Residency Program Structure and Curriculum

The mission of the Vanderbilt Health Internal Medicine Residency Program is to train future leaders in academic medicine who will improve the human condition through the practice of medicine, education, research, and service. Our program aims to: 

  • Recruit highly qualified trainees who desire a rigorous clinical experience, supervised autonomy, and deep exposure to medical discovery.
  • Connect our residents with institutional resources to cultivate scientific curiosity and innovative thinking.
  • Provide comprehensive and compassionate care across the spectrum of internal medicine to patients from all backgrounds.
  • Maintain and expect the highest standards of clinical care and professionalism at all times.
  • Tailor each resident’s experience to align with their career objectives.
  • Solicit critical input from all stakeholders into our program structure and focus, driving innovation in medical education and professional development.

All residents rotate on a “4+2” block schedule with two-week ambulatory rotations separated by four-weeks of inpatient or elective rotations. Residents rotate through a variety of inpatient subspecialty services at Vanderbilt University Hospital (VUH) and the Nashville VA Medical Center, including general medicine, medical intensive care and geriatrics. Inpatient rotations are usually two weeks in duration.  

While customizable, this chart summarizes the rotation distribution of a typical resident: 

RotationPGY-1PGY-2PGY-3
Inpatient General Medicine*10 weeks4-8 weeks4-8 weeks
Ambulatory Medicine14 weeks14 weeks14 weeks
Medical/Cardiac Intensive Care6 weeks4-8 weeks4-8 weeks
Inpatient Subspecialty Services**10-12 weeks6 weeks6-8 weeks
Geriatrics***2 weeks2 weeks-
Emergency Medicine2 weeks-2 weeks
Neurology2 weeks--
Night Float4-6 weeks3 weeks2-3 weeks
Electives-4-6 weeks8 weeks
Vacation3 weeks4 weeks4 weeks

* Inpatient general medicine rotations may be either at VUH or at the VA. At the VA, we utilize a swing shift (2 to 10 p.m.) system, which helps offload daytime admissions from the admitting teams.

** Inpatient subspecialty services include: general cardiology, heart failure, malignant hematology, medical oncology, hepatology, infectious diseases, nephrology, and pulmonary medicine. 

*** Limited space

All residents are granted additional vacation time (usually five days) beyond that listed in late December or early January. 

The residency rogram offers an array of established electives, including: inpatient subspecialty consult rotations at VUH and/or the VA as well as outpatient-based rotations, including all internal medicine subspecialties, dermatology, neurology, psychiatry, and sports medicine. 

​We also assist residents in creating their own unique elective experiences based on their clinical interests and career goals. These are frequently coordinated outside of the Department of Medicine. These include: 

Faculty and residents have created an overall curriculum map for the educational experiences provided throughout the three years of the residency program.

Our goal in creating this educational map is for all residents, fellows, and faculty to have the same mental model or shared expectations of each educational unit. 

Please see the full outline of the resources available in the Internal Medicine Residency Program Curriculum. 
 

The clinical environment of the Vanderbilt Health Internal Medicine Residency Program offers the advantages of a metropolitan population base and a cohesive, fully integrated multi-hospital system.  

Training is centered at VUH and adjacent Nashville VA Medical Center. These clinical training sites give residents a chance to care for patients from all backgrounds. and to develop clinical competencies across a wide range of internal medicine problems. 

Vanderbilt University Hospital (VUH): A comprehensive general hospital for Nashville/Davidson County and a major tertiary care center. It includes all major medical and surgical specialties, and the emergency service has Level 1 trauma certification.  

The Department of Medicine inpatient service includes seeing patients in general medicine, medical subspecialties, CCU/cardiovascular medicine, medical intensive care unit, and the bone marrow transplant service.  

Nashville VA Medical Center: An acute care facility with medicine, neurology, surgery, and psychiatry services. Located adjacent to VUH, the Nashville VA Medical Center functions as a primary care and referral center for eligible veterans in the region.  

