PGY-2

General medicine ward rotations comprise the core experience of the internal medicine residency. Residents lead teams of two interns and oversee management decisions, teach interns and medical students, and guide their team through clinical decision making. During ward rotations, each team of interns and residents has their own clinical attending and two additional dedicated general internal medicine or subspecialist attendings who lead teaching conferences each day with a particular focus on current medical dilemmas on the wards. Residents typically have one to two wards blocks per year.

The West Roxbury VA allows residents the opportunity to care for a unique patient population and to work with other residents in the Boston area. Residents at West Rox work on the general medical wards and on nightfloat with housestaff from BIDMC, Boston Medical Center, and Brigham and Women's Hospital, providing them the opportunity to learn different practice styles and meet new people. Most interns and residents are at the VA for one ward rotation every year. Residents also spend 1-2 weeks annually admitting patients on VA nightfloat.

Three junior/senior residents are responsible for all overnight admissions to the medical, cardiology, and liver/kidney services without cross-coverage responsibilities. Residents admit in a geographic format and usually admit approx 5-6 patients/ night. This rotation allows for significant resident autonomy and co-resident collaboration — a strength of BIDMC residents. Resident night float is from 8:30 p.m. to 7:30 a.m. This a one week rotation and residents typically have two night float rotations per year. Residents also may rotate as night float at the VA hospital, with similar responsibilities as the BIDMC night float rotation.

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). Primary care residents add a second practice in their junior year and can chose to add any of these sites, or can choose amongst a wide range of additional sites depending upon their interests. In the past, residents have participated in clinics at a local prison, an alternative medicine clinic and other local specialty or private practices.

The BIDMC "BMT" rotation is a comprehensive inpatient rotation on the management of hematologic malignancies. The service consists of three interns, a second- or third-year BIDMC Heme/Onc fellow, and a Heme/Onc faculty member who specializes in hematologic malignancies; there is also a resident on the rotation during the first few months of the academic year.

The OMED rotation is an inpatient rotation at BIDMC focusing on the management of solid tumor oncology and various oncologic emergencies. The service consists of two residents, two interns, and a BIDMC oncology faculty member.

The DFCI rotation gives housestaff a comprehensive exposure to inpatient management of both solid and hematologic oncology. The rotation is run through the Dana-Farber Cancer Institute (DFCI) and takes place on the oncology wards at the Brigham & Women's Hospital (BWH). 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 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. There are several different ICU experiences at BIDMC, including MICU Orange (residents & interns), Finard ICU (residents & interns), and MICU Green (residents only). Residents are on call every third night.

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 Zoll rotation is staffed by three teams of 1 resident and 2 interns. The CCU is staffed by a cardiology attending, fellow, 3 residents and 3 interns. Residents take overnight call every third night while in the CCU in a weekly staggered day-night schedule.

On this rotation, housestaff manage patients with end-stage liver disease under the guidance of an attending hepatologist. Residents also care for undergoing evaluation for renal or liver transplant, or that have recently undergone transplantation. Residents frequently perform diagnostic and therapeutic paracenteses on this service, with the Hepatology fellow overseeing all procedures.

Junior and Senior residents have 15-16 ambulatory practice weeks per year, during which they work in their continuity practice and attend ambulatory curriculum didactics in the morning. Ambulatory electives are incorporated into the overall elective options available and are scheduled during dedicated elective weeks.

Emergency Department rotations provide the vital experience of initial patient assessment, triage, and management while building cooperative ties with our colleagues in the ED. 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.

MERIT is a unique rotation that provides coverage to services needed throughout the hospital-caring for medical patients in the emergency room with prolonged wait times for transfer, helping busy wards teams whose residents or interns are in clinic, and performing medical consultation. MERIT exists as both a day and night rotation in twelve-hour shifts (7 am to 7 pm or 7 pm to 7 am). This is a JAR/SAR only rotation and lasts for one week.