Post-Graduate Year 1

General medicine ward rotations comprise the core experience of the internal medicine residency. Interns admit, diagnose, and manage patients with a broad range of internal medicine problems, while serving as the primary caregiver for their patients. Interns are led by residents who oversee management decisions and guide interns clinical decision making. Interns typically have three to four wards months per year and residents have one to two wards blocks per year.

One ward rotation each year is at the West Roxbury VA, which allows residents the opportunity to care for a unique patient population and to work with other residents in the Boston area. This rotation is a mix of COPD, renal failure, end-stage liver disease, GI bleeds and many other advanced presentations of diseases.

All categorical interns will have a continuity clinic at Healthcare Associates, the Jamaica Plain and West Roxbury VA Hospitals, Dimock Community Health Center, or Fenway Community Health (Center). Preliminary interns may request but are not required to do continuity clinic.

The BIDMC "BMT" rotation is a comprehensive inpatient rotation on the management of hematologic malignancies, consisting of three interns, a second- or third-year BIDMC Heme/Onc fellow, and a Heme/Onc faculty member who specializes in hematologic malignancies. Interns admit on a rotating basis and are in the hospital from 7AM through 7PM Monday through Saturday (a "moonlighter" covers the service on Sundays); there are no dedicated "on call" days.

The OMED rotation is an inpatient rotation at BIDMC focusing on the management of solid tumor oncology. The service consists of two residents, two interns, and a BIDMC oncology faculty member. Teams admit on a rotating basis and are in the hospital from 7AM through 7PM six days per week (either Saturday or Sunday is off); there are no dedicated "on call" days.

The DFCI rotation gives housestaff a comprehensive exposure to inpatient management of both solid and hematologic oncology. Each block, 1 resident and 2 interns rotate through DFCI. The solid malignancy team is composed of 2 residents and 3 interns with 1 resident and 1 intern from BIDMC. The hematologic malignancy team is composed of 1 resident and 2 interns with 1 intern from BIDMC. Residents and interns take call until 5PM.

Each intern completes, on average, two critical care months per year (usually one month in the medical ICU and one in the cardiac ICU). Critical care rotations expose the housestaff to a breadth of common disease processes, such as sepsis and septic shock, respiratory failure, and life-threatening gastrointestinal bleeding.

While in the ICU, interns have opportunities to place central venous lines and arterial lines and to perform other common procedures such as arterial puncture, paracentesis, thoracentesis, and lumbar punctures. These procedures are always done with supervision by the attendings and the residents, but the intern is expected to be the primary operator.

The internal medicine residency provides opportunities to work directly with cardiology attendings and fellows on the inpatient cardiology wards (Zoll rotation) and in the cardiac care unit (CCU) with a focus on management of patients with cardiovascular issues. The cardiology service is staffed by three teams of 1 resident and 2 interns. The CCU is an 8 bed intensive care unit and staffed by a cardiology attending, fellow, 3 residents and 3 interns.

On this rotation, housestaff manage patients with end-stage liver disease under the guidance of an attending hepatologist.

All interns have approximately 6-8 weeks of ambulatory medicine, including a 2- week introduction to outpatient medicine at the beginning of the academic year. Continuity practice sessions provide an opportunity for growth of your own practice. Our intern ambulatory curriculum is focused on common medical problems in primary care. We also provide teaching on resources in our practice that help you to provide care to complex patients.

Interns rotating through the Emergency Department will interview, assess, and evaluate new patients presenting to the ED following initial nursing triage. Interns and residents in Internal Medicine, like ED interns and residents, work directly with a senior ED resident and an ED attending. Interns and residents working in the ED have the opportunity to perform lumbar punctures, paracenteses, arthrocenteses, and central line placements under the supervision of a senior ED resident or attending. In addition, the ED provides a unique opportunity to perform procedures done less commonly on the inpatient floors including incision and drainage, suturing, and stapling.

Interns are responsible for cross-covering all inpatients overnight on the West Campus. Each night the on-call interns sign out the ward patients to a night float intern. The night float's primary responsibility is to manage acute issues overnight as well as follow up on labs and studies that are pending at the time of the call team's sign-out. Each night float intern covers approximately 10 intern's patients. Interns at BIDMC are supervised by the MERIT resident whose primary responsibility is intern support overnight. Intern night float rotations are 5:30 p.m. to 7:30 a.m. and typically a two week rotation with one night off per week.