Training Program
Residency Training Program
The Medical House Staff Training Program at Tufts Medical Center provides exceptional training in Internal Medicine in preparation for careers in general medicine, medical subspecialties, academic medicine and clinical investigation. We do not offer a preliminary year. The program, consisting of three postgraduate years usually taken sequentially, offers direct patient care responsibility under close full time faculty supervision in an academic setting. The goals of the program are to optimize house officers clinical skills, knowledge base, problem solving abilities, clinical judgment, and patient interactions. Many of the rotations, both inpatient and outpatient, are set up along subspecialty lines. This emphasis on concentrated learning in a given subject area with teaching given by an expert in the area results in a well rounded internist.
The vast majority of the house staff rotations in all three years is at the Tufts Medical Center. A small amount of outside experience is designed to complement the education at the tertiary care center. Most of these blocks are at the Brockton Hospital, a Tufts-affiliated community hospital. In this setting, house officers are exposed to the community based practice of medicine. In addition, there is one rotation at the Lemuel Shattuck Hospital, a state-operated facility providing care to the economically disadvantaged. These outside rotations balance the experience at the Center and broaden the house staff's education.
Internship
In conjunction with their residents and attendings, interns have primary responsibility for patient care. The interns have fourteen rotations over the course of their year. The experiences include ward rotations at Tufts Medical Center on the Cardiology services, General Medicine Service, Renal, Pulmonary, Infectious Diseases, Hematology/Oncology, Gastroenterology, and Leukemia/Bone Marrow Transplantation Services. Interns are on call until 8 pm every fourth night during these rotations. There is one rotation through the Medical Intensive Care Unit. In addition, there are elective blocks, night float experiences and several ambulatory blocks, in the General Medicine Associates, in our walk-in clinic and in the emergency room. The internship starts approximately ten days prior to July 1 to facilitate the transition of the house staff. As a result, throughout the year there is a 10 day period between the intern switch and the resident switch to allow for better continuity of care. At the end of the year, the interns will have 10 days off prior to starting their residency. Interns successfully performing the duties of their initial year of training are expected to continue in the program.
Second Postgraduate Year
Junior residents are responsible for the care and supervision of patients on the inpatient services. At the Tufts Medical Center they rotate through the Cardiology, Pulmonary, Infectious Diseases, Gastroenterology, Renal and Hematology/Oncology services as well as the Medical Intensive Care Unit. At Brockton Hospital, one or two rotations are available in the Intensive Care Unit. In addition to these experiences, a substantial amount of ambulatory and non-inpatient time has been incorporated into the program. Junior residents have one or two blocks in the General Medical Associates ambulatory practice and several subspecialty ambulatory experiences. Elective time is available as well. A day float has been instituted to cover the ward residents when they are in their continuity clinic.
Third Postgraduate Year
The senior residency is designed to complement the first two years of intensive training in inpatient medicine with an emphasis on ambulatory medicine. At present, the senior year consists of inpatient experiences on the General Medicine service and in the Medical Intensive Care Unit at Tufts Medical Center. There are two blocks of emergency medicine, two blocks in the General Medicine Associates, outpatient rotations in Endocrinology and Rheumatology, three additional subspecialty ambulatory rotations, and an experience as the medical consultation resident. There are several blocks of elective time with opportunities for research projects. There is currently one rotation on the General Medicine Service at the Lemuel Shattuck Hospital and one or two at the Brockton Hospital. The on-call requirements occur only during the inpatient rotations.
Daily Schedule
A typical day on an inpatient service starts at 7:00 a.m. when the interns get "sign out" from the previous night and also have their new admissions from the night float transferred to them. Work rounds are held from 7:15-9:00. Morning report is held daily from 9-10 a.m.. Attending rounds are held daily, usually between 10:30 and noon. During this period, each team has time to review x rays with a Radiology attending. House staff noon conferences are held Monday through Thursday with Medical Grand Rounds on Friday. In the afternoon, house staff care for their patients and start to work up their admissions for the day. House officers go to their on-site continuity clinic once a week.
Call Schedule
On the ward rotations, the call schedule is every fourth night with an extensive night float system. Long call admits until 8 p.m. When the long call house officers' work is done, they go home, usually between 9-10 pm. The inpatient services are covered at night by two intern night floats who do cross coverage from 7 p.m. - 7 a.m. the following day. Three resident night floats (2 juniors and 1 senior) back up the interns and do all of the admissions to the medical service after 8 p.m. The Medical Intensive Care Unit is self contained and has every third night in-house call. The non-inpatient rotations have minimal on call responsibilities.
