OHSU > Department of Medicine > Residency Program > Applicant Information

Training Programs

Training Programs

• Overview
• Inpatient Services: OHSU and VAMC
• Subspecialty Selectives and Electives
• Ambulatory Training
• Primary Care Track
• Program Resources
• Research
• Fellowships
• Program Development
• Sample Schedules

Overview

The program provides training leading to qualification for entry to the certifying exam of the American Board of Internal Medicine. Graduates of our programs have achieved a 100 percent first attempt pass rate over the last three years (see the abim.org site for data on the board pass rates for all internal medicine programs).

The major focus of our residency program is to support the diverse career goals of our housestaff. As the only University-based training program in the state of Oregon, we have a broad mission in serving the public interest. This mission ranges from training the finest practitioners in primary care to preparing residents for entry into investigative careers.

Our residents divide their time among general medicine and subspecialty wards, intensive care units, ambulatory care, consultation services; and emergency room and long-term care settings. Those residents planning careers in primary care spend additional time in ambulatory care, focusing on behavioral medicine and experiences in related areas such as gynecology, dermatology and medical orthopedics. In the PGY-2 year, Primary Care residents complete a community-based preceptorship, usually in a rural area of Oregon.

Our PGY-1 residents spend their entire year at OHSU Hospital and the adjacent VAMC, which are connected by a sky-bridge. We believe that limiting the first year rotations to the "Hill" fosters strong collegial relationships among the housestaff and between the housestaff and faculty, building a strong esprit de corps. In addition to acquiring experience in general inpatient and subspecialty medicine, interns rotate through ambulatory care and emergency room services, intensive care units, geriatrics, neurology and subspecialty consultation services.

The second and third years of the programs include general and subspecialty ward services and intensive care units, where residents supervise a team of interns and students, subspecialty consultation services (“selectives”), electives, geriatrics, ambulatory blocks, including an innovative curriculum in Chronic Illness Management (CIM), and a combined OHSU-VAMC emergency room rotation. Residents also rotate for two months in both their PGY 2 and PGY 3 years at Kaiser Permanente in Portland and may also rotate for one month at another local hospital (Providence Portland). These community-based facilities provide exposure to a broad-based and diverse practice environment.

Examples of resident schedules for the PGY-1,2,3 years are shown in the appendix of this brochure.

Portland also has three other Internal Medicine Residency programs:

• Providence Portland
• Providence St. Vincent
• Legacy Health System

 

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Inpatient Services: OHSU and VAMC

OHSU

At the OHSU Hospital, five general medicine ward teams share call every fifth night. On weekdays, there is both a short call and long call team. Ward teams are composed of an intern, a resident, medical students and an attending physician. The attending physicians for the general medicine teams are full time faculty of the Department of Medicine, the majority of whom are full time hospitalists in the Division of Hospital Medicine whose primary goal is to teach.

At OHSU Hospital, there are two critical care teams that operate in the recently opened Peter O. Kohler Pavilion: a MICU service and a CCU-Cardiology team. The MICU team has four interns and four residents. Each of the 4 resident-intern teams takes a week serving as the night team. The CCU-Cardiology team has 3 residents and 1 intern that alternate long and short call shifts. Each member of the CCU team takes one week of night coverage with supervision from the Cardiology fellow.

Faculty from the Divisions of Cardiology and Pulmonary-Critical Care, respectively, serve as the attendings for these teams. Critical care and cardiology fellows are present in the hospital 24/7 and provide assistance to the on-call teams and coverage of overflow patients.

VA Medical Center

At the VAMC, a night float team (1 resident, 1 intern) is on call overnight Monday through Friday. Five general medicine teams (1 resident, 2 interns, 2 medical students) share 12-hour call and short call. Each weekday morning, one team accepts patients admitted during night float. Teams take 24-hour call in rotation on Saturdays and Sundays. On average, interns and residents on these 5 ward teams have one to two 24-hour call days during a 4-week rotation. Attendings are full time faculty and include a mixture of hospitalist, general internal medicine and subspecialty faculty. We limit (cap) these teams to 16 patients. A separate team (3 residents, 3 interns) is responsible for the combined CCU/MICU and take call every third night. Faculty from both the Division of Cardiology and Pulmonary-Critical Care attend on those patients.

