Rotations

We provide a comprehensive ambulatory curriculum to all medical residents. It is presented over a three-year period and includes lectures, case-based discussions, physical diagnosis, and clinical skills workshops, and seminars. Primary Care Track residents receive additional curriculum for content that is germane to these areas. The intern outpatient curriculum is delivered during ambulatory block rotations in a one-year cycle. The junior and senior resident curriculum is delivered during practice week rotations in a two-year cycle.

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 educational experience includes caring for patients on the heart failure, electrophysiology and interventional cardiology services. The cardiology rotations are all staffed by residents, interns and fellows and offer residents and interns the opportunity to work with experts in the field of cardiology.

All categorical interns 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. 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.

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) and MICU Green (residents only) located on BIDMC's West Campus and Finard ICU (residents & interns) located on BIDMC's East Campus. 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.

Emergency Medicine 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. 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.

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. Residents lead teams of two interns and oversee management decisions, teach interns and medical students, and guide their team through clinical decision making. Interns typically have three to four wards months per year and residents have one to two wards blocks per year.

The West Roxbury VA Rotation allows residents the opportunity to care for a unique patient population and to work with other residents in the Boston area. Residents at West Roxbury VA 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. During this rotation, housestaff manage patients with COPD, renal failure, end-stage liver disease, gastrointestinal diseases, spinal cord injuries, new oncologic diagnoses, and many other service-connected disabilities.

During the Liver and Kidney 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. Commonly encountered diagnoses include acute and chronic graft rejection, acute renal failure, hepatic encephalopathy, spontaneous bacterial peritonitis and refractory ascites. Residents frequently perform diagnostic and therapeutic paracenteses on this service, with the Hepatology fellow overseeing all procedures.

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. This is a JAR/SAR only rotation and lasts for one week

The Division of Medical Oncology offers three inpatient rotations to internal medicine students. The BIDMC "BMT" rotation is a comprehensive inpatient rotation on the management of hematologic malignancies. Housestaff are exposed to patients with acute (i.e. newly-diagnosed) leukemia, various oncologic emergencies, patients undergoing either allogeneic or autologous stem-cell transplantation, therapy- and disease-related complications, and palliative care.

The OMED rotation is an inpatient rotation at BIDMC focusing on the management of solid tumor oncology. Housestaff are exposed to various oncologic emergencies, solid tumor treatment, including disease-related complications, as well as pain management and palliative care.

This 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). Housestaff are exposed to a wide variety of cases including oncologic emergencies, disease-related complications, pain management, and palliative care. Interns and residents have one day off per week.

The Sub-Intern Resident Service (SIRS) is a dedicated resident-sub-intern rotation on a general medical floor. This is a highly rewarding rotation for both residents and students. Residents have the opportunity to build upon their teaching skills while working closely with the supervising attending and the sub-interns. Sub-interns truly feel like interns as they perform initial assessments, write all orders, respond to all pages, and prepare all discharge paperwork. The residents supervise closely while teaching the students basic concepts important to inpatient care. The rotation includes dedicated teaching conferences through the weeks, regular attending rounds, and geographic distribution of the patients.

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 medicine rotation is a unique experience, affording the resident an opportunity to function autonomously and work directly with a supervising attending.