There is a strong academic affiliation between the Nashville VA and Vanderbilt Health. All VA medical faculty have academic appointments within the Department of Medicine. Approximately three months of the intern year are spent on rotations at the Nashville VA Medical Center.

Residents rotate through the inpatient general medicine service, combined pulmonary and cardiac intensive care units, subspecialty consult services and outpatient clinics. There are six general medicine inpatient teams as well as a stem cell transplant team and a swing shift, which assists admitting teams with admissions.

Inpatient attending physicians typically rotate for two weeks and typically switch on PGY-1 switch days, thus maximizing continuity with the resident team. Bedside teaching rounds are conducted daily on all inpatient clinical services to optimize learning and patient care.  

The emphasis of attending rounds is on developing fundamental clinical skills, diagnostic reasoning, and professionalism as well as on the bedside review of the pathophysiology of disease. Special emphasis is given to evidence-based medicine. On our subspecialty services, this format allows residents direct access to experts in the field of specialization. 

Our residents are provided with a number of information resources, including Up-to-Date, ePocrates, Micromedex, and PubMed. As a result, our residents can access clinical information and literature from any location within the hospital or clinic. 

All medicine residents receive a copy of our annual Housestaff handbook, which provides general and hospital specific guidance on diagnosis and management of common medical problems internists manage. 

Continuity Clinic
Our program emphasizes the importance of ambulatory medicine and primary care for all medical residents. Each incoming intern is assigned a continuity clinic for which they provide longitudinal care to a panel of patients throughout their entire residency.

Under our 4+2 block schedule, all residents have three half-days of continuity clinic per week during their two-week ambulatory blocks. Our continuity clinics are located at Village at Vanderbilt, Vanderbilt Health One Hundred Oaks, and the Charlotte Avenue VA Clinic.

Residents work closely with a subset of faculty clinic preceptors who provide oversight, teaching and mentorship throughout their residency. Our clinic nurses and support staff, along with robust informatics within our customized Epic-based EHR platform eStar, allow residents to keep up with their responsibilities to their panel of clinic patients while rotating through various inpatient services.

Throughout residency, residents also gain experience working in a wide array of subspecialty clinics that reflect the breadth of outpatient medicine, including:

  • Allergy and Immunology  
  • Cardiology  
  • Community Health Centers  
  • Dermatology  
  • Endocrinology  
  • Gastroenterology  
  • Hematology  
  • Hypertension  
  • Infectious Diseases  
  • Nephrology  
  • Oncology  
  • Pulmonary Medicine  
  • Rheumatology  
  • Women’s Health 
  • Adult LGBTQ
  • Wound Care

Residents with a specific clinical area of interest may arrange for a longitudinal specialty or community-based clinic experience in addition to their primary care continuity clinic starting in their PGY-2 year.

 

Quality Improvement in the Continuity Clinic setting
Employing principles and tools of quality improvement, our residents learn how to develop and test interventions designed to improve patient care. These opportunities occur at multiple points throughout residency. 

Each year, residents measure the care they provide to their continuity clinic patients along various preventative and chronic disease management metrics using tools acquired during quality improvement (QI) didactics. 

Mentors in quality improvement, many of whom have completed the VA Quality Scholars Fellowship, subsequently assist residents in developing improvement targets and using Plan-Do-Study-Act cycles to achieve their targets.

 

PGY-2 Quality Improvement Project
The quality improvement (QI) curriculum empowers residents to be involved in QI efforts at both the microsystem and the macrosystem level. 

Utilizing the Institute for Healthcare Improvement Model for Improvement framework, residents chose and execute QI projects. Projects are resident-driven and have focused on improvements in patient care, addressing a myriad of areas including patient safety, patient care, clinical efficiency, and resident wellness. Curricular time for QI is within the academic half day, and content is a mix of integrated didactics and team-based, experiential learning.

 

Morbidity, Mortality, and Improvement (MM&I) Conferences
Residents participate in at least two quarterly MM&I conferences: one conference is limited to residents and core faculty and one is open to the entire Department of Medicine. With a focus on process-related issues, conference participants identify and propose solutions to system-based problems. Quite frequently, these conferences generate a resident-run quality improvement project that is subsequently addressed in dedicated QI didactic sessions. Many of these projects have resulted in changes with hospital-wide impact.

