Post-Graduate Year 3

This rotation comprises 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. Residents have one to two wards blocks per year.

The 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.

Twilight is an evening rotation that admits patients to the geographic pods, allowing the primary ward teams to stop admitting at 4 p.m. and go home by 5:30 p.m. Each team is comprised of a junior or senior resident, two interns, 0-1 subinterns, and 1-2 Core 1 students.

Nightfloat is an overnight rotation that covers admitted inpatients and admits new medical patients overnight, after Twilight teams go home. Three junior/senior residents are responsible for all overnight admissions to the medical, cardiology, and liver/kidney services without cross-coverage responsibilities. This is a one week rotation and residents typically have two night float rotations per year. Resident night floats are 8:30 p.m. to 7:30 a.m.

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.

The BMT rotation is a comprehensive inpatient rotation on the management of hematologic malignancies (leukemia, lymphoma, multiple myeloma, etc.) and consists of three interns, a second- or third-year BIDMC Heme/Onc fellow, a Heme/Onc faculty member who specializes in hematologic malignancies and a resident during the first few months of the academic year.

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.

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. PGY3 residents gain clinical ICU experience in medical or cardiac care units during the 6-9 week rotation.

During the third year rotation, residents have the opportunity 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 CCU is an 8 bed intensive care unit and one of the highest rated rotations for the notable teaching opportunities and complex physiology. 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 care for undergoing evaluation for renal or liver transplant, or that have recently undergone transplantation. Residents also 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.

The Sub-Intern Resident Service (SIRS) is a dedicated resident-sub-intern rotation on a general medical floor where residents have the opportunity to build upon their teaching skills while working closely with the supervising attending and the sub-interns. The Resident-Attending Service (RAS) is a dedicated one resident to one attending service, caring for general medical patients located off the geographic floors for the FIRM and SIRS teams. This rotation is a unique experience, affording the resident an opportunity to function autonomously and work directly with a supervising attending.

Junior and Senior Residents have 1-3 week electives evenly spaced throughout the year in our ACES schedule. Elective options include traditional medicine specialties and clinical rotations outside of internal medicine. Almost half of each year is spent in a combination of ambulatory time, ambulatory electives, traditional electives and research opportunities. Area of Concentration, or AOC time, is also available to junior and senior residents interested in pursuing an independent project in basic science or clinical research, medical education, health policy, quality improvement, or hospital or primary care medicine.

Each year, a group of junior and senior residents travel to Mount Desert Island in Maine for a 1-week basic science immersion experience in comparative physiology. The goals of the course are to increase appreciation for physiology and enhance residents' routine incorporation of pathophysiology into their teaching and clinical roles on the general medical ward and ICU rotations.

The Botswana Medicine Resident Elective provides an opportunity for internal medicine residents to work in a resource-limited setting and provide medical care to a population challenged by ongoing HIV and TB epidemics as well as a rising burden of non-communicable diseases. The elective provides a valuable opportunity to develop participants’ teaching skills, gain clinician educator experience and contribute to longitudinal quality improvement efforts.