, they also provide osteopathic skills development conferences at various points in the year. Residents are evaluated by osteopathic track faculty on their ability to perform full musculoskeletal assessments on inpatient and outpatient rotations.
In compliance with ACGME rules, PGY 1 residents do not participate in overnight call. However, experience in admissions and patient care overnight is a valuable experience for general internal medicine training at all levels. Therefore, PGY 1 residents participate in night medicine rotations, giving residents experience caring for and evaluating patients that present to the hospital during evening hours. PGY 2 and 3 residents participate in overnight call during ward months and selected outpatient rotations, no more than every fourth night.
Each resident is required to complete one scholarly activity during their residency, which may consist of research, presentation at a conference, or other academic pursuits. Residents are encouraged to write up interesting cases and submit posters and articles for publications, with assistance of their assigned faculty advisor. In addition, during the ambulatory block, each resident participates in ongoing, longitudinal quality improvement projects in the continuity clinic at Academic Internal Medicine Partners.
Advocacy and community involvement are some of the cornerstones of being a well-balanced physician. In this spirit, residents participate in a community service project yearly that gives back to the Gwinnett County community in which we serve. Former resident projects have included volunteering at community health fairs, providing medical care at free clinics, and creating “swag bags” to provide feminine hygiene products to low income middle school girls.