 

Simulated Patient Experiences
Residents use the Center for Experiential Learning and Assessment (CELA), VUH’s state-of-the-art patient simulation center, to supplement their education. Residents practice critical care procedures, such as central venous catheter insertion, paracentesis, thoracentesis, nasogastric feeding tube placement, peripheral ultrasound-guided IV placement, and arterial line insertion. 

Additionally, CELA is utilized for the longitudinal point-of-care ultrasound (POCUS) curriculum during the PGY-1 year. Residents also participate in code simulation sessions before they become code team leaders in their PGY-2 year. CELA experiences are used to evaluate residents in the core competencies using standardized patients. These individualized sessions allow residents to receive one-on-one feedback from clinical faculty.

  • The Vanderbilt University John S. Sergent Morning Report: During inpatient rotations at VUH residents attend inpatient morning reports several times weekly (Monday, Wednesday, and every other Friday). Inpatient morning report is led by the VUH Inpatient Chief Resident and is regularly attended by program leadership and core faculty, including Dr. John Sergent, after whom this didactic is named. The structure of morning report consists of a selected case presentation by one of the rotating senior residents. Residents work through the cases in groups with faculty members, developing differential diagnoses and practicing clinical reasoning. Residents presenting the case often benefit from hearing experts in the room comment on the differential diagnosis. The chief resident will then guide a full group discussion of the differential diagnosis and/or potential clinical pearls pertinent to the case. After a diagnosis is revealed, the resident gives a brief presentation on the disease and answers a clinical question using primary literature.
  • VA Morning Report: During inpatient rotations at the Nashville VA Medical Center, residents attend inpatient morning reports several times weekly (Monday, Wednesday, and Friday). The structure of these mirrors that of the VUH Morning Report. This didactic is facilitated by the VA Inpatient Chief Resident and well-attended by faculty including Dr. Bart Campbell, who performed the first heart catheterization in Nashville.
  • Other Morning Report styles: There are a variety of other morning report structures, including ‘Fresh Catch,’ in which a currently admitted, unsolved and/or interesting cases are presented and discussed; Evidence-based morning report, in which the high-yield medical literature/practices are reviewed by Dr. Steven Allon, who is a core faculty member and also runs our ambulatory resident journal clubs; and Board Review, which consists of board-styled questions reviewed with the VUH Inpatient Chief.
  • Core Lecture Series: This inpatient didactics series takes place on Wednesdays, Fridays, and occasional Mondays at noon. It is a set of foundational lectures given by core faculty and subspecialists and is directed at clinical problems commonly encountered by residents on the wards and in clinic. The pathophysiology of hallmark diseases is reviewed in an interactive manner, and the presenting faculty often use a “chalk talk” approach without PowerPoint slides. Subsequently, the management of these diseases is reviewed according to best evidence with the added goal of familiarizing residents with the most often-cited studies in internal medicine and its specialties. Other didactic lectures are more management-focused and are often provided by both Vanderbilt Health fellows and attendings in various medicine subspecialties. These topics are selected both from the American Board of Internal Medicine Blueprint, which outlines core competencies for internal medicine, as well as more nuanced subspecialty topics.
  • Professor Rounds: Residents on inpatient rotations at VUH attend Professor Rounds on Mondays at noon. With the assistance of the inpatient teams, Dr. Anna Hemnes, the Chair of Medicine and Vanderbilt Health System Physician-in-Chief, critically thinks through a challenging case. The focus is on developing skills in clinical reasoning. Advanced questions particular to the disease being discussed are directed towards an expert faculty ringer in the audience after a diagnosis is reached.
  • Electrolyte Rounds: Thursday mornings at the Nashville VA Medical Center, Dr. Juan Pablo Arroyo (former Chief Resident and current Nephrology attending) provides chalk talks on electrolyte disturbances and other pathophysiologic principles.
  • Medicine Grand Rounds: Medicine Grand Rounds takes place on Tuesdays at noon. The entire department gathers to learn about the latest in disease management and patient care from top faculty at Vanderbilt Health and invited speakers from across the nation.
  • Other lectures: There are other lecture series on Mondays, Wednesdays, and Fridays throughout the year, including Palliative Care Educational Curriculum (PCEC), Social Medicine, Global Medicine, Point-of-Care Ultrasound (POCUS), and EXCellence In Teaching (EXCITE), our medical education pathway. Select Tuesdays are reserved for Clinicopathological Conferences (CPCs) and Departmental Morbidity, Mortality, and Improvement (MM&I) Conferences.
  • VUH Inpatient Conference Schedule: 
    • Monday: VU Morning Report 7:30 - 8:15 a.m., VU Professor Rounds* 12-1 p.m. 
    • Tuesday: Department of Medicine Grand Rounds* 12-1 p.m. 
    • Wednesday: VU Morning Report 7:30 - 8:15 a.m., VU Residency Noon Conference* 12-1 p.m. 
    • Thursday: none 
    • Friday: VU Morning Report 7:30-8:15 a.m., VU Residency Noon Conference* 12-1 p.m. 
    • Sat/Sun: none 
      • *lunch provided to in-person conference attendees 
  • VA Inpatient Conference Schedule: 
    • Monday: VA Morning Report 8-9 a.m., VU Professor Rounds* 12-1 p.m.
    • Tuesday: none 
    • Wednesday: VA Morning Report 7:30-8:15 am, VU Residency Noon Conference* 12-1 p.m. 
    • Thursday: VA Electrolyte Rounds (chalk talk) 11:00 - 11:30 a.m. 
    • Friday: VA Morning Report 7:30-8:15 am, VU Residency Noon Conference* 12- 1 p.m. 
    • Sat/Sun: none 
      • *lunch provided to in-person conference attendees
  • Ambulatory Conference Schedule (VU and VA PCPs) 
    • Interns -- Thursday 8 a.m.–12 p.m. (first hour is POCUS training) 
    • Residents -- Thursday 9 a.m.–12 p.m.

