Overview



SIZE AND SCOPE

The NYMC (Richmond) Internal Medicine Residency is sponsored by New York Medical College and takes place at Richmond University Medical Center, a hospital with approximately 200 beds in the Department of Medicine, including 10 Intensive Care Unit beds, 10 Coronary Care Unit beds, a cardiac catheterization laboratory, a pulmonary function laboratory, a sleep center, an endoscopy suite, and fully equipped laboratory and radiology departments.

All levels of training and all rotations involve both outpatient and inpatient management. Approximately 33% of total training time is in ambulatory settings and 66% involves inpatients.

The hospital load includes sufficient housestaff-managed patients to provide an adequate experience of patients with all varieties of internal medicine problems, but does not produce an overwhelming service need. The number of AIDS patients has been constant at a low of approximately 5% of the in-patient complement.
DAILY ROUTINE

The day begins with Morning Report, from 7:30-8:30 a.m., followed by Work Rounds and then Teaching rounds daily from 10:00 a.m.-11:30 a.m. Every day at 11:30 a.m.-12:30 p.m. there is a conference in the Bloomfield Conference Room. The entire Internal Medicine curriculum is reviewed in block didactic sessions over the course of the academic year.

There is a monthly Radiology/Medicine conference, a two month Emergency Medicine course held in July and August, a monthly Journal Club, a Research Course, and several case presentations.

Endorsement rounds are held at 4 p.m. as each floor turns over their cases to the team on call that night for that floor.
Outpatient experiences include two continuity clinics a week for each resident. Every resident goes to his/her continuity clinics no matter what rotation he or she is doing. Each resident follows a panel of patients which is assigned to him or her throughout the three years of residency. In the 2nd and 3rd years, residents go to outside preceptors, who are doctors in practice in Staten Island, for their 2nd continuity clinic. After hours, one of the residents on call holds the "clinic beeper" and is available at all times to any clinic patient who is having a problem. That resident will speak to the patient, take care of any acute problem, and then notify the primary care resident that his or her patient had a problem when he/she returns to the hospital. If a clinic patient is admitted to the hospital, that patient's primary care resident is notified, and he/she is required to follow the patient and be aware of what happens during the patient's hospital admission.
ON CALL SCHEDULE

The schedule meets all New York State requirement for housestaff work hours. PGY1s are usually on call until 9pm when the night float takes over, unless they are rotating in the ICU or CCU when they are on call over night every 4th night. Each PGY1 resident has at least four weeks of elective, and more during the PGY2 year. PGY3 residents have elective without night or weekend call at least eight months out of twelve. Every resident has four weeks vacation each year.
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TESTING

The teaching program is intensive and extensive. The conference schedule (as described above) includes monthly quizzes on each subject, with regular feedback to the housestaff regarding test performance. Those residents who are having test-taking difficulty are identified early and referred for evaluation and education to a group of educational psychologists at the Robert Wood Johnson Cognitive Skills Department.

Each year the housestaff sits the national In-training examination and the results are reviewed with each resident. Problem areas are identified and each resident is required to prepare a study plan in conjunction with the Program Director based upon personal performance on departmental and national tests.
EVALUATION

The performance of housestaff on the general rotation, specialty rotations, and outpatient clinics are evaluated monthly by the Teaching Attending supervising those programs, full time Faculty, Chief medical Residents, other residents, and the nursing.

Physical examination skills are evaluated during the first year. Each PGY1 is required to do 4 mini-clinical competency examinations in order to be promoted to PGY2. Written histories and physicals, consultations and progress notes are evaluated and reviewed with residents quarterly. Interview skills are evaluated in small group sessions using role play techniques.




MEDICAL STUDENTS

Medical students from New York Medical College and SUNY/Health Science Center of Brooklyn (Downstate Medical Center) do rotations and a variety of electives at the Hospital. Residents are responsible for working with no more than one medical student at a time.