Internal Medicine Subspecialties
One of the primary goals of the teaching program is to train physicians to attain the skills and experience necessary for the increasingly important practice of ambulatory medicine. To accomplish this, we create an individual "office" for each member of our house staff. Residents are scheduled to see patients in the Medical Clinic two half-days each week, and these sessions remain the same throughout the three years of training. Residents follow a panel of patients throughout their training, and discharge the patients they treat in the Hospital to their own office practices. 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.
Ambulatory medicine also demands experience in a wide array of medical disciplines. To this end, residents 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 also participate in clinics in obstetrics and gynecology, adolescent medicine, dermatology, otolaryngology, orthopedics, and allergy and immunology.
Didactic learning is part of any training program and during ambulatory block rotations residents are exposed to daily conferences covering all aspects of internal medicine. In addition, emphasis is placed on social, psychological, economic, and compliance factors, which may influence the outcome of medical treatment. Ideal internal medicine physicians must be educators, problem solvers, and advocates for each person for whom they provide care.
Finally, to bring all of their experiences back into focus, residents work with private practitioners in their offices. During their block time, senior residents are also given the opportunity to observe care in one of the nursing homes affiliated with the Hospital.
Our Hospital has been at the forefront of incorporating electronic medical records (EMR) into the ambulatory care setting. In the medical clinic, all progress notes and prescriptions are put into the Hospital's clinical information system. The incorporation of EMR into the outpatient setting has improved our approach to documentation, medication safety, chronic disease management and preventive care.
Full-time physicians who staff the Division of Cardiology are responsible for the consultation services, the outpatient clinics, the three state-of-the-art cardiac catheterization laboratories, the electrophysiology laboratory, supervision of the CCU and the telemetry unit, and the ancillary laboratory services (EEG, echocardiography, cardiac MRI, stress testing, Holter monitors and tilt-table testing). Currently, there are over twenty board-certified cardiologists on the staff. The division is involved in several active research projects, including some national cooperative studies.
The division provides didactic teaching to the resident physicians through an extensive lecture series, conference schedule, Journal Club and formal teaching rounds. Clinical skills are developed during rotations in the coronary care and telemetry units and through participation in the cardiology clinic.
The third-year consultation rotation offers an in-depth experience, providing the resident with the competency needed by an internist in the area of cardiology. We also offer ACGME-accredited fellowship training in cardiovascular diseases, interventional cardiology and electrophysiology. Services of this Division are included in the Hospital's Institute for Cardiology and Cardiac Surgery.
Full-time physicians on staff and voluntary physicians in the Division provide education in all aspects of endocrinology with an emphasis on diabetes mellitus, thyroid disease, adrenal disorders, calcium and bone metabolism (including osteoporosis), reproductive endocrinology and lipid metabolism. The curriculum includes 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 center
provides further specialized training in the management of diabetes.
Residents on the endocrinology elective consult with patients and review cases in detail with the attending physician. Thyroid scans and specialized laboratory tests are reviewed weekly during conferences 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 the skills
necessary to manage endocrine diseases. Services of this Division are included in the Hospital's Institute for Diabetes and other Endocrine Disorders.
Full-time physicians on staff and voluntary physicians in the Division of Gastroenterology (GI) 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 weekly GI clinic, a weekly hepatology clinic, and a series of multidisciplinary conferences with the Departments of Surgery, Radiology and Pathology. Medical residents have the opportunity to observe and assist fellows and attending physicians in procedures, including ERCP, and endoscopic ultrasound, hepatology, esophageal manometry, inflammatory bowel disease, EGD, celiac disease, and gastroenterology research. There is a fully integrated fellowship program with Interfaith Medical Center. A recently opened four-room endoscopy suite with state-of-the-art equipment assures that patients have access to advanced endoscopic technology. Services of the Division are included in the Hospital's Institute for Digestive and Liver Disorders.
