Saint Vincent Hospital
Internal Medicine Residency Program
 

• Categorical Internal Medicine (NRMP #1290140CO)

• Preliminary Year (NRMP #1290140PO)

• Traditional Osteopathic Rotating Internship (AOA #65811)
   

Saint Vincent Hospital at Worcester Medical Center is a 350 bed, tertiary care, community teaching hospital in Worcester, Massachusetts. The hospital serves not only the greater Worcester area (approximately 235,000 population) but also Worcester County at large (population approximately 650,000), and referrals from out of state. During the last fiscal year, there were 19,881 admissions plus 1,830 births, and 45,434 patients were treated in the Emergency room. The annual operating budget was over $206 million.

Saint Vincent Hospital serves as a major affiliate of The University of Massachusetts Medical School and provides student teaching in all four years. In addition, the hospital provides training for fourth year students from The University of New England College of Osteopathic Medicine and second year (physical diagnosis) students from Tufts University School of Medicine. The hospital has residents and fellows in Internal Medicine, General Surgery, Diagnostic Radiology, Emergency Medicine, Gastroenterology, Cardiology, Interventional Cardiology, and Podiatry.

The Department of Medicine at Saint Vincent Hospital currently maintains a fully or partly salaried teaching staff of 44 and a voluntary faculty of 64. Our categorical medicine training program has 73 houseofficers: 3 chief medical residents and approximately 16 senior residents, 17 junior residents, and 40 interns, including a mix of Categorical and Preliminary Year positions and, for Osteopathic graduates, Traditional Rotating Internship positions. Our program is dually accredited by the Accreditation Council for Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA).

We accept all ACGME PG-1 applications exclusively through the Electronic Residency Application Service (ERAS). While osteopathic positions are filled through the American Osteopathic Association Match, our Categorical and Preliminary positions in Internal Medicine are filled through the National Resident Matching Program. The Preliminary Year is for those who seek a medical internship before entering programs in Neurology, Anesthesiology, Psychiatry, Radiology, Ophthalmology, etc.

Our residents consistently score impressively on the Boards. Our program in Internal Medicine is designed to produce a first-rate general internist, eminently capable of entering the practice of primary care internal medicine. Although in the past about one-half of our graduates had gone into primary care, now the great majority of our residents choose to enter subspecialty training or hospitalist positions instead. Our record of placement of residents into excellent fellowships or hospitalist/primary care positions remains very strong, and we provide whatever support is necessary to maintain that tradition. All of our graduates have acquired a unique and essential perspective on managed care, since Saint Vincent is closely affiliated with the Fallon Healthcare System, which is affiliated with an HMO repeatedly nationally recognized for outstanding quality care and innovation.

The important characteristics of our primary care internal medicine training program may be summarized as follows:

1. The average daily census on the medical service is 170 patients, approximately 75 of whom are assigned to houseofficer teams on the general medical inpatient service and 15-20 to teams in the medical intensive and coronary care units. Approximately 70 patients are "not covered," i.e., not assigned as teaching cases to houseofficer teams. The decision as to whether or not a patient will be "covered" is made by the admitting resident, based on the severity and nature of the patient's illness.

2. It is a fixed policy that all diagnostic and therapeutic orders on covered patients are written by the housestaff. The attending staff has voluntarily agreed to refrain from writing orders in the interest of our educational program.

3. Each inpatient admitting team consists of an attending physician, one resident, two interns, one third-year medical student on the required clinical clerkship, and/or a fourth-year student on a subinternship.

4. Each intern is responsible for carrying a census of approximately 6-l0 patients and for working up not more than five new patients when on call (8 in 48 hours).

5. PGY-l residents in the categorical Internal Medicine program spend eight months on service: four months on the wards, two months in the intensive and coronary care units, two weeks in both stroke service and night float and one month pulmonary medicine. The remaining four months are spent on Ambulatory Medicine, other electives, and vacation. Preliminary year interns spend three months on the wards, two months in the ICU/CCU, one month in the Emergency Medicine, two weeks in both stroke service and night float, one ID selective, and four months on elective (if including vacation time to be taken during an elective month). The PGY-1 track for osteopathic graduates who wish to satisfy the "classic" American Osteopathic Association requirements consists of three months of wards, two months of ICU/CCU, and one month each of Ambulatory Medicine, Emergency Medicine, General Surgery, a surgical subspecialty, Ob/Gyn, Pediatrics, and an elective. The osteopathic graduate who wishes to participate in the newer AOA approved curriculum will spend four months on the wards, two months of ICU/CCU, one month of outpatient, one month of Emergency Medicine, and four months on elective (if including vacation time to be taken during an elective month).

