Saint Vincent Hospital 
Internal Medicine Residency Program

Categorical Internal Medicine (NRMP #1290140C0)
Preliminary Year (NRMP #1290140P0)

• Our Internal Medicine Training Program has 75 house officers: 24 senior residents, 24 junior residents, and 27 interns, including a mix of categorical and preliminary year positions. We also have three PGY-4 chief residents. The Department of Medicine at Saint Vincent Hospital currently has over 100 teaching faculty members composed of internists and subspecialists. Our program is accredited by the Accreditation Council for Graduate Medical Education (ACGME).
• We accept all PGY-1 applications through the Electronic Residency Application Service (ERAS). All PGY-1 categorical and preliminary positions are filled through the National Resident Matching Program (NRMP). The preliminary year is for those who seek a medical internship before entering programs in allied specialties such as Neurology, Anesthesiology, Psychiatry, Radiology, Ophthalmology, Dermatology, Physical Medicine/Rehabilitation, etc.
• Our residents consistently score impressively on the ABIM Boards. More than half of our graduates choose to enter subspecialty fellowships, while the rest enter primary care or hospital medicine. Our record of placement of residents into excellent fellowships or hospitalist/primary care positions remains very strong, and we provide necessary support to maintain this tradition. All of our graduates have acquired a unique and essential perspective on managed care since Saint Vincent is closely affiliated with Reliant Medical Group, which is affiliated with an HMO and is nationally recognized for outstanding care and innovation. They also have the opportunity to work with other physicians practicing in private groups.

The important characteristics of our internal medicine training program may be summarized as follows:

• Our curriculum is designed to give residents progressive responsibility in patient care, so that they are confident in managing patients independently using evidence-based medicine by the end of their training.
• Leadership skills are developed as residents run wards rounds and learn how to manage their teams effectively.
• Residents grow into becoming educators as they progress through their training, by taking an active role in teaching interns and medical students.
• We pride ourselves on a culture of collegiality and fostering a team-based approach to providing excellent patient care.
• We have a 6+2 schedule, in which 2- or 4-week blocks of inpatient service rotations (Wards, MICU, CCU, PCU, ED, and Night Float) or electives are always followed by a 2-week block in the ambulatory setting. Please see the Continuity Clinic and Ambulatory Care section for more details.
• The Preliminary interns rotate through a series of service months, including Wards, MICU, ED and Night Float interspersed with electives.
• Our policy dictates that all diagnostic and therapeutic orders on teaching patients are entered by the house staff. The attending staff has voluntarily agreed to refrain from writing orders in the interest of our educational program.
• Point of Care Ultrasound (POCUS)

Exceptional Educational Opportunities

• Morning Report sessions, in which the house officers and medical students present and review patient cases, hospital courses, and other clinical information, often leading up to the diagnosis or final outcome.   Morning Report sessions are typically attended by the chief medical residents and one of the members of program leadership.    Specialists and hospitalists attend the specialty Morning Report sessions. 
• Daily noon conferences, including subspecialty lectures devoted to the core curriculum, including the basic science pertaining to each subspecialty. Socially relevant issues are also discussed, such as  Health Care Disparities, Managed Care, Life After Residency, Ethics, Domestic Violence, and End of Life/Palliative Care.
• In addition to morning reports and noon lectures, we have regularly scheduled Grand Rounds, Morbidity and Mortality conferences, Patient Safety Rounds, PI project presentations, Journal Club, Senior Resident lectures and a Board Review Series.
• Professor Rounds are held for one hour on a weekly basis. The cases to be discussed are determined by the resident and the focus of these sessions are on clinical reasoning and bedside physical examination.
• During the Ambulatory block, an academic half-day is dedicated to focusing on topics such as motivational interviewing, professionalism, approach to geriatrics and perioperative care. These sessions will also dedicated to PI/QI projects and point-of-care ultrasound training. See Ambulatory Clinic schedule section.
• In the ICU and CCU, there are daily teaching rounds with an intensivist or cardiologist, respectively.
• Mock codes and central line simulation are regularly conducted by the chief residents locally at SVH.
• Several other interdisciplinary learning opportunities include Tumor Board, Radiology and Pathology Conferences, Surgery and Neurology Grand Rounds, and Inter-hospital GI, Cardiology, Renal, Endocrinology and Infectious Disease Rounds.