The Division of Geriatric Medicine has more than a dozen board-certified geriatricians on its teaching faculty and a fully accredited fellowship program. The Division provides residents with a
core curriculum in all aspects of geriatric medicine, including end-of-life and palliative care.
Throughout the residency, issues in geriatric medicine are emphasized during grand rounds, subspecialty rounds, morbidity and mortality conferences, Journal Club discussions and lectures at noon conferences. Many of the lectures given by internal medicine subspecialists
incorporate specific issues relevant to geriatric patients.
One inpatient service maintains a clinical focus on geriatric patients. During assignment to this 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 in the elderly. Special emphasis is placed on the treatment of common syndromes of interest to geriatricians including memory disorders,
falls, incontinence, osteoporosis, dysthermias, sensory impairment, decubitus ulcers and
malnutrition. Services of this Division are included in the Institute for Healthy Aging and the Institute for Neurosciences.
The Division of Hematology/Oncology is staffed by full-time and voluntary physicians, all involved in the Division's teaching activities. Three fellows are active in an ACGME-approved fellowship program in the Division.
New York Methodist Hospital has a 37-bed inpatient unit dedicated to hematology/oncology. All inpatient chemotherapy is administered in this unit. In addition, there is an ambulatory infusion center for outpatients needing chemotherapy, other types of intravenous medication and/or blood products. The residents rotating through the inpatient service 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, radiologyoncology
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. Services of this Division are included in the Hospital's
Institute for Cancer Care.
Full-time and voluntary attending physicians in the Division of Infectious Diseases are involved in all resident education. The third-year resident on the infectious diseases 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 conferences and subspecialty conferences. Residents evaluate patients and then discuss them in detail with attending
physicians. Emphasis is placed on history and physical examination, consideration of both infectious and non-infectious causes of patients' problems, appropriate use of antibiotics, and on the microbiology laboratory's usefulness in diagnosis and management. For HIV-positive patients in particular, we stress comprehensive care, including psychological 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 nine-bed acute care dialysis unit. An outpatient dialysis unit, with more than 20 beds, is managed by the Rogosin Institute, a premier not-for-profit medical treatment and research institution for kidney disease affiliated with NewYork-Presbyterian Healthcare System.
The Division of Pulmonary, Critical Care and Sleep Medicine includes board certified full-time and voluntary physicians who are experienced teachers and clinicians. Over 1,500 patients are admitted for pulmonary conditions annually 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 nine fellows enrolled. The residents and fellows are expected to perform consultations and manage patients with lung disease under the close supervision of the attending faculty.
Facilities include a 10-bed medical intensive care unit and a 30-bed pulmonary medicine step-down unit. A state-of-the-art sleep disorders center, video bronchoscopy unit, exercise physiology lab and pulmonary function testing unit round out our facilities.
The Division also offers interventional pulmonology and pulmonary rehabilitation services and a pulmonary hypertension center.
Residents are trained in the technique of thorocentesis and in the use of mechanical ventilators. In addition, residents participate in pleural biopsies and bronchoscopies. The Division conducts daily management and teaching rounds and provides an academic environment through didactic
lectures, conferences and research activities.
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. Services of this Division are included in the Hospital's Institute for Asthma and Lung Diseases.
The Division of Rheumatology's primary activities include staffing the outpatient rheumatology clinic and the inpatient rheumatology consultation service.The clinic is open to patients two days a week and is also staffed by two attending physicians, medical residents and medical students.
The rheumatologic history and physical examination are emphasized in patient care. All patients are presented to the attending physician and management is discussed in depth. Radiologic studies are reviewed and discussed with the attending physician. Diagnostic procedures (arthrocentesis) and therapeutic procedures (injection of joints, tendons, bursae and trigger points) are conducted under the supervision of the attending physician. Rheumatology
conferences are held monthly. Most rheumatology outpatients are seen in the Hospital's Spine and Arthritis Center, which provides residents with excellent training in an ambulatory setting.
All medical residents rotate through the Emergency Department, where they work with emergency medicine residents and are supervised by full-time attending emergency medicine physicians.
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