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Our curriculum is designed to equip residents with the skills to be competent and confident physicians prepared to sit for the American Board of Internal Medicine (ABIM) examination. We also offer optional training in Osteopathic Manipulative Therapy (OMT) to both allopathic and osteopathic residents interested in musculoskeletal medicine.
The curriculum emphasizes focused learning in inpatient and outpatient settings. In 2020, we moved to a “3+1” block scheduling system, where residents are split up into four “firms” and are scheduled for 3 week blocks of an inpatient service (including ED or ICU) or elective, followed by a 1 week ambulatory block rotation that occurs 13 times a year.
This model allows for focus on scheduled rotations with limited cross-coverage, opportunities for wellness and self-care and improved continuity with patients in clinic.
Residents rotate with a core of teaching attendings on the wards and in continuity clinic. Teaching attendings take residents to the bedside and engage patients, family and nursing staff to provide patient-centered care. In the continuity clinic, residents
participate in team-based care with medical assistants, nurse practitioners, nurses and IM faculty.
In addition to our general internal medicine training, we offer several pathways (led by core faculty) to help individualize learning and prepare residents for their future career goals. Information for our specific pathways can be found below.
The ambulatory experience occurs in 1 week blocks every 4 weeks (13 blocks a year) throughout the year. Here, residents spend time in continuity clinic as well as other educational settings to enhance practice and understanding of primary care (see below). This allows residents to experience all aspects of ambulatory care, including acute illness care, routine continuity and chronic disease management, post-hospital discharge and health care transitions and subspecialty care in nephrology and infectious disease. Some unique features of our ambulatory curriculum include:
Academic Internal Medicine Partners Continuity Clinic
Residents are precepted in continuity clinic by Internal Medicine (IM) faculty at both Academic Internal Medicine Partners (AIMP) clinic locations. AIMP has two Lawrenceville locations, one at GMC Health Park across the street from the Northside Hospital Gwinnett campus and one location attached to the hospital on the Gwinnett campus. Residents build a patient panel at the practice which they will follow throughout their residency program. Many of the patients are recruited during a resident’s inpatient ward experience and continuity in transition into the outpatient setting is maintained.
Foundations in General Internal Medicine Curriculum
Residents on ambulatory and quality improvement rotations participate in an ambulatory morning report discussing core topics in ambulatory general internal medicine and evidence based medicine. Residents complete online pre-work and readings and discuss landmark articles and guidelines in a case based format.
Outpatient procedural training occurs both during acute visits when required and in our weekly Procedure Clinic in which residents learn and perform both simple and advanced outpatient procedures under the guidance of an experienced general/trauma surgeon.
Osteopathic Manipulative Therapy (OMT)/Musculoskeletal Clinic
Residents interested in musculoskeletal medicine can participate in weekly OMT/MSK clinic as well. The focus is on practical, hand-on experience in dealing with common musculoskeletal complaints that are abundant in all primary care practices. Residents learn common modalities of manual therapy, exercise therapy and supplemental medical therapy to optimize patients’ functional and quality of life.
Veterans Affairs Ambulatory Clinic
Through collaboration with the Atlanta VA Medical Center senior residents see patients at the Lawrenceville VA Community Based Outpatient Clinic during the ambulatory block to gain experience in the health care of veterans. This exposes residents to a unique patient population as well as a unique health care system.
Public Health/Tuberculosis Clinic
Perhaps one of the most unique experiences residents at Northside receive is working at the Gwinnett-Rockdale-Newton Public Health Preventative Health Clinic in Lawrenceville. Here, residents get the opportunity to treat patients with tuberculosis as well as other common chronic conditions, which are often diagnosed at presentation. Residents see cases of extrapulmonary TB from head to toe, including TB meningitis, peritonitis, Pott’s disease, genitorurinary TB and TB arthritis. Additionally, residents get to learn the fundamentals and practice of social medicine, as many of the patients in the clinic do not have insurance or any history of prior healthcare. Residents get to practice continuity of care as our patients from this clinic continue to follow us at AIMP after their tuberculosis is treated.
During this experience, residents also learn to place and read PPDs, read common x-rays and CT findings suggestive of TB, do home visits and directly observed therapy (DOT) and see opportunities for working with the Department of Public Health (DPH).
Academic Half Day
Residents have a dedicated educational block ("academic half day"), during their ambulatory week. This highly interactive small group session focuses on health promotion and disease prevention, advocacy and health equity, practice of evidence-based medicine, high value care, and point of care US (POCUS).
Hospital Noon Conference
Hospital noon conference occurs 3-4 times a week and focuses on inpatient medicine. Early in the year is focused on foundations of inpatient medicine primarily for PGY-1’s, while later in the year focuses on higher level diagnosis/management and board review.
Internal Medicine residents participate in a weekly Grand Rounds series that brings guest presenters, both locally and nationally, to talk about various topics in Internal Medicine.
