Hospitalist and Subspecialty Learner-Directed Pathways

Overview

Residents in our Internal Medicine Program have ample opportunity to personalize their educational goals by creating a specialized area of interest for their future careers. Our program provides the scheduling flexibility, mentorship and electives to individualize a resident’s rotations and projects and help our postgraduates align their learning with their personal and career goals. Residents may elect to enter these pathways anytime during their residency. This allows residents to experiment with possible career choices prior to committing to an area of expertise. Each Learner-Directed Pathway provides an experienced mentor and guidance to assist our residents in making career choices that best fit her or his needs and goals. At the University of Wisconsin-Madison, we strive to ensure that each resident develops the general skills of an internist while, if they wish, enhancing specific skills through a pathway of his or her choosing. Here we describe two examples.

Hospitalist

The Divisions of Hospital Medicine and Pulmonary and Critical Care Medicine collaborate to offer interested residents a Hospitalist Learner-Directed Pathway. This learning focus, while meeting all ACGME and ABIM requirements for internal medicine board eligibility, emphasizes the care of hospitalized patients with illnesses ranging from acute and immediately life threatening to decompensated chronic conditions.

This pathway is intended for residents who plan to practice hospital medicine, critical care medicine, or other inpatient focused specialties. A multi-disciplinary approach to training is considered an integral part of all of our training as well as this emphasis pathway. Residents will receive mentorship from an experienced practicing hospitalist known for his or her teaching skills. Mentors in critical care and other specialties are also available if desired.

Ward, ICU, CCU, consultative, emergency, outpatient and transitions in care rotations ensure that graduates have heterogeneous experiences which will enable them to adapt to a broad array of hospitalist work environments upon graduation. Our Hospitalist Division works closely with the residents to ensure that they have progressive responsibilities and independence and the mentorship and role models needed to become the physicians they wish to be.

Residents will graduate with advanced procedural, triage, consultative and surgical co-management skills and the ability to work as a team leader and member in an interdisciplinary model of care. In addition, residents will develop the ability to analyze their and their colleagues practices, work with relevant institutional stakeholders, and develop their own quality improvement projects by applying our human factors engineering, transitions in care and patient safety curriculum across three years of training.

Residents may elect rotations from the following:

  • General Medicine Ward with a traditional learning team of third and fourth year students and a hospitalist physician. Over three years the resident progresses to the PG-3 “junior attending” level.
  • Hospital Medicine where a single resident works with a hospitalist physician, nurse practitioner, case manager, pharmacist and social worker and progresses to independent management of the entire service.
  • Inpatient Medicine Consults, focusing on surgical co-management and consultative medicine for a wide array of patients.
  • Critical Care in our Trauma Life Center, focusing on management of the most unstable medical and surgical patients.
  • Inpatient Cardiology, CCU Care, and Heart Failure Services.
  • Neurology Critical Care, focusing on the management of patients with acute unstable neurologic injuries.
  • Stroke service rotation.
  • Selected subspecialty inpatient consultative services including infectious diseases, diabetes management, nephrology, cardiology, GI/hepatology and pulmonary are prioritized for learners on this pathway.
  • A general surgery hospitalist rotation is available; the medicine resident works with a surgery team to gain experience in evaluation and management of the most common postoperative complications and the issues specific to surgery patients.
  • Non-physician-based learning opportunities include wound care (evaluation and management of acute and chronic wounds), nutrition (methods and means of enteral/parenteral elementary support) and respiratory therapy (chronic ventilator management/weaning and available interventions) expand the versatility of the learner as a physician.

We also establish for each trainee an advisor/mentor with hospitalist faculty and the residency education team for portfolio enhancement and job searching.

Subspecialty Medicine Learner-Directed Pathway

Each subspecialty (Cardiology, GI, Allergy/Immunology, Geriatrics, Endocrinology, Hematology/Oncology, Infectious Diseases, Rheumatology, Women’s Health, Pulmonary/Critical Care, Sleep Medicine, Hospice and Palliative Care, Nephrology) offers our residents a Subspecialty Learner-Directed Pathway in their field. This learning focus, while meeting all ACGME and ABIM requirements for general internal medicine board eligibility, provides additional learning and experience in the inpatient, outpatient, and consultatory care of patients with acute and chronic illnesses and in research scholarship in the respective field.

This pathway is intended for residents who plan to practice, teach and/or do research in the subspecialty of their choice. Mentors in the field, e.g., division head, fellowship director, researchers and cinician-teachers, and our residency’s education team guide the residents through the available opportunities.

Inpatient, outpatient and research rotations ensure that residents have a broad array of experiences to affirm their interest. These electives greatly enhance a resident’s portfolio for fellowship application. Residents complete the program as well trained internists with significant research and quality improvement project experience. The two-year longitudinal subspecialty continuity clinic allows residents to learn how to care for patients with chronic diseases in an outpatient, multidisciplinary team and how to consult for other providers.

Residents may elect rotations from the following:

  • Subspecialty consult experiences: inpatient, outpatient or a hybrid with both
  • Focused subspecialty experiences (e.g., Heart Failure, Hepatology, Asthma, HIV, Alzheimer’s, Osteoporosis, Diabetes/Thyroid, Single Disease Hematology/Oncology Clinics, Palliative Care/Hospice, Acute Renal Care, Transplant) in their area of interest
  • Three dedicated research rotations in resident’s field of choice
  • A second continuity clinic in subspecialty or focused subspecialty of choice in PG-2 and PG-3 years
  • Relevant clinical electives in related fields
  • Quality improvement project in field of choice

Advising for fellowships, CV and portfolio building and mock interviews are done by faculty in the respective fields and the residency’s education team.

In Conclusion

The Internal Medicine Residency Program is devoted to its learners and helping them decide their true career path, by offering experiences in these Learner-Directed Pathways as well as other ad hoc elective opportunities so that our residents can choose which career path is best for them and be fully prepared to fulfill their professional goals upon graduation.