  We also strongly encourage membership to the Massachusetts Medical Society, Worcester District Medical Society, American College of Physicians, American Medical Association and other subspecialty organizations

Continuity Clinic and Ambulatory Care

• All residents in the Categorical Program are assigned to faculty mentors who supervise their outpatient ambulatory rotations. Categorical residents are assigned to the Ambulatory Clinic at SVH and Primary Physician Partners.  Our X+Y schedule allows for significant time dedicated to the ambulatory setting with focus on learning the skills necessary for outstanding outpatient medicine performance.
• Residents are assigned a panel of patients, and they care for these particular patients longitudinally over their three years of training.  As they progress through training, residents increase their panel size as well as the number of clinic visits per session with progressive level of responsibility and growth.  By the end of their PGY3 year, residents will be managing their own patient care needs independently with support of their preceptor. 
• The ambulatory care and preventive medicine rotation is intended to be an experience where residents focus on chronic disease management, management of acute care issues, assessing and managing patients to preempt hospitalization, identifying and managing patient psychosocial and unique patient characteristics, and progress with a strong focus on preventative medicine. 
• During ambulatory blocks, residents are scheduled for an Academic Half Day Session where there are teaching sessions dedicated to topics covering ambulatory medicine, as well as varied topics in professionalism, communication, opioid prescribing, and research.
• During ambulatory blocks, residents are assigned to a Clinical Concentration, which consists of sessions with a subspecialist in the outpatient setting.  This allows for ambulatory experience in medical subspecialties, with the subspecialty varying over the course of the year.  Examples include cardiology, urology, dermatology, gastroenterology and geriatrics.
• Residents also audit their own patient panel and care practices, craft solutions to improve their delivery of evidence-based medicine, and re-measure their performance through our Panel Management Initiative.

Electives

• Electives are offered during all three years of residency.Electives are available in cardiology, pulmonary, rheumatology, endocrinology, nephrology, gastroenterology, hematology/oncology, infectious disease, and more.
• House staff perform inpatient consultations.In discussions with the faculty about these consultations, they draw on the expertise of the faculty and learn the approach to diagnosis and management of conditions in that subspecialty.The small group setting facilitates deeper learning in these areas.Our subspecialty faculty is composed of seasoned clinicians who are highly dedicated to education.
• Reading lists, didactic sessions, and hands-on experiences specific to that elective round out the educational experience.
• Ambulatory experience in subspecialties may be part of electives and are also available as Clinical Concentrations during ambulatory blocks.

Other Unique Features

• State of the Art Hospital: We have been named as one of the top 100 hospitals in America, and have been the recipients of several recognitions including Leapfrog A. Our MICU has been named by the federal government as one of the top ten intensive care units in the country, and recently was the first ever winner of the “Patient and Family Focused ICU” award. Specialized diagnostic and therapeutic services include three very busy cardiac catheterization labs and OR’s with 24 hour cardiac catheterization/stenting, trans-catheter aortic valve replacement (TAVR), mitral valve clipping, pulmonary physiology, fiberoptic bronchoscopy, non-invasive cardiology, cardiac electrophysiology (housed in a brand new lab), neurophysiology, G.I. endoscopy and physiology, nuclear cardiology, open heart surgery, coronary angioplasty, plasmapheresis, radiation oncology including Cyberknife, in-house hemodialysis and peritoneal dialysis, variceal sclerotherapy, laparoscopic and thoracoscopic surgery.
• Patient Diversity: The inpatient population is an exciting mixture of bread-and-butter community-hospital medicine blended with rare and exciting cases similar to those seen at a university hospital tertiary care center. Residents are responsible for taking care of patients with ethnic and socioeconomic diversity.
• Excellent Ancillary and Support Services: The Radiology Department has a large full-time faculty and its own residency program. It offers a full range of radiological services, including neuroradiology, vascular radiology, ultrasonography, computerized axial tomography, CT-guided needle biopsies, embolization of arterial bleeding sites, treatment of vascular occlusions by percutaneous intraluminal balloon angioplasty, placement of vascular stents, full scale nuclear medicine (including myocardial scintigraphy, gated pool scanning etc.) and advanced MRI imaging. Emergency procedures are available twenty-four hours a day, seven days a week. With the opening of our new facility, we were the first hospital in central Massachusetts with our own MRI unit on site and the first facility in New England with a completely digital Radiology Department, which includes instant access to radiological studies on hospital or home computers. Three dimensional (3D) Mammography is the latest addition to our Cancer and Wellness tertiary care facility.
• Learning without Burnout: By design, our residency training is “scut-free”.  Our faculty is fully aware of the differences between service and education. It is a basic principle of our program that house officers should spend most of their time taking care of patients to enhance their learning. We also encourage our house officers to participate in a variety of social activities, including group/family outings for apple picking, local shows, skiing, snow tubing, our annual “International Food Festival,” and other extracurricular and cultural events.
• Committed Faculty Members: The faculty, while recognizing that their primary commitment is to patient care and medical education, is also committed to academic productivity. The bibliography of our faculty over the past ten years numbers over 500 articles, book chapters, and textbooks.
• Participation in Conferences and Medical Jeopardy Competition: Our residents are active participants in the annual state-wide American College of Physicians (ACP) abstract and “Medical Jeopardy” competitions. Each year we have local and national winners. Our Jeopardy Team won the state championships over the past several years.
• Mandatory and Thorough 360 Degree Evaluations: Our procedures for evaluating the performance and competence of our residents are well developed. They include observation of the resident as early as during orientation performing histories and physical examinations, utilizing the standardized patient technique (OSCE’s) with the collaboration of our faculty, web-based critiques following each rotation, end of the month exercises, and the Internal Medicine In-Training Examination each year. The program also uses several web-based teaching tools, such as MKSAP Tracker, Johns Hopkins modules and the Institute for Health Improvement modules. Patient and nursing evaluations are also sought.

