Internal Medicine Subspecialties
NYM offers a wide variety of Subspecialties for Internal Medicine residents. Your options include:
Developing physicians who possess the skills and experience necessary for the increasingly important practice of ambulatory medicine is the primary goal of the teaching program. We stimulate our residents to provide patient care utilizing the skills and experience of the primary care practitioner. To accomplish this we create a continuity clinic for each member of our house staff, which is scheduled for two half-days per week. Residents will follow a panel of patients throughout their training and will discharge the patients they treated in the Hospital to their clinic practice. Continuity of care affords the practitioner the opportunity to observe and participate in the natural course of disease. It also provides residents with experience in how diseases affect the lives of patients and their families. Our physicians are expected to offer comprehensive care to their patients, including preventive medical strategies. Developing a close rapport with patients and helping them to maximize their health are the rewards treasured by dedicated primary care providers.
Ambulatory medicine also demands experience in a wide array of medical disciplines. To this end, residents will participate in a total of five months of intensive ambulatory block rotations during which they have no inpatient responsibilities. Trainees rotate through clinics in internal medicine and its subspecialties, including cardiology, pulmonology, endocrinology, gastroenterology, geriatrics, hepatology, hematology/oncology, infectious diseases, nephrology, neurology, and rheumatology. To gain valuable experience in the wider arena of medicine, residents participate in clinics in obstetrics and gynecology, neurology, adolescent medicine, dermatology, otolaryngology, psychiatry, orthopedics, and allergy and immunology.
Of course, didactic learning is part of any training program, and during ambulatory block rotations, residents conduct conferences covering all aspects of primary care medicine. In addition, emphasis is placed on social, psychological, economic, and compliance factors, which influence the outcome of medical treatment.
Finally, to bring all of their experiences back into focus, residents work with private practitioners in their offices. Also, during their block time, senior residents are given the opportunities to rotate in a nursing home affiliated with the Hospital. In this setting, they get hands-on experience learning about chronic care management and physical therapy/rehabilitation in a skilled nursing facility.
The Division of Cardiology has undergone significant growth over the past few years, culminating in the establishment of an independent fellowship program in cardiology on July 1, 2005. Full time physicians who staff the division are responsible for the consultation services, the outpatient clinics, the cardiac catheterization laboratory, interventional cardiology services, the electrophysiology laboratory, supervision of the CCU and the telemetry unit, and ancillary services such as EKG, echocardiography, stress testing, Holter monitors, tilt-table testing and cardiac MRI. There are several active research projects in the division, including national cooperative studies.
The division provides didactic teaching to the house staff through an extensive lecture series, conference schedule, journal clubs, and formal teaching rounds. Clinical skills are developed during rotations in the coronary care and telemetry units and participation in the Cardiology Clinic. The third-year rotation consultation offers an in-depth experience providing the resident with the competency needed by an internist in the area of cardiology. [top]
Three full-time physicians, along with community-based faculty in the division provide education in all aspects of endocrinology with emphasis on diabetes mellitus, thyroid disease, adrenal disorders, calcium and bone metabolism (including osteoporosis), reproductive endocrinology, and lipid metabolism. Our faculty teaches this curriculum during weekly endocrine conferences, noon lectures, ambulatory-care conferences in the endocrine clinic, and grand rounds. Multidisciplinary nutrition conferences are held monthly. An American Diabetes Association-recognized diabetes education and resource center provides further specialized training in the management of diabetes.
Residents on the endocrinology elective consult with patients and review the cases in detail with the attending physician. Thyroid scans and specialized laboratory tests are reviewed weekly during conferences and with the nuclear medicine staff. Residents attend the endocrinology clinic weekly. Diabetes education and preventive aspects of endocrine diseases are emphasized. This rotation exposes our residents to the breadth and depth of endocrine conditions and develops skills necessary to manage endocrine diseases.
Four full-time physicians on staff and voluntary physicians in the community practice of gastroenterology provide medical residents and fellows with a core curriculum in gastroenterology which integrates theory and practice. This is accomplished through a series of conferences and a lecture series on GI emergencies.
There is a well-supervised consultative service, a GI and Hepatology clinic, and a series of multidisciplinary conferences with the Departments of Surgery, Radiology, and Pathology. There is also a New York Methodist sponsored Fellowship in Gastroenterology. Our state-of-the-art endoscopy suite assures that residents have access to advanced laparoscopic technology. Services of the division are marketed through the Hospital's Institute for Digestive and Liver Disorders. [top]
The division of geriatric medicine has over a dozen board-certified geriatricians on its teaching faculty and a fully accredited fellowship program with two fellows enrolled. The division provides residents with a core curriculum in all aspects of geriatric medicine.
Throughout the residency, issues in geriatric medicine are emphasized in grand rounds, sub-specialty rounds, morbidity and mortality conferences, journal club discussions, and a series of didactic lectures at noon conferences. Many of the lectures given by internal medicine subspecialists incorporate specific issues relevant to geriatric patients.
During an assignment to the acute geriatric care unit, residents are part of a multidisciplinary team and gain skills in geriatric assessment (cognitive and functional), general principles of geriatric rehabilitation, psychosocial aspects of aging, polypharmacy, the economics of support services, and ethical and legal issues pertinent to geriatric medicine. In addition, residents become familiar with aspects of preventive medicine, including nutrition, exercise, screening, and immunization. Special emphasis is placed on the treatment of common syndromes of interest to geriatricians including, but not limited to, memory disorders, falls, incontinence, osteoporosis, dysthermias, sensory impairment, decubitus ulcers, and malnutrition.