PGY-2 residents spend three months on ward medicine (one of which may be in pulmonary medicine), two months in the intensive care unit, one month in Emergency Medicine, Geriatric Medicine, and Night Float, four months in Ambulatory Medicine and other electives.

PGY-3 residents spend two months on the wards, six months in Ambulatory Medicine and other electives, one month of Consultation Medicine, one month ICU and two months in either the Emergency Ward, ICU, Pulmonary Medicine, or Night Float. One elective month is used for vacation in both the PGY-2 and PGY-3 years. There is flexibility in all these schedules to accommodate houseofficer and/or program needs.

6. On the general medical inpatient service, six resident-intern teams admit on a six-day cycle. Day 1 of the cycle is AM call, from 7:00 AM to 3:00 PM. Day 2 is post call, day 3 is pre-PM call, and day 4 is PM call from 3:00 PM to 10:00 PM. Day 5 is post call, and day 6 is pre-AM call. At 10 PM the PM call team is relieved by a night float team, which handles all admissions until 7 AM the following day. Patients worked up by the night float team are transferred the next morning to the AM call and post PM call teams. Thus, in a six-day period, each team has three days on which they receive new admissions, and no days of overnight hospital duty. The on-call and night float teams are assisted by a cross-coverage intern who, from 5 PM until 7 AM the following day, handles calls for housestaff no longer on duty. The two night float residents and the cross-coverage intern work five nights per week, Sunday through Thursday. On Friday and Saturday, the night float and cross-coverage assignments are taken by houseofficers who, during outpatient and elective months, have periodic assignment to these duties. During the MICU rotation, a five-resident, four-intern team covers the MICU. Three interns and a cardiology fellow cover the CCU. Call is every third night for the CCU interns and every fourth night for the MICU interns. Pulmonary Medicine consists of one resident and one intern covering patients on the pulmonary floor from 7:00 AM to 5:00 PM. The admitting resident covers the floor during the night. In the Emergency Ward our houseofficers work four l0-hour shifts/six days. At least one 24-hour day off is provided per week to all houseofficers on all rotations.

7. The program is designed to include an extensive and carefully conceived experience in ambulatory care. Each categorical medical resident spends one month in the first year, one or two months in the second, and two or three months in the third year practicing ambulatory care under the tutelage of a "mentor." The relationship with the mentor, if mutually acceptable, spans the full three years. Clinic sites include the SVH Ambulatory Care Department, the Fallon Clinic (a 300+ physician member multi-specialty group practice associated with a large, successful, nationally recognized HMO) and offices of independent practitioners. During these 6 months the resident will experience the broad scope of clinical problems that present to the internist in the ambulatory setting. These same sites are used for the half-day per week clinic experience extending throughout the three years. This aspect of the program gives the trainee an opportunity to learn the principles involved in continuity of care. Finally, the Emergency Ward rotation presents an exposure to first-contact primary care. These three complementary experiences provide the Saint Vincent-trained internist with extensive skills, acquired in "real life" rather than simulated conditions, in the fundamentals of primary care: first-contact management, long-term continuity of care, primary responsibility for health maintenance, and expertise not only in classical Internal Medicine but in all disciplines (e.g., Dermatology, Ophthalmology, Gynecology, ENT) represented in current primary care practice.

The hospital supports an ambulatory osteopathic manipulation clinic. Under the supervision of an osteopathic mentor, the osteopathic residents practice OMT diagnosis as well as direct and indirect treatments for one half-day per week. Full musculoskeletal examinations and osteopathic diagnoses are required on all inpatients worked up by the interns in the Osteopathic Track internship. Candidates for treatment as well as outpatients will be referred to the clinic.

8. The scheduled components of the educational program include the following:

a. Morning Report, in which the houseofficers and students on the general medical inpatient service meet with the Chief Resident, the Program Director, Associate Program Director, and several generalists and specialists, for presentation of recent admissions, follow-up reports, and planned and unplanned discussions of selected clinical problems, differential diagnosis, work-up and management plans.

b. Teaching Attending Rounds 90 minutes at least three times per week. The cases to be discussed are determined by the resident. The teaching-attending physician is either a member of the full-time faculty or a selected member of the private attending staff, many of whom are SVH alumni. For private attendings, assignment is based on evaluations submitted by houseofficers. Service as a teaching attending is considered an honor and is assigned only to attending physicians deemed to be effective in teaching the logic of clinical management. In the ICU and CCU there are daily teaching rounds with the critical care and cardiology faculties, as well as daily radiology rounds.

c. Daily conferences including subspecialty lectures devoted to the core curriculum, including the basic science of each subspecialty. Socially important issues are also included, such as Woman's Health, Managed Care, Life After Residency, Ethics and End of Life. In addition, we have regularly scheduled Grand Rounds, Morbidity and Mortality conferences, Journal Club, and a Board Review Series.

d. Special conferences on osteopathic principles and practices are scheduled throughout the year for our interns in the osteopathic track. These include regional meetings coordinated through the University of New England College of Osteopathic Medicine as well as an OMT clinic.

e. Optional scheduled teaching events include Tumor Board, Radiology-Pathology Conferences, Surgery and Neurology Grand Rounds, and Interhospital GI, Cardiology, Renal, and Infectious Disease Rounds.

