Introduction

Vanderbilt University was founded in 1873 by a $1 million gift from Commodore Cornelius Vanderbilt in order "to contribute to strengthening the ties that should exist between all sections of our common country." For the first 50 years of the university's existence, the School of Medicine occupied buildings in downtown Nashville. However, in 1925, under the leadership of Canby Robinson, a new hospital was built on the main campus and the modern School of Medicine was born.

Over the ensuing three quarters of a century the Vanderbilt University School of Medicine has gained national prominence in many areas. Two Vanderbilt faculty, Dr. Earl Sutherland (cyclic AMP) and Dr. Stanley Cohen (epidermal growth factor) have won the Nobel Prize in Medicine, and Vanderbilt scientists continue to excel in research. At the present time Vanderbilt University School of Medicine ranks 10th in the nation in total NIH research grants, and the total value of Vanderbilt's external support for competitive research grants exceeds $417 million. In addition, Vanderbilt's rate of growth in NIH grants has been among the fastest in the nation over the past several years.

The Department of Medicine has had an equally illustrious history, dating from Canby Robinson to Dr. Eric Neilson, who is the current chair and the institution's 7th since the reorganization of the medical school in 1925. Research in the Department of Medicine at Vanderbilt has led to major improvements in our understanding of disease, and currently the Department ranks 5th in the nation in NIH funding among Departments of Medicine.

The first Chief Resident in Medicine in the new facility in 1925 was Dr. Tinsley Harrison, who would remain on the faculty until 1941. The outstanding clinical leadership begun by Harrison and others continues to this day, and the Department of Medicine proudly trains residents to be the finest physicians anywhere. This is facilitated through an integrated medical campus including the 800-bed University Hospital, the adjacent 350-bed Veterans Affairs Hospital, and the Vanderbilt Clinic, which sees approximately 1,000,000 outpatient visits per year.

The Annette and Irwin Eskind Biomedical Library, which opened in 1994 adjacent to the main hospital, is home to traditional print materials and state of the art electronic information. Housestaff are able to access the library's databases from computer stations located throughout the patient care units and clinics, and the digital library is easily accessed through the Departmental website. The Library is also home to the Dept. of Medical Informatics, one of the outstanding informatics programs in the nation. Through cooperation between Informatics and clinical departments, chiefly the Department of Medicine, Vanderbilt University Hospital has one of the most advanced electronic systems in the nation for both order entry and for its electronic medical record.

The Department of Medicine is committed to residency education. While service is always a component of residency training, we have made a number of important changes in order to maximize the educational experience for all of our residents. These include:

• Emphasis on bedside teaching. On all of our units, attending rounds are daily and are conducted at the bedside.
  
  
• Dedicated subspecialty units (Rogers service) in infectious diseases, pulmonary medicine, GI/hepatology, and nephrology; cardiology (Harrison service); and hematology/oncology (Brittingham service), in order to maximize and concentrate teaching opportunities.
  
  
• Development of non-teaching (Scoville and Riven) services at Vanderbilt hospital, in order to ensure that the patients on the general medicine teaching (Morgan) service are those providing the most important clinical material for housestaff to care for.
  
  
• MICU rounds led by a pulmonary/critical care attending that emphasize a team approach to care of the critically ill.
  
  
• Expansion of the primary care faculty (currently at 90) and reorganization of the ambulatory blocks into 2-week units for better teaching and an overall richer experience.
  
  
• Utilization of the electronic medical record (Starpanel) to maximize care by building practice guidelines into the computer-based record, so that residents can know precisely how their patients are doing with issues like blood pressure control, diabetes management, and congestive heart failure.
  
  
•  Increased staffing on the VA wards and on the subspecialty units to one resident/2 intern teams in order to eliminate the need for night floats and to improve continuity of care.
  

The Vanderbilt tradition fosters strong peer and faculty mentor relationships with emphasis on excellence in patient care, attention to detail, and a scholarly approach to clinical issues. The qualities we value most are intellectual curiosity, honesty, compassion, and genuine enthusiasm for learning and for sharing what has been learned.

Jacob Hathaway, M.D. Vanderbilt University Ambulatory Chief Resident

To make good decisions, physicians need the right information at the right time.  Vanderbilt is a national leader in biomedical informatics, which is the application of information technology to the medical care system.  Decision support systems at Vanderbilt integrate patient specific data and pharmacy data with order entry to provide immediate help with clinical decision making.  For example, all the information you need to renally dose medications is provided at the time of prescribing.  The electronic medical record system developed at Vanderbilt allows seamless navigation of patient records, registries of patients, disease specific quality dashboards and the current medical literature.  These tools have been developed by physicians and are continually improved with direct input from residents.  Together, these tools not only make it easy to do the right thing for patients, but also make learning an organic part of patient care.