Program Structure

Our mission is to train future leaders in academic medicine who will improve the human condition through the practice of medicine, education, research, and service. As such, our Program Aims include:

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 a diverse group of patients from all backgrounds, including those from underserved urban and rural communities.
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.
Promote diversity to ensure that our trainees and faculty reflect the population we serve.
Solicit critical input from all stakeholders into our program structure and focus, driving innovation in medical education and professional development.

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.

ROTATION SCHEDULE

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 services at Vanderbilt University Medical Center and the Nashville VA, including general medicine, medical intensive care, geriatrics, and several inpatient subspecialty services. Inpatient rotations are usually two weeks in duration. While highly customizable, this chart summarizes the rotation distribution of a typical resident:

	PGY-1	PGY-2	PGY-3
Inpatient General Medicine	10 weeks	4-8 weeks	4-8 weeks
Ambulatory Medicine	14 weeks	14 weeks	14 weeks
Medical/Cardiac Intensive Care	6 weeks	4-8 weeks	4-8 weeks
Inpatient Subspecialty Services*	10-12 weeks	6 weeks	6-8 weeks
Geriatrics	2 weeks	2 weeks	-
Emergency Medicine	2 weeks	-	2 weeks
Night Float	4-5 weeks	3 weeks	2-3 weeks
Electives	-	4-6 weeks	8 weeks
Vacation	3 weeks	4 weeks	4 weeks

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

**All residents are granted additional vacation time (usually 4-5 days) beyond that listed in late December or early January.

ELECTIVES

We offer a wide array of established electives, which include:

Inpatient subspecialty consult rotations at VUMC and/or the VA Outpatient-based rotations, including all internal medicine subspecialties, dermatology, neurology, psychiatry, and sports medicine

Palliative care
Women’s health
Addiction medicine (inpatient and outpatient)
Integrative medicine
Community medicine (rotations are available at several local facilities)
Social Medicine
Procedure service
Point-of-care ultrasound (POCUS)
Adult Sickle Cell
Global health
Research electives (protected research time and the Clinical Investigator Toolbox)

Internal Medicine Residency Program Curriculum (IMRPC)

IMRPC

Program Aims of the Internal Medicine Residency Program Curriculum

Faculty and resident have created an overall curriculum map for the educational experiences provided throughout the three years of Vanderbilt Internal Medicine Residency. 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.

Here is the full outline of the resources availalble in the Internal Medicine Residency Program Curriculum.

Program Guiding Documents

Inpatient Educational Units

Inpatient ward rotations

ICU Rotations

Inpatient Consult Electives

Outpatient Educational Units

Continuity Clinic

Subspecialty Clinic Electives

Acute Medicine Practice
Allergy/Immunology
Cardiogenetics
Cardiology
Center for Integrative Health
Dermatology
Endocrinology
Gastroenterology
Genetics
Geriatrics
Health Equity Elective
Hematology
Infectious diseases
Lipid/HTN Clinic
Medical Weight Loss
Mental Health Elective
Nephrology
Oncology
Pulmonary
Rheumatology
Sports medicine
Vanderbilt walk-in clinic - acute care
Women’s health

Community Clinic Electives

Charis Clinic
Cool springs IM/Peds Practice
Matthew Walker Clinic
Neighborhood Health
Rural Health - Byrdstown Regional Medical Center
Shade Tree Clinic
Siloam Refugee Health Clinic

Required educational experiences in other departments

Projects

High-Value Care Curricula and Projects

International Electives Resources

Physical Exam skills -

1. Sim lab exams with rheumatology

2. Standford 25 - Physical Exam Demonstrations

Research

CIT - Clinical Investigator Toolbox Elective
Longitudinal Research Experience
Research Clinic Rotation

Quality improvement

Didactics
MM&I
Projects

Didactic Education

Academic Half Day - outpatient curriculum

VA Conference Curriculum - inpatient curriculum

VUMC Conference Curriculum - inpatient curriculum

Special Tracks

Certificate in Ethics

Excite - EXcellent In TEaching - Pathway

Global Health Track

Harrison Society

R38 - STARR - Stimulating Access to Research in Residency

Reflection, self-assessment, and life-long learning

Individualized learning plans

Writing learning goals and objectives

ATTENDING ROUNDS

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

AMBULATORY MEDICINE

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 Vanderbilt One Hundred Oaks or at the Nashville VA Medical Center. 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, allow residents to keep up with their responsibilities to their panel of clinic patients while rotating through various inpatient services. Throughout residency, house staff 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*

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 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 at Vanderbilt empowers residents to be involved in quality improvement efforts at both the microsystem and 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, clinically 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 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 quality improvement didactic sessions. Many of these projects have resulted in changes with hospital-wide impact.