Morning Report and Intern Report
During the week, residents participate in morning report, where cases from the night prior are discussed in depth. The focus of learning is on clinical reasoning and evidenced based diagnosis and management. Once weekly, there is a conference dedicated to interesting radiology or EKG findings seen in the past week.
Intern report is a once weekly interactive session, which focuses on clinical reasoning and the diagnostic process.
Patient Safety Conference
Once monthly, we have a patient safety conference where cases that highlight issues of patient safety are discussed. Residents learn the process of root cause analysis and the multifactorial nature of patient safety. Conferences end with discussion of institutional changes that can happen to prevent similar patient safety issues in the future, as well as discussion of implementation of prior changes from previous conferences.
As one of our most innovative rotations, the skills development block is a dedicated educational session in block 7 of intern year that aims to enhance physical exam skills, medical knowledge and clinical decision-making. The rotation takes interns through a variety of learning methods, including simulation, didactic lecture, game-based review and resident-led teaching. Residents teach and learn physical exam techniques, presentation skills, self-assessment and feedback skills and other tools to help them transition to the second half of the intern year. Topics covered during the block are based on a needs assessment determined by rotation feedback, in-training exams, and directly observed needs by faculty.
Simulation is one of the most important innovations in medical education in recent times. Northside Hospital Gwinnett has embraced simulation-based training in its residency programs and throughout the hospital. We have a growing and robust simulation center with cutting-edge technology, including multiple hi-fidelity simulators, a cardiopulmonary physical exam simulator, and procedural task trainers for central line placement, thoracentesis, paracentesis, lumbar puncture and knee/shoulder injections.
Internal Medicine residents also receive individual licenses for online instructional modules for point of care diagnostic ultrasound with the ability to practice on both real ultrasound and an ultrasound that simulates common pathologies.
Simulation sessions are held weekly on the ambulatory rotation, in academic half day, and at various times in the year including intern orientation and Skills Development. Internal medicine faculty, led by a faculty physician certified in simulation education, individualize simulation experiences to the needs of each resident to ensure they receive the most out of simulation training.
Resident as Teacher/Personal-Professional Development Series
Residents have multiple opportunities to grow as educators throughout their training. During inpatient general medicine wards and cardiology service, residents will supervise 3rd and 4th year medical students. Senior residents also serve as team leaders and managers of the inpatient team, supervising interns in Internal Medicine and Transitional Year programs.
Retreats are held on a semi-annual basis that focus on team building, leadership, and teaching methods to improve skills as a team managers and educators.
Structure of the ward teams include PGY 3 senior residents who serve as the team educators, leading teaching sessions with residents and students and teaching core inpatient medicine topics. Senior residents may also take a senior teaching elective in either their PGY2 or PGY 3 year, where they spend 2-4 weeks working on an educational project. Past projects have included night float and ultrasound curricula and a resident needs assessment.
Towards the second half of the year, rising PGY 2 and PGY 3 class split up in interactive sessions which focus on personal and professional development, and being a team leader and educator. These have been well received and our series has been presented nationally at educational conferences.
Residents have ample exposure to geriatrics during their residency training. Each resident will complete a geriatrics rotation, where they rotate at Northside Gwinnett Extended Care Center, located on the Northside Hospital Gwinnett campus, caring for sub-acute rehabilitation and skilled nursing patients on the nursing home teaching service.
Medical knowledge is constantly evolving and to assist residents in keeping up with reading and self-assessment, the program provides several web-accessible curricula and question banks specifically for Internal Medicine residents. Residents have paid access to Challenger, a large online question bank and reference material for topics in internal medicine and Rosh Review, an interactive board review platform. Online access to the Physician Education and Assessment Center’s Internal Medicine Ambulatory Care Curriculum provides focused ambulatory education for residents to complete during their outpatient rotations. In addition, residents may use CME funds for access to any other board review programming of their choosing, such as the American College of Physicians MKSAP program. All residents have access to Uptodate and Dynamed, as well as the full online medical library at Northside Hospital.
Residents interested in OMT have multiple longitudinal opportunities to grow as osteopathic practitioners. Residents may participate in OMT clinic and teaching during the ambulatory block. They have opportunity to perform OMT during inpatient and outpatient patient visits under the supervision of osteopathic trained faculty. With our osteopathic affiliate, Philadelphia College of Osteopathic Medicine – Georgia Campus right around the corner, residents also benefit from the teaching and mentorship of osteopathic physicians who are board certified in OMM/Neuromuscular Medicine. In addition to small group review sessions, they also provide osteopathic skills development conferences monthly throughout the year.
Advocacy and community involvement are some of the cornerstones of being a well-balanced physician. In this spirit, residents participate in a community service project yearly that gives back to the Gwinnett County community in which we serve. Former resident projects have included volunteering at community health fairs, providing medical care at free clinics, and participating in Breathe Better Gwinnett, a system wide community health fair funded by a CHEST Foundation grant focusing on respiratory disease identification and prevention.