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Internal Medicine Residency
2009-2010 Department of Medicine Faculty and Residents
Union Memorial offers 16 post-graduate year 1 positions (R1) in medicine, designating six of these positions to candidates seeking only one year of internal medicine training. The 10 categorical R1s rotate through the general medical service, critical care units, and the geriatric and cardiology services. They also spend one block (one block = 4 weeks) each at an ambulatory center based off campus in a working class neighborhood of East Baltimore, and Union Memorial’s outpatient clinic. There is one elective block. Preliminary year Rls have additional critical care experience, one block of ambulatory specialty clinic, and three elective blocks. All R1s as well as R2s do two weeks of "day float."
R1s are responsible for the care of approximately six to ten patients on the general medical service and four patients in the Critical Care Unit. Supervision for R1s is provided by the senior resident, the chief resident and the faculty. R1 night call averages every 6th night; every fourth night on call during the nine blocks of medical and critical care inpatient service and no call for the other four blocks. In addition to working with inpatients, RIs spend one afternoon weekly in the medical outpatient clinics, seeing many of the patients who have been discharged from their inpatient services. There are four weeks of vacation and six to eight weeks of subspecialty electives.
We offer 10 residency positions in each of the post-graduate second (R2) and third (R3) years. Second year residents are assigned to rotations on the general medical service, critical care units, neurology and the emergency department. Geriatric block time has been moved to the second year. One block is dedicated to outpatient medicine and two to three blocks are spent on subspecialty electives.
R3s have three ambulatory blocks and three blocks of inpatient responsibilities.
Four blocks are available for electives. R2s and R3s continue to attend their weekly continuity clinic where they follow their own patients. Night call averages every seventh night on an annualized basis for R2s and every tenth night for R3s. Vacations are four weeks in the second and third year.
Medical students and residents training in other disciplines add important dimensions to our teaching program. Union Memorial sponsors residencies in general surgery and orthopedics. Second and third year medical students from Johns Hopkins and first, second, third and fourth year students from the University of Maryland perform portions of their early clinical training with us. All GMS teams have two third-year medical students assigned to work closely with our PGY1s. A cap of two is kept on third year clerks per team to optimize teaching. Teams commonly have fourth-year students from many different schools performing medical sub-internships.
Internal medicine residents at Union Memorial Hospital receive a excellent outpatient care experience. Our clinic faculty stresses the role of the resident as the patient's primary caregiver, with support and advice from the attending physician.
 The Adult Medicine Center provides primary and specialty care for over 2,500 patients with more than 8,000 patient visits per year. Many of our patients have multiple, complicated medical problems. Because of its educational potential, the AMC is used as a teaching facility by the University of Maryland and the Johns Hopkins schools of medicine.
The primary care continuity clinic is run on a group practice model. Each house officer has clinic one afternoon per week. The resident builds a population of patients that he or she follows throughout residency training. The patients have access to their doctors through a phone mail system and coverage is provided by colleagues when the primary care physician is unavailable.
The Adult Medicine Center also provides care within the medical subspecialities. These include cardiology, dermatology, neurology, pulmonology, rheumatology, endocrinology, and gastroenterology. Residents see patients in these clinics during their rotations through the outpatient department and while on elective rotation in a particular specialty. Residents also see patients in busy opthalmology clinic and ENT practices while on the clinic rotation.
The AMC is a completely modern facility. All exam rooms are fully equipped for complete medical examinations, and the conference room is well-suited for case-oriented clinical teaching. The clinic has numerous computer stations with access to computerized medical records and the internet.
Residents at Union Memorial Hospital have access to the information needed to make the most informed clinical decisions as well as a collection of resources needed for their education and for doing research. These resources are available anywhere that offers internet access: on the MedStar network or offsite.
Access to patient information, available electronically, includes labs, transcribed dictation, radiology/cardiology images and reports, EKG tracings and reports, other diagnostic studies, pharmacy data and scanned ED notes. At MedStar Health, Medical Record Document Imaging (MRDI) is available onsite as well as offsite for chart entries and signature authorizations.
MedStar Health's IT strategy includes a comprehensive plan for the future. During the next few years initiatives include: wireless campus for clinical applications; ambulatory and oncology EMR; bar-coding for patient safety; new integrated systems for lab, pharmacy, surgery, anesthesia and critical care; and progression toward a computerized physician order entry system.
MedStar's Online Clinical Library provides access, both onsite and offsite, to electronic resources for drug information, evidence-based medicine, point of care, full-test textbooks and more the 400 full-text journals.
The Medical Library at Union Memorial also houses an extensive print collection of books, journals and study guides. The library provides wireless access for personal computers and PDAs. Staff also provides training and education on and ad-hoc basis as well as bi-monthly library sessions that are integrated into the teaching program. Because patient education is important, we provide a separate library of current consumer health information and public computers throughout the hospital for patients and visitors. Library staff also works with clinicians to provide the most appropriate resources for each patient.
 July 2008 saw the first procedural instruction using mannequin simulation. This is being done in cooperation with the Union Memorial and Washington Hospital Center emergency medicine departments. We anticipate having all complex medical procedures in this fashion, often using ultrasound guidance as illustrated in the IV central line procedure in the photo at right.
For more information about residency opportunities at Union Memorial Hospital, please call 410-554-2284 or email fran.violanti@medstar.net. All applications for training must be made through ERAS.
Dr. Cynthia Buchman-Webb is training residents at Union Memorial hospital how to gain access to central veins.
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