SIMULATED PATIENT EXPERIENCES:

CENTER FOR EXPERIENTIAL LEARNING AND ASSESSMENT

Residents use Vanderbilt's state-of-the-art patient simulation center called CELA (the Center for Experiential Learning and Assessment) to supplement their education. Residents practice critical care procedures, such as intraosseous or central venous catheter insertion, and participate in mock codes before they become code team leaders in their PGY-2 year. Additionally, 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.

Vanderbilt’s residency program features a robust series of educational conferences that are designed to solidify or expand residents' knowledge of clinical medicine; develop their analytical, critical thinking, and teaching skills; and engage their drive to pursue scientific discovery.

Inpatient Conferences:

	Monday	Tuesday	Wednesday	Thursday	Friday
8:00 AM				Grand Rounds
9:00 AM				Academic Half Day 9am-12pm (Clinic Residents Only)
10:30 AM	Morning Report (separate VA and VU)	Imaging & Gel Rounds (VA)	Morning Report (separate VA and VU)	Academic Half Day 9am-12pm (Clinic Residents Only)	Morning Report (VU) Clinical Reasoning Conference (VA)
11:00 AM				Professor Rounds (VU) Electrolyte Rounds (VA)
12:00 PM	Chalk Talk Lecture Series	Chief Resident Lectures	Clinical Approach Series/ Board Review, PCEC, Wellness		Intern Report Social/Global Medicine, POCUS, EXCITE

All lectures occur in-person with masking, following VUMC Guidelines, with a virtual option for those off-campus.

*residents spend a higher proportion of time in these outpatient-oriented specialty clinics

Residents with a specific clinical area of interest are able to arrange for a longitudinal specialty or community-based clinic experience in addition to their primary care continuity clinic.

"Benjamin Palmer, MD" — **Benjamin Palmer, MD**
University of Alabama
*VUMC Ambulatory Chief*

"The primary care clinic experience is an integral part of Vanderbilt’s internal medicine residency program. As interns, you assume care for a panel of patients for whom you act as the primary care physician throughout residency. You manage their chronic diseases, identify and diagnose new problems, and practice preventative medicine. Continuity clinics provide an opportunity to build long-term relationships with patients and their families and to obtain a sense of patient care that can be measured in years rather than days.

In the “4+2” block system, residents have 4 weeks of inpatient time followed by 2 weeks of clinic. Time dedicated exclusively to clinics provides residents an opportunity to immerse themselves in ambulatory practice. The block schedule also facilitates regularly scheduled clinic visits and promotes ownership of your patients. Each clinic is organized into a team of into a team of attendings, residents, and nurses which creates continuity of learning for residents and continuity of care for patients. The mentorship and opportunity for professional development gained by working with the same small group of outpatient attendings throughout residency is a huge asset for residents.

Taking care of patients at Vanderbilt and the Nashville VA is a rewarding experience. As a resident, you will facilitate access to a variety of diagnostic modalities and specialized treatments at Vanderbilt and/or the Nashville VA. Over three years, residents will experience graduated autonomy that creates a fulfilling educational experience that empowers residents to become fully functioning physicians in their future practice."

QUALITY IMPROVEMENT ACTIVITIES

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.

Quality Improvement in the Continuity Clinic Setting

Morning Lectures:

Inpatient Morning Report: During inpatient rotations at Vanderbilt University Medical Center and the Nashville VA Medical Center, residents attend inpatient morning reports several times weekly. Inpatient morning reports are led by the inpatient chief residents and are regularly attended by program leadership and core faculty, including Dr. Christman, Chief of Medicine at the VA, and Drs. McPherson and Sergent, our current and former program directors

We begin morning report with a case recently admitted to the teaching services and then a selected case by a resident. Residents work through the cases in groups with faculty members, developing differential diagnoses and practicing clinical reasoning. Team members presenting the case often benefit from hearing experts in the room chime in on the differential diagnosis. After a diagnosis is revealed, the resident gives a brief presentation on the disease and answer a clinical question using primary literature.

Professor Rounds: Residents on inpatient rotations at Vanderbilt University Medical Center attend Professor Rounds on Thursdays. With the assistance of the inpatient teams, Dr. Rathmell, our Chair of Medicine, 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.

X-ray Rounds: Interns on inpatient rotations at the Nashville VA Medical Center attend Imaging Rounds on Mondays. The Chief of Medicine at the VA (and one of our Assistant Program Directors), Dr. Christman, builds intern confidence in reading chest X-rays and other imaging studies.

Gel Rounds: New this year! Residents on inpatient rotations at the Nashville VA Medical Center attend Gel Rounds on Tuesdays on their non-admitting day. Hospitalists and fellows from subspecialty services to hands-on point-of-care ultrasound (POCUS) teaching at the bedside.

