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House Staff Training Program

Overview

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.

This three year program 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 often in the subspecialties which allows trainees to learn each subject area from an expert in that field.

Clinical Experience at Tufts Medical Center and in the Community

The vast majority of the house staff rotations are at Tufts Medical Center. Trainees rotate through the medical subspecialties as well as the ambulatory care practices. House staff have several primary care block rotations at the Medical Center – Tufts Primary Care Boston (our internal medicine practice) and our walk in clinic. In the weekly continuity clinic, interns and residents follow their own patients, many of whom they took care of on their inpatient services.

Each trainee also spends some time rotating in a community hospital (MetroWest Medical Center). In this setting, house officers are exposed to community-based medicine and a diverse case load. In addition, there is one rotation at the Lemuel Shattuck Hospital, a state-operated facility providing care to the economically disadvantaged.

House Staff

The house staff at Tufts Medical Center is composed of a diverse group selected from a pool close to 3,000 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 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 hospitalist.

Clinical Opportunities

Internship

In conjunction with their residents and attendings, interns have primary responsibility for patient care. The interns have 13 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, Geriatrics, Hematology/Oncology, Gastroenterology, and Leukemia/Bone Marrow Transplantation Services. In general, interns are on long call until 8 pm every fourth night during these rotations.  There is one rotation through the Medical Intensive Care Unit.

We have instituted a “3+1” structure for interns so that each three week block is followed by a one week block of ambulatory and/or elective time. In addition, there are night float experiences.

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 one-week 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 7 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 Post Graduate Year

The second year consists of 17 three week blocks.  Residents do not have back to back ward rotations. Junior residents are responsible for the care and supervision of patients on the inpatient services. At 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.

In addition to these experiences, a substantial amount of ambulatory and non-inpatient time has been incorporated into the program. Junior residents have two blocks in the General Medical Associates ambulatory practice, and several subspecialty ambulatory experiences (including required rotations in Rheumatology and Endocrinology. Elective time is available as well. A day float and night float rotations also exist.

Third Post Graduate Year

The senior residency also consists of 17 three week blocks and 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, Geriatric service and in the Medical Intensive Care Unit at Tufts Medical Center.

There are two blocks in the General Medicine Associates, several outpatient rotations in medical subspecialty clinics, a month in the emergency room 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 at MetroWest Medical Center. The on-call requirements occur only during the inpatient rotations.

Additional Training 

With the addition of a new simulation center at the Tufts University School of Medicine, we have enhanced our educational curriculum with several new learning experiences.  All incoming interns participate in an OSCE and central line training session to improve their patient care skills.  All second year residents participate in mock code and high urgency clinical scenarios to enhance their performance in these challenging situations.  Each year we have been expanding our physical diagnosis teaching as well.  These programs are expanding every year.

Research Opportunities

There are opportunities for the house staff to become involved in research, using elective time for research projects. Our faculty is always willing to have house officers spend elective time becoming involved in various research 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.

If you are interested in learning more about our research opportunities, please download the Department of Medicine annual report.

Teaching Opportunities

The program leadership believes that residents should become good teachers because good teachers make good doctors.  Accordingly, we have a strong residents as teachers program. Our program has several key components:

  • Semi-annual teaching workshops during the general medicine ambulatory block covering topics like teaching clinical reasoning, bedside teaching, and giving feedback.
  • A teaching workshop during intern orientation
  • A rising second year resident retreat with workshops on work rounds and bedside teaching, feedback, running codes, and leadership, as well as other topics pertinent to becoming a team leader
  • Work rounds observation of 2nd year residents by the chief residents
  • At least one ambulatory co-precepting experience where 2nd year residents serve as ambulatory clinic preceptor to 4 colleagues with the actual preceptor as back-up

Additional opportunities:

  • Renal pathophysiology small group facilitator: Several house officers have taken advantage of the opportunity to lead small group sessions in some of the second year medical school pathophysiology courses (and have received rave reviews).
  • Physical diagnosis teaching to second year medical students.

Ambulatory Training

Over the past several years, the ambulatory training has greatly expanded. Interns have several weeks of primary care in our on-site Internal Medicine practice (Tufts Primary Care Boston). Interns will also have experiences in Dermatology and Gynecology. During both the junior and senior years, there are two primary care ambulatory blocks with a variety of experiences in other related clinics. 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. Each house officer has an assigned preceptor in primary care under whose supervision they manage their panel of patients over time.  To minimize conflicts with inpatient responsibilities, house officers essentially do not have continuity clinic during their ward blocks.

Our Tufts Primary Care practice is located on site at the hospital which facilitates the ability of our house officers to become primary care providers. Almost all house officers rotate through Endocrinology and Rheumatology which are predominantly ambulatory rotations 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. We also have a new community based practice which will give our house officers exposure to primary care outside of the academic center.

Schedule

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 a.m. 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. Interns go to their on-site continuity clinic once a week (although less frequently when on the wards) while residents do not have continuity clinic when they are on the wards.

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 6 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 fourth night in-house call.  The non-inpatient rotations have minimal on call responsibilities.

Conferences + Lectures

In addition to regular 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 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 urgent medicine topics (intern boot camp) 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.

Rotations

PGY I
PGY II
PGY III
Bone Marrow Transplantation
X
Cardiology Inpatient
X
X
Continuity Clinic
X
X
X
Electives
X
X
X
Emergency Department
X
Gastroenterology Inpatient
X
X
General Medicine Inpatient
X
X
General Medicine -Shattuck Hospital
X
Geriatrics Inpatient
X
X
Hematology/Oncology Inpatient
X
X
Infectious Diseases Inpatient
X
X
MetroWest Medical Center - Ward Medicine

X
Medical Consults
X
Medical ICU - Tufts Medical Center
X
X
X
Nephrology Inpatient
X
X
Night Float
X
X
X
Primary Care Ambulatory Block
X
X
X
Pulmonary Inpatient
X
X
Rheumatology Outpatient
X
X
Subspecialty Ambulatory Blocks
X
X
X
Business Track
X
X
Medical Education Track
X
X

Salary + 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 for 2016-2017 are $57.830 for interns, $60,015 for junior residents and $62,830 for senior residents. House officers are provided four weeks of vacation per year.

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, the three week rotations, the 3+1 structure for interns 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.