The hematology/oncology division is staffed by full-time and voluntary physicians, all involved in the division's teaching activities. Three fellows are active in an approved fellowship program in the division.
New York Methodist has a thirty-seven bed dedicated hematology-oncology unit. All inpatient chemotherapy is administered in this unit. In addition, there is an outpatient unit for daily delivery of chemotherapy and blood products. The residents rotating through this unit or on an elective are exposed to a wide variety of hematologic and oncologic diseases. They work closely with the fellows and participate in daily bedside rounds with a member of the divisional faculty. The rotation offers instruction in bone marrow aspiration and interpretation, blood bank procedures, problems related to coagulation defects, and diagnosis and treatment of hematologic and oncologic disorders.
Residents participate in divisional conferences, including weekly evaluation of bone marrow slides, surgical pathology of cancer biopsies, journal club, radiology-oncology conference, and tumor board sessions.
Medical residents are encouraged to participate in clinical research activities. In addition, many of our patients are enrolled in treatment protocols from national cooperative study groups. [top]
Full time and voluntary attending physicians are involved in resident education. Third-year residents on the ID service will participate in the busy consultative service and two weekly outpatient clinics. The core curriculum is delivered during these rotations as well as through noon lectures and subspecialty conferences. Residents evaluate patients and then discuss them in detail with attending physicians. Emphasis is placed on the history and physical exam, consideration of both infectious and non-infectious causes of a patient's problems, appropriate use of antibiotics, and on the microbiology laboratory's usefulness in diagnosis and management.
For HIV+ patients in particular, we stress comprehensive care, including psychosocial support.
The division of nephrology runs an active service, providing consultations in hypertension, electrolyte disorders, and renal diseases. The faculty in nephrology manages a large group of patients who expose residents to a wide variety of common and uncommon renal problems. Several board-certified nephrologists provide didactic teaching in nephrology. Nephrology is taught through daily rounds, noon lectures, outpatient clinics, case presentations at morbidity and mortality sessions, and journal clubs.
New York Methodist Hospital has a seven-bed acute dialysis unit. In addition, The Rogosin Institute administers an adjacent twenty-station outpatient dialysis unit. Our residents are involved in common procedures in nephrology such as hemo- and peritoneal dialysis, CAVH, plasmapheresis, and renal biopsies. Opportunities for resident research are available. [top]
Learn more about our Fellowship Opportunities
The division of Pulmonary and Critical Care Medicine includes board certified full-time and voluntary physicians who are experienced teachers and clinicians. Admissions for pulmonary conditions exceed 1500 patients per year and over 2,000 patients per year are seen on consultation. The division includes an ACGME-accredited three-year pulmonary and critical care fellowship program with six fellows enrolled. The fellows are expected to perform consultations and manage pulmonary and critical care patients under the close supervision of the attending faculty.
Facilities include a thirty-bed critical care unit and a twenty-bed non-invasive and invasive respiratory care unit. A state-of-the-art sleep center, video bronchoscopy unit, exercise physiology lab, and pulmonary function testing unit (including high altitude oxygen titration studies and cold air challenge studies) round out our facilities. Fellows are trained in the technique of thoracentesis and in the use of mechanical ventilators. In addition, fellows participate in pleural biopsies, medical thoracoscopies, percutaneous tracheotomies, and bronchoscopies.
The division conducts daily management and teaching rounds and provides an academic environment through daily didactic lectures, conferences, and research activities. A rotation through the division assures a rich experience in the care of the critically ill as well as exposure to a wide variety of acute and chronic pulmonary diseases.
The Rheumatology Division has two principal activities: first, the clinic which runs two days per week and is staffed by an attending physician, medical residents, and medical students, and second, the consultation service on the in-patient units.
The rheumatologic history and physical examination are emphasized. All patients are presented to the attending physician in a formal fashion and management is discussed in depth. Radiologic studies are reviewed and discussed with the attending physician. Diagnostic (arthrocentesis) and therapeutic (injection of joints, tendons, bursae and trigger points) procedures are conducted under the supervision of the attending physician. Rheumatology conferences are held monthly.
Many outpatients are seen in the Hospital's Spine and Arthritis Center. [top]
All medical residents rotate through the Emergency Department. They work with emergency medicine residents and are supervised by full-time emergency physicians. A Neurosciences rotation offers experience in Neurology, Physical Medicine/Rehabilitation, and Psychiatry.
Because the program structure is built on the need to develop internists capable of providing primary care to patients, it is designed to provide expertise in delivering such care, emphasizing out-patient as well as in-patient management. Training is also available in ambulatory services not specifically in the sphere of internal medicine, such as adolescent medicine, dermatology, ENT, office gynecology, and ophthalmology.
Medical residents at New York Methodist have the opportunity to work at Memorial Sloan-Kettering Cancer Center (MSK), a world renowned cancer care and research institution. Residents at all levels of training rotate through the floors and the ICU at MSK. At the PGY3 level, electives are available in hematology/oncology, infectious diseases, nephrology, dermatology, endocrinology, gastroenterology, pulmonary medicine, urgent care, and general medicine. [top]