Electrolyte Rounds: This is also a new conference in which former VUMC Chief Resident and current nephrology attending, JP Arroyo, walks through electrolyte disturbances with the residents on the inpatient rotations at the Nashville VA Medical Center on Thursdays.

Ambulatory Didactics:

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. 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. This is taught by faculty from the various divisions of internal medicine, guest lecturers from other departments, and our current residents. 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. Residents also have the opportunity to present patients at our ambulatory intake, which allows for resident-led case discussions focused on 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 Preventative Medicine, Pain Management, and Anxiety and Depression Management. Following this, the interns join the residents for the core curriculum; although throughout the year, there are additional didactic sessions reserved for interns for training sessions on the management of a primary care clinic and a didactic series in geriatrics.

Quality Improvement Didactics: PGY-2 residents have time reserved during academic half-day to participate in a longitudinal quality improvement curriculum. Residents receive training in the principles of quality improvement and acquire the essential tools to perform quality improvement. They then apply these tools in two ways: (1) to improve outcomes for their cohort of continuity clinic patients and (2) to solve system-level problems identified during program morbidity, mortality, and improvement (MM&I) conferences. Residents present the outcomes of these projects in a program-wide conference at the end of the academic year. Resident-generated projects can result in changes that impact the entire hospital.

Longitudinal Conferences:

Core Lecture (Chalk Talk) Series: The inpatient didactics series takes place on Mondays at noon. It is a set of foundational lectures given by core faculty-directed at clinical problems commonly encountered by residents on the wards. The pathophysiology of hallmark diseases is reviewed in an interactive manner, and the presenting faculty use a “chalk talk” approach – PowerPoint slides are strongly discouraged. 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.

Clinical Approach Series: This inpatient didactic series takes place on Wednesdays at noon. This series was created after a resident QI project in 2018-2019 year showed residents desired more clinical-based teaching during noon conference and speakers are arranged by a resident-led committee. These lectures are typically management-focused lectures provided by VUMC Fellows in various medicine subspecialties and the core topics include: Respiratory failure, Hypotension on the floor, Afib/flutter, Heart failure, Cirrhosis, Adrenal insufficiency, Pancytopenia, Inpatient HIV admission, Hyponatremia, Oncologic Emergencies.

Board Review Series: Upper-level residents attend a Board Review Series on Wednesdays, which is division-themed so that a fellow expert from the featured division can be present to address any questions that may arise.

Intern Report: Intern Report takes place on select Fridays at noon and is dedicated time for Vanderbilt University Medical Center administrative leaders to hear intern feedback on processes relevant to day-to-day clinical operations. Many operational improvements have emerged from this conference.

Chief Resident Lectures: The chief residents present a weekly Tuesday conference in a "Curbsiders" format with an expert discussant. They use a case to highlight important clinical evaluation and management using evidence-based practice. Select Tuesdays are reserved for Clinicopathological Conferences (CPCs) and Departmental Morbidity, Mortality, and Improvement (MM&I) Conferences.

Medicine Grand Rounds: Medicine Grand Rounds takes place on Thursday mornings. The entire department gathers to learn about the latest in disease management and patient care from top faculty at Vanderbilt and invited speakers from across the nation.

Other Lectures: There are other lecture series on Wednesdays and Fridays throughout the year, including Wellness Wednesdays, Palliative Educational Curriculum (PCEC), Social Medicine, Global Medicine, Point-of-Care Ultrasound (POCUS), and EXCellence In Teaching (EXCITE), our medical education pathway.

"As part of your clinical education at Vanderbilt, you will participate in a variety of conferences on your inpatient and outpatient rotations that are part of a comprehensive curriculum. While the Covid-19 pandemic moved many of our conferences to virtual platforms, they are returning to safe, socially distanced, in-person meetings in accordance with Vanderbilt guidelines. On inpatient services, residents participate in our morning report, which is regularly attended by faculty, program directors, and the chair of medicine. Our noon lecture series is attended by residents on inpatient and outpatient services and encompasses pathophysiology, clinical management, resident wellness, board review, and social medicine. Vanderbilt also offers an academic half-day for residents on outpatient rotations, allowing an interactive learning environment where residents can work on problem-solving, critical thinking, and their own teaching skills. These conferences prepare our residents for their future roles as clinicians, teachers, researchers, and leaders."

ROTATION SCHEDULE

ELECTIVES

Internal Medicine Residency Program Curriculum (IMRPC)

IMRPC

Program Aims of the Internal Medicine Residency Program Curriculum

Here is the full outline of the resources availalble in the Internal Medicine Residency Program Curriculum.

ATTENDING ROUNDS