• Easy Access to Miscellaneous Support Services: Support services include medical photography, medical illustration, and an excellent library. High-speed Internet connections are readily available on all our 1200 computers, allowing for medical literature searches and texts throughout the hospital.  Departmental libraries utilize UpToDate, OVID, Access Medicine, and other useful resources.

• Additional Teaching and Learning Opportunities: We have a close relationship with the University of Massachusetts Medical School (UMMS). Saint Vincent Hospital is a few minutes’ drive from UMMS.
• Our close relationship with U Mass Medical School also permits our staff to participate actively in the everyday life of the medical school. Our full-time staff members serve on essential committees of the medical school. Our teaching faculty members hold academic appointments there. The most important feature of the affiliation is our involvement in the training of the medical students. Saint Vincent Hospital’s teaching staff is involved in all four years of medical student training. The presence of third-year clinical clerks and fourth-year sub-interns on our ward medical teams provides an essential stimulant and a vital opportunity for interns to learn by teaching.

• Opportunities to Observe and Work with Wide Varieties of Physicians: Our unique relationship with Reliant Medical Group, Saint Vincent Physician Services and other private clinician offices provides not only the educational support of a large and experienced managed health care group but the potential for excellent employment positions after graduation in various settings.
• Participation in Scholarly Activities: We have a great track record for publications. The Department of Medicine provides necessary support for statistical analysis and writing manuscripts. The residents are also involved in monthly ambulatory care PI projects.
• Fun-filled extracurricular activities are planned by the chief medical residents and the social committee throughout the year.

In Summary, Our Program Features:

• A design to produce first-rate internists by challenging our house staff to manage patients with progressive independence through the course of their training, with a culture of collegiality and a team-based approach to patient care.
• A curriculum that meets all of the general and specific requirements of the Accreditation Council for Graduate Medical Education with respect to administration, faculty, teaching staff, clinical resources, facilities, supporting services, curriculum, resident responsibilities, and trainee evaluations.
• A wide array of patient pathologies
• Active residency programs in all the major disciplines
• An excellent track record of placing our graduates in desirable fellowship programs, and highly attractive primary care and hospitalist practice settings (many of our teaching attendings are graduates of our program)
• An evening and night float rotation which relieves the admitting resident and intern at 5 p.m. so that there is no evening or overnight call during ward months
• A variety of well-conceived and thoroughly-developed ambulatory experiences exceptionally well suited to preparation for Primary Care
• Excellent Radiology, clinical laboratories, and support services
• A “scut-work” free environment
• Genuine responsibility on the part of the house staff
• The opportunity to experience the full range of contemporary diagnosis and therapy.

If you have any questions, please do not hesitate to contact our Program Coordinator Tina Kachadoorian at [email protected].