Our mission is to train future leaders in academic medicine who will improve the human condition through the practice of medicine, education, research, and service. As such, our Program Aims include:
- Recruit highly-qualified trainees who desire a rigorous clinical experience, supervised autonomy, and deep exposure to medical discovery.
- Connect our residents with institutional resources to cultivate scientific curiosity and innovative thinking.
- Provide comprehensive and compassionate care across the spectrum of internal medicine to a diverse group of patients from all backgrounds, including those from underserved urban and rural communities.
- Maintain and expect the highest standards of clinical care and professionalism at all times.
- Tailor each resident’s experience to align with their career objectives.
- Promote diversity to ensure that our trainees and faculty reflect the population we serve.
- Solicit critical input from all stakeholders into our program structure and focus, driving innovation in medical education and professional development.
All residents rotate on a “4+2” block schedule with two-week ambulatory rotations separated by four-weeks of inpatient or elective rotations. Residents rotate through a variety of inpatient services at Vanderbilt University Medical Center and the Nashville VA, including general medicine, medical intensive care, geriatrics, and several inpatient subspecialty services. Inpatient rotations are usually two weeks in duration. While highly customizable, this chart summarizes the rotation distribution of a typical resident:
|Inpatient General Medicine||10 weeks||4-8 weeks||4-8 weeks|
|Ambulatory Medicine||14 weeks||14 weeks||14 weeks|
|Medical/Cardiac Intensive Care||6 weeks||4-8 weeks||4-8 weeks|
|Inpatient Subspecialty Services*||10-12 weeks||6 weeks||6-8 weeks|
|Geriatrics||2 weeks||2 weeks||-|
|Emergency Medicine||2 weeks||-||2 weeks|
|Night Float||4-5 weeks||3 weeks||2-3 weeks|
|Electives||-||4-6 weeks||8 weeks|
|Vacation||3 weeks||4 weeks||4 weeks|
*Inpatient subspecialty services include: general cardiology, heart failure, malignant hematology, medical oncology, gastroenterology, hepatology, infectious diseases, nephrology, and pulmonary medicine.
**All residents are granted additional vacation time (usually 4-5 days) beyond that listed in late December or early January.
Inpatient attending physicians typically rotate for two weeks and switch on PGY-1 switch days, thus maximizing continuity with the resident team. Bedside teaching rounds are conducted daily on all inpatient clinical services in order to optimize learning and patient care. The emphasis of attending rounds is on developing fundamental clinical skills, diagnostic reasoning, and professionalism as well as on the bedside review of the pathophysiology of disease. Special emphasis is given to evidence-based medicine. On our subspecialty services, this format allows residents direct access to experts in the field of specialization.
Our program emphasizes the importance of ambulatory medicine and primary care for all medical residents. Each incoming intern is assigned a continuity clinic for which they provide longitudinal care to a panel of patients throughout their entire residency. Under our 4+2 block schedule, all residents have three half-days of continuity clinic per week during their two-week ambulatory blocks. Our continuity clinics are located at Vanderbilt One Hundred Oaks or at the Nashville VA Medical Center. Residents work closely with a subset of faculty clinic preceptors who provide oversight, teaching, and mentorship throughout their residency. Our clinic nurses and support staff, along with robust informatics, allow residents to keep up with their responsibilities to their panel of clinic patients while rotating through various inpatient services. Throughout residency, house staff also gain experience working in a wide array of subspecialty clinics that reflect the breadth of outpatient medicine, including:
- Allergy and Immunology
- Community Health Centers
- Infectious Diseases
- Pulmonary Medicine
- Women’s Health*
*residents spend a higher proportion of time in these outpatient-oriented specialty clinics
Residents with a specific clinical area of interest are able to arrange for a longitudinal specialty or community-based clinic experience in addition to their primary care continuity clinic.