9. In addition to these scheduled activities, our houseofficers are welcome to utilize the teaching consultation. This is an educational exercise in which the subspecialist teaches at the bedside in response to the request of the houseofficer team. It is a fundamental principle of this program that houseofficers have the privilege, at any time, of requesting a teaching consultation in lieu of, or in addition to, any clinically indicated consultations on patients under their care. The teaching consultation differs from the formal consultation in that the service provided is theoretically to the housestaff, but patient care is clearly enhanced as well.

10. We encourage our houseofficers to participate in a variety of social activities, and these include group/family outings for apple picking, local shows, skiing, "International Food Festival" and other extra-curricular and cultural events. We also strongly encourage membership in the Massachusetts Medical Society, Worcester District Medical Society, and the American College of Physicians.

We believe that the following are the special virtues of the Saint Vincent Hospital training program in Internal Medicine:

1. The inpatient population blends an exciting mixture of bread-and-butter, community-hospital medicine with university-hospital, tertiary-care, referred patients.

2. The faculty, while recognizing that its primary commitment is to patient care and medical training, is committed also to academic productivity. The bibliography of this faculty over the past ten years numbers over 500 articles, chapters, and textbooks.

3. Our residents are extraordinarily active participants in the annual state-wide American College of Physicians (ACP) abstract and “Medical Jeopardy” competitions. Each year we have had local and national winners.

4. The Radiology Department has a large full-time staff and its own residency program. It offers a full range of radiological services, including neuroradiology, vascular radiology, ultrasonography, computerized axial tomography, CT guided needle biopsies, embolization of arterial bleeding sites, treatment of vascular occlusions by percutaneous intraluminal balloon angioplasty, placement of vascular stents, the full array of diagnostic nuclear medicine (including myocardial scintigraphy, gated pool scanning, etc.) and advanced MRI technology. Emergency procedures are available twenty-four hours a day, seven days a week. With the opening of our new facility, we were the first hospital in central Massachusetts with our own MRI unit on site and also the first facility in New England with a completely filmless (digital) Radiology Department, which includes instant access to radiological studies from any of the 1200 PC's in the hospital or from home.

5. Specialized diagnostic and therapeutic services include three very active cardiac catheterization labs with 24 hour cardiac catheterization/stenting, pulmonary physiology, fiberoptic bronchoscopy, non-invasive cardiology, cardiac electrophysiology (housed in a brand new lab), neurophysiology, G.I. endoscopy and physiology, nuclear cardiology, open heart surgery, coronary angioplasty, plasmapheresis, radiation oncology (with two linear accelerators with electron beam capability), hemodialysis, variceal sclerotherapy, laparoscopic and thoracoscopic surgery. Except for organ transplantation, Saint Vincent Hospital is a full-service hospital.

6. Our procedures for evaluating the performance and competence of our residents are well developed. They include observation of the unexposed resident as early as during orientation performing histories and physical examinations, utilizing the standardized patient technique (OSCE's) pioneered in our medical school with the collaboration of our faculty (Ann Int Med. 1986; 105:762-71 and Ann Int Med. 1991; 114:393-401), web-based critiques following each rotation, end of the month exercises, and the Internal Medicine In-Training Examination each year.

7. By design, our residency training is nearly "scut-free." It is a basic principle of our program that houseofficers should spend their time doing, not what is purported to be good for their souls, but what they will do, and must do, as practicing clinicians.

8. Support services include medical photography, medical illustration, and an excellent library. High-speed Internet connections are readily available on all of our 1200 computers for computerized searches of the medical literature and texts in both the hospital and departmental libraries, the wards, and on-call rooms, utilizing UpToDate®, OVID®, and other powerful resources.