Academic Half-Day

While on ambulatory blocks, interns and upper-level residents participate in our academic half-day that occurs on Thursday mornings. This is a three-hour interactive session that incorporates case-based learning, physical exam skills, journal club, and other didactic sessions. There is an additional session from 8 to 9 a.m. for PGY-1s for procedural and POCUS curriculum. This is led by the ambulatory chief residents and is regularly attended by program leadership. 

The core curriculum includes advanced general internal medicine and medical subspecialties and is taught by faculty from the various divisions of internal medicine and guest lecturers from other departments. Academic half-day focuses on a “theme” for each block, which is typically a medical subspecialty area (i.e. Rheumatology, Cardiology, Infectious Diseases, etc.). This allows our interns and residents to focus their learning within one subspecialty while actively concentrating on evidence-based approaches to outpatient medicine. Academic half-day also serves as a time for discussions in ethics, resiliency, and high-value care. 

Ambulatory Intern Didactics 

During the first part of the year, the interns receive didactic lectures in general internal medicine which are taught by faculty from the Division of General Internal Medicine and Public Health. Topics include: How to be a PCP, Preventative Medicine, Pain Management, and Anxiety/Depression Management. Following this, interns join the residents for the core curriculum; throughout the year, there are additional didactic sessions reserved for interns for training sessions on the management of a primary care clinic and a narrative medicine. 

Quality Improvement Didactics 

PGY-2 residents have time reserved during academic half-day to participate in a longitudinal QI curriculum. Residents receive training in the principles of QI and acquire the essential tools to perform quality improvement. They then apply these tools in two ways:

  • To improve outcomes for their cohort of continuity clinic patients
  • To solve system-level problems identified during program MM&I conferences

Our QI structure involves large-scale group QI projects, where each clinic cohort of PGY-2s works together on a project to influence positive change within our institution and residency program. Resident-generated projects have resulted in changes that impact the entire hospital.

Residency at Vanderbilt is:

Conferences and Didactics

Clinical Experience

Camaraderie