The curriculum for the internal medicine resident is designed to cover all areas of internal medicine and its subspecialties. The curriculum addresses all of the requirements of the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education.

The schedule is divided into 13 four-week blocks for each year. The typical schedule for each year of training is listed below. Rotation duration will vary based on patient care needs and individual resident’s rotation schedule history and interests. Over-night continuity of care is provided by a night float team, with in-house overnight call limited to the Medical Intensive Care Unit (MICU).

First Year Medicine Residency (PGY-1)

The PGY-1 curriculum supplies fundamental clinical skills for the future internist. This is accomplished through the provision of supervised care for acutely ill patients in both the inpatient and outpatient settings. The trainee develops confidence in the care of patients with many and varied complex clinical problems. Integrative problem-solving skills and a broad range of clinical tools are thus acquired by the intern, all of which are supplemented by exposure to a structured didactic curriculum.

Second Year Medicine Residency (PGY-2)

During the PGY-2, junior residents become team leaders on inpatient general medicine, inpatient specialty medicine, and in the intensive care units, where they learn to direct a health care team in the management and care of patients. This system facilitates the integration of the cognitive and organizational skills necessary for clinical independence, the development of accurate differential diagnoses and the synthesis of effective therapeutic plans. The number of ward rotations decreases to foster development of fluency in the sub-specialties of internal medicine.

Third Year Medicine Residency (PGY-3)

PGY-3 training is designed to fine tune leadership, decision-making and teaching skills, through increased autonomy. Rotations in the sub-specialties of medicine and supervisory roles on all services facilitate development of the skill-set necessary to transit into the practice of internal medicine or pursue additional training in a sub-specialty fellowship program. Ambulatory clinical development is also emphasized through a two-month ambulatory clinic block rotation.

Ambulatory medicine is a crucial component of any internal medicine residency program. We prepare our residents for the care of patients in the outpatient arena in a variety of platforms, including urgent care clinic, subspecialty outpatient medicine rotations and the resident physician's continuity care practice. The latter averages one half day per week over the 36 month residency and allows the resident to provide care to his/her own panel of patients under the guidance of the internal medicine faculty. Residents do not see patients in their outpatient practice during their MICU or night float rotations.

An integral part of the Ambulatory Rotation is protected time devoted to Quality Improvement activities as well as research. Here residents spend time developing and participating in Practice Based Learning Improvement (PBLI) projects. Residents learn to investigate and evaluate their care of patients, appraise and assimilate scientific evidence, and continuously improve patient care based on constant self-evaluation and life-long learning. The results of PBLI projects can then be submitted by residents for presentation at local, regional and national meetings.

Residents will have the opportunity to participate in the care of homeless adults in the City’s Sulzbacher Center, an outreach to the downtown community, under the direction of its Medical Directors. Residents will learn about healthcare disparities that affect socioeconomically disadvantaged populations through a didactic web-based curriculum.

The ultrasound guided procedure rotation is intended to acquaint the medical resident with a wide variety of procedures performed while on the inpatient wards service. Faculty supervise and evaluate residents throughout the rotation. Bedside ultrasound is an integral part of many procedures, including central lines, paracentesis, thoracentesis, mid-line placements and anatomically-difficult lumbar punctures. Residents will go through a methodical training regimen consisting of pre- and post-tests, procedural knowledge and technical skills acquisition, full simulation training using high-fidelity simulators, and patient procedures. Throughout the rotation the resident receives feedback and is able to learn and teach others the intricacies and troubleshooting of individual procedures.

The 2-week quality improvement and patient safety rotation has components of QI/patient safety didactic sessions, Hospital Committee participation, mentorship, self-study in the Institutes for Healthcare Improvement (IHI) Open School modules, and development of a QI project that is to be presented at the end of the rotation. Residents work with our Office of Research Affairs for the purposes of learning how to combine research and quality improvement. Lastly, they participate in simulations to practice evaluating systems errors and develop processes for improvement.

The night float rotation is an effective solution to meeting the duty hour requirements mandated by the ACGME, as well as providing trainees with after-hours decision-making opportunities. The duties of the night float intern provide the trainee with the experience necessary to make acute, inpatient care decisions, of a broad range of severity. The senior night float resident supervises and supports the night float intern. The cardiology night float resident provides after hours management experience with potentially unstable cardiac patients, as well as cross cover decision-making in more stable cardiology patients. Night float teaching rounds with the program leadership keep the educational spirit of the rotation viable, and provide continuous feedback between the night float team and the residency leadership group.

Mega teams on inpatient general medicine is a program that uses a mega team concept for structuring ward teams on inpatient general medicine. Mega teams facilitate the conduction of effective work rounds and allow for easy cross coverage for days off, clinic, etc. By increasing the number of senior residents per team from one to two, every intern has a designated senior resident partner for the month (as opposed to one senior for every two interns). Mega teams are used at the beginning of each academic year and greatly facilitate work rounds and bedside teaching by senior residents, allow interns a gradual adjustment to decision making in acute patient management, and facilitate patient care and a team concept by simplifying necessary absences from the service.

Research

Numerous research opportunities and participation in other meritorious activities are available for motivated trainees. The categorical curriculum includes a 2-week research rotation in the PGY-2 year that allows residents dedicated time to work on their own projects for 2 weeks under a faculty supervisor. It is preceded by a 2-week rotation devoted to an innovative quality improvement and patient safety didactic experience that is monitored by the program director, the chief residents and a patient safety fellow. Opportunities are available to perform research in clinical outcomes, quality improvement/patient safety, as well as in the basic sciences. Residents have participated in the presentation and publication of clinical vignettes, retrospective studies and in prospective clinical trials.

Faculty throughout the department of medicine assist trainees in developing projects and provide guidance and advice on abstract submissions, presentations at local and regional meetings and manuscript preparation. Each incoming intern is assigned a faculty mentor based on the intern’s career goals that they can turn to for direct aide as well as fostering connections to additional faculty when appropriate for more nuanced expert help. The new internal medicine research club offers a laid-back environment that permits trainees to present new ideas for original research to a group comprised of fellow trainees as well as members of the IRB and collected faculty to facilitate the development of high-quality research proposals.

Every spring, a Research Day is held on campus, with residents and fellows from all disciplines presenting their work. Additionally, the UF College of Medicine – Jacksonville's annual Celebration of Resident and Fellow Education and Research Day allows for the promotion of investigation into fields such as quality improvement and advances in medical education techniques, methods and outcomes. Well-designed studies conducted in collaboration with the faculty have resulted in residents and fellows presenting their research at regional, national and international meetings. Funding is made available for these presentations and trainees are strongly encouraged to publish the results of their scientific projects.