9. The programmatic elements that enable us to graduate outstanding general internists include these:

a. The private attending staff includes Board-certified internists who are committed to, and skilled in, bedside teaching. We make extensive use as teaching attending physicians of these practitioners whose teaching skills are endorsed by the housestaff. Thus, the resident will have an opportunity to have, as teaching attending physicians, not only the full-time, hospital-based subspecialist, but also the community-based practicing internist.

b. During the ambulatory assignments described above, the resident will learn a great deal from practicing internists about the office practice of non-medical specialties such as Orthopedics, Neurology, Gynecology, Otolaryngology, Ophthalmology, Dermatology, and Psychiatry. The ambulatory experience includes outpatient teaching rounds and ambulatory case conferences. We have additional well-designed preceptorial electives with practicing Orthopedists, Gynecologists, and other non-medical specialists, and we now have new clinics for free careOsteopathic Manipulation and Women's Health.

c. Since all adult patients in our Emergency Room are seen first by a resident in either Internal Medicine or Emergency Medicine under the supervision of a full-time faculty member of the Department of Emergency Medicine, this rotation provides an excellent experience in the first-contact aspects of primary care. Our ER staff has been newly revised to an exceptionally talented team nearly exclusively from the Beth Israel Deaconess/Harvard Medical School system.

10. We have a close relationship with our medical school. Saint Vincent Hospital is only ten minutes from the University of Massachusetts Medical School. This encourages interchange of faculty and access of our teaching and resident staffs to the library and other facilities of the school. It also permits our staff to participate actively in the everyday life of the school. Our full-time staff members have served and are serving on the essential committees of the school, including the Faculty Council, the Clinical Years Committee, the Executive Council, the Admissions Committee, the Educational Policy Committee, and the Personnel Action Committee. Our teaching faculty members all hold academic appointments at the school. The most important feature of the affiliation is our involvement in the training of medical students. Saint Vincent's teaching staff is involved in the four years of medical student training. The presence of third-year clinical clerks and fourth year subinterns on our ward medical teams provides an essential stimulant and a vital opportunity for interns to learn by teaching.

Our relationship with the University of New England College of Osteopathic Medicine continues to grow, and we have enjoyed the presence of an increasing number of fourth year students and interns every year. We are developing new conferences, including tele-conferencing as part of the "OPTI" network.

For over ten years we have also enjoyed providing physical diagnosis instruction for medical students from Tufts University School of Medicine.

11. We have been named as one of the top 100 hospitals in America, and our patient satisfaction surveys have been consistently lofty. Our MICU has been named by the federal government as one of the top ten units in the country and recently was the first ever winner of the "Patient and Family Focused ICU" award.

12. Our unique relationship with the Fallon Clinic provides not only the educational support of a large and mature managed health care group but the potential for excellent employment positions after graduation. (Newsweek and U.S. News and World Report, based on national surveys, named the Fallon HMO best in the country in three of the recent past four years.)

In summary, our program, which is designed to produce first-rate subspecialists, hospitalists, and general internists, meets all of the general and special requirements of the Accreditation Council for Graduate Medical Education and the American Osteopathic Association with respect to administration, faculty, teaching staff, clinical resources, facilities, supporting services, curriculum, resident responsibilities, and trainee evaluations. Our special advantages include a very wide array of patient pathologies; active residency programs in all of the major disciplines; an excellent track record of placing our graduates in desirable fellowship programs; an equally excellent track record of placing our graduates in highly attractive primary care and hospitalist practice settings (many of our teaching attendings are graduates of our program); a night float rotation which relieves the admitting resident and intern at 10 p.m. so that there is no overnight call during months on the wards; a variety of well-conceived and thoroughly-developed ambulatory experiences exceptionally well suited to preparation for Primary Care; excellent Radiology, clinical laboratories, and support services; a minimum of "scut-work"; genuine responsibility on the part of the housestaff; and the opportunity to experience the full range of contemporary diagnosis and therapy.

Finally, we are pleased to announce that our Internal Medicine Programs (both allopathic and osteopathic) has consistently received the maximum, full 5-year accreditation cycle from the ACGME and the AOA.

If you have any questions, please do not hesitate to contact our Program Administrator, Ms. Julia White at 1-877-633-2368, Ext. 26208 or (508) 363-6208, or any of us.

 Thank you,

Anthony L. Esposito, MD, FACP
Chief, Department of Medicine
Professor of Medicine
University of Massachusetts Medical School

Jane A. Lochrie, MD, FACP
Residency Program Director
Associate Professor of Clinical Medicine
University of Massachusetts Medical School

George Abraham, MD, FACP, MPH
Associate Program Director
Director, Ambulatory Care and Preventive Medicine
Associate Professor of Clinical Medicine
University of Massachusetts Medical School

Susan George, MD, FACP
Associate Program Director
Associate Professor of Medicine
University of Massachusetts Medical School
Chairperson, Department of Medicine Performance Improvement Committee

David A. Weinstock, DO
Director, Osteopathic Medical Education
Instructor of Clinical Medicine
University of Massachusetts Medical School

Ms. Julia White
Program Administrator for Internal Medicine