The primary care clinic experience is integral to the internal medicine residency program. As interns, Vanderbilt residents assume care of a panel of patients for whom they act as the primary care physician for all three years of residency. Throughout these years with the same patient panel, residents manage chronic diseases while also working up patients' new issues and practicing preventative medicine. The aspect of longitudinal care is often missed in the inpatient setting, but the regular use of continuity clinics provides a more comprehensive sense of patient care in a time frame measured in years rather than days.
Vanderbilt has fully converted to block scheduling on a “4+2” system, in which residents have 4 weeks of inpatient time followed by 2 weeks of dedicated clinic time. This allows for regularly scheduled clinic visits and development of a true sense of ownership for patients. Also, each clinic in the residency program is organized into a team of attendings with several residents and multiple medical staff including nurses. Over the course of three years, direct and consistent teaching from a dedicated group of attendings as well as the same staff and patient panels allows for continuity of learning for the resident as well as continuity of care for the patient, no matter if the resident is on an inpatient or outpatient block.
Access to the larger medical system at Vanderbilt Medical Center and/or the Nashville VA, including diverse diagnostic and treatment modalities and specialty referrals, allows for primary care to be delivered at a high level as a resident. The continuous link between attendings, residents, medical staff, and patients over years creates a different experience from the fast paced and often episodic inpatient world and provides an educational experience that helps prepare residents to become fully functioning physicians in their eventual practice.
QUALITY IMPROVEMENT ACTIVITIES
Employing principles and tools of quality improvement, our residents learn how to develop and test interventions designed to improve patient care. These opportunities occur at multiple points throughout residency.
Morbidity, Mortality, and Improvement (MM&I) Conferences
Residents participate in two quarterly MM&I conferences: one conference is limited to residents and core faculty and one is open to the entire Department of Medicine. With a focus on process-related issues, conference participants identify and propose solutions to system-based problems. Quite frequently, these conferences generate a resident-run quality improvement project that is subsequently addressed in dedicated quality improvement didactic sessions. Many of these projects have resulted in changes with hospital-wide impact.
Quality Improvement in the Continuity Clinic Setting
Each year, residents measure the care they provide to their continuity clinic patients along various preventative and chronic disease management metrics using tools acquired during quality improvement didactics. Mentors in quality improvement, many of whom have completed the VA Quality Scholars Fellowship, subsequently assist residents in developing improvement targets and using Plan-Do-Study-Act cycles to achieve their targets.
SIMULATED PATIENT EXPERIENCES:
Residents use Vanderbilt's state-of-the-art patient simulation center called CELA (the Center for Experiential Learning and Assessment) to supplement their education. Residents practice critical care procedures, such as intraosseous or central venous catheter insertion, and participate in mock codes before they become code team leaders in their PGY-2 year. Additionally, CELA experiences are used to evaluate residents in the core competencies using standardized patients. These individualized sessions allow residents to receive one-on-one feedback from clinical faculty.
PGY-2 Quality Improvement Project
The quality improvement (QI) curriculum at Vanderbilt empowers residents to be involved in quality improvement efforts at both the microsystem and macrosystem level. Utilizing the Institute for Healthcare Improvement Model for Improvement framework, residents chose and execute QI projects. Projects are resident-driven and have focused on improvements in patient care, addressing a myriad of areas including patient safety, patient care, clinically efficiency, and resident wellness. Curricular time for QI is within the academic half day, and content is a mix of integrated didactics and team-based, experiential learning.
CENTER FOR EXPERIENTIAL LEARNING AND ASSESSMENT
Residents use Vanderbilt's state-of-the-art patient simulation center called CELA (the Center for Experiential Learning and Assessment) to supplement their education. In CELA, house staff receive additional training in ultrasound, procedural techniques, care of rapidly deteriorating patients and mock codes prior to each MICU rotation. Additionally, CELA experiences are used to evaluate residents in the core competencies using standardized patients. These individualized sessions allow residents to receive one-on-one feedback from clinical faculty in a controlled setting.