Ambulatory Training
Over the past several years, the ambulatory training has greatly expanded. Interns have block primary care rotations in both the General Medicine Associates and our walk-in clinic. As an intern, they see patients with an attending physician during the urgent care sessions and also have rotations through Dermatology, Geriatrics and Gynecology. During the junior and senior year, there are additional primary care ambulatory blocks. A series of conferences is held for all block residents. In the weekly continuity clinic, interns and residents are expected to follow their own patients many of whom they took care of on their inpatient services. In the outpatient setting, house officers are able to follow patients over time under the supervision of an attending from the General Medicine Associates. The Endocrinology and Rheumatology rotations are predominantly ambulatory in nature and several other subspecialty ambulatory blocks are scattered throughout the three years. Our goal in these blocks is to expose the house staff to the common problems for which a general internist might seek a subspecialty consultation.
Conference Schedule
In addition to regular teaching attending rounds, a variety of teaching sessions are oriented toward the house staff. Morning Report is a unique session geared to improving the clinical problem solving skills of the residents. It is run by the Chief Residents with attendings on a rotating basis. Every Friday, Morning Report is supervised by Dr. Jerome Kassirer, formerly Vice Chairman of the Department of Medicine and then Editor-in-Chief of the New England Journal of Medicine. Medical Grand Rounds are held on Fridays and on the other days of the week, a house staff noon conference is held. During the summer months, these conferences are geared toward emergency medicine topics and during the rest of the year a wide variety of subjects are covered. There is an ongoing series of electrocardiography and basic radiology sessions. Ethics and morbidity and mortality conferences are held as well as a regular Journal Club with the goal of teaching the house staff how to critically read the medical literature. There is a separate primary care conference schedule for both the continuity clinics and for the block rotations. The subspecialty divisions all have a variety of conferences at which the house staff are always welcome.
Research
There are opportunities for the house staff to become involved in research on a limited basis. Our faculty is always willing to have house officers spend elective time becoming involved in various projects. House officers will receive support to attend national meetings if their material is selected for presentation. The clinical investigator pathway as outlined by the American Board of Internal Medicine is available to interested house staff. This should be discussed with the Program Director at an early stage.
House Staff
The house staff at Tufts Medical Center is composed of a diverse group selected from a pool of approximately 700-800 applicants. Over the past 8 years, we have accepted graduates of 65 medical schools into our program all with a broad range of interests and goals. Approximately 70% of our graduates enter subspecialty internal medicine fellowships, about half of which are at own institution. Many graduates go on to further training at other major medical centers across the country and in specialized programs such as the National Institutes of Health, the Robert Wood Johnson Clinical Scholars Program, and the Centers for Disease Control. Many of the graduates of our program stay in academic medicine and many others retain some academic affiliation. Over past the past few years an increasing number of our residents have pursued careers in primary care, many of whom have joined our faculty or as a hospitalist..
The Future of the Program
We constantly revise the training program for house staff to maximize its educational value and to optimize the quality of patient care. A house staff review committee composed of faculty and house officers meets regularly to assess the program and make recommendations for changes. Many of our current rotations such as the night float system, the Endocrinology, Rheumatology and other ambulatory rotations and the medical intensive care unit team emanated from proposals by this committee. The rotations outlined in this brochure are a working plan. Because changes may be required due to unforeseen events, the Chairman of the Department and the Program Director reserve the right to alter the program as necessary.
Remuneration and Fringe Benefits
The hospital provides a comprehensive flexible benefits program that includes health insurance, full maternity benefits, uniforms, laundry, on-call rooms, and malpractice insurance for all assigned rotations. The stipends as of July 1, 2009 are $47,266.70 for interns, $49,168.08 for junior residents and $51,551.50 for senior residents. House officers are provided three weeks of vacation per year. Please see benefits information.
Available Rotations
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PGY I |
PGY II |
PGY III |
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General Medicine Inpatient |
X |
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X |
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Cardiology Inpatient |
X |
X |
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Nephrology Inpatient |
X |
X |
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Gastroenterology Inpatient |
X |
X |
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Pulmonary Inpatient |
X |
X |
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Hematology/Oncology Inpatient |
X |
X |
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Bone Marrow Transplantation |
X |
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Infectious Diseases Inpatient |
X |
X |
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Medical ICU - Tufts Medical Center |
X |
X |
X |
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ICU - Brockton |
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X |
X |
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General Medicine - Shattuck Hospital |
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X |
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Emergency Department |
X |
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X |
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Night Float |
X |
X |
X |
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Primary Care Ambulatory Block |
X |
X |
X |
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Continuity Clinic |
X |
X |
X |
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Endocrinology Outpatient |
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X |
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Rheumatology Outpatient |
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X |
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Subspecialty Ambulatory Blocks |
X |
X |
X |
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Medical Consults |
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X |
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Electives |
X |
X |
X |