Patient Care

At both the OHSU and VAMC hospitals, residents have primary supervisory responsibility for patient care. Residents enjoy considerable autonomy in their decision-making but always receive appropriate support and guidance from their faculty attendings. Residents also have a major obligation to teach interns and medical students. To assist them in this responsibility, second year residents participate in faculty-directed workshops designed to enhance their teaching skills.

Interns have primary responsibility for patient care, including diagnostic planning, charting and interacting with patients and their families. The house staff has ready access to consultations from the medical subspecialty and non-medical specialty services, such as surgery, gynecology, and psychiatry.

Conferences and Rounds

Each ward and ICU team makes daily work rounds. Our faculty conducts attending rounds seven days per week. Residents on inpatient services are expected to attend the following teaching conferences: Morning Report in their respective hospital (OHSU or VAMC), Tuesday morning Medical Grand Rounds (OHSU), Friday noon Clinical Case Conference (OHSU) and the Monday through Thursday noon conferences (VAMC).  At OHSU, ward teams review daily radiographic studies with faculty from the Department of Radiology in a teaching conference Monday through Friday.

Morning Report is held each day except Tuesday at both OHSU and the VAMC and lasts 45 minutes. The discussions are directed by the program director at the OHSU and the Chief of Medicine at the VAMC, along with the chief residents. Residents, fellows and faculty participate in the discussion of a single patient chosen and presented by the long-call ward team resident. The discussions focus on the diagnostic and management issues, with an emphasis on clinical reasoning, problem solving, and formulation of clinical questions to be answered from the literature.

On Thursday mornings, there are separate resident and intern morning reports. At OHSU, residents from both the OHSU and VAMC general medicine teams meet with the Department Chair, Dr. Lynn Loriaux, as well as the division chiefs from Cardiology, Pulmonology, Nephrology, and Infectious Disease to review selected patients, focusing on challenging diagnostic or management issues. At the VAMC, interns meet with the Chief Residents as well as the Associate Program Director Dr. Judy Bowen to present a case, with a specific focus on diagnostic reasoning.

Noon conferences are the forum for our core internal medicine curriculum that is presented over approximately 18 months and thus presented twice during the usual residents’ tenure in the program. Noon conferences are presented Monday through Thursday. During the initial 2 months of each academic year, the noon conference is devoted to a review of medical urgencies and emergencies that new interns and residents often confront in the ER, ICU and on the wards. When this series concludes in September, the curriculum turns to review of material organized around specific specialty areas such as Hematology, Infectious Diseases, Nephrology, etc.

In addition to the core curriculum, the noon conference series includes additional content. First, there is a monthly physical diagnosis conference that uses an extensive catalog of images that has been developed locally by faculty and housestaff. Second, faculty from the Division of Cardiovascular Medicine conducts a monthly interactive EKG conference that covers in the course of the year a core curriculum in electrocardiography. Finally, as part of their scholarly requirements for residency, senior residents (PGY-3) prepare and present topics of their choice during the academic year.

The Clinical Case Conference is held Fridays at noon. During this conference both chief residents and Department of Medicine Faculty lead a clinicopathologic case discussion or a monthly morbidity and mortality conference

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Subspecialty Selectives and Electives

The OHSU and VAMC offer subspecialty consultation rotations (“selectives”) in Cardiology, Endocrinology, Gastroenterology, Hematology/Oncology, Infectious Diseases, Nephrology, Pulmonary, and Rheumatology. Over the course of 3 years, residents spend six to eight months on these “selectives”, with assignments based on resident preferences. When on subspecialty consultation services, residents participate in the clinics, conferences, consulting rounds and diagnostic laboratories of those subspecialties, working closely with the faculty and fellows. The residents play a central role in the consultation component of those disciplines, but also have opportunities to develop related procedural skills. Senior medical students on subspecialty electives often work with the consulting residents.

 In addition, rotations in Neurology and Geriatrics are available during internship and residency. The neurology rotation is available at OHSU Hospital and is usually done in the PGY-1 year. Interns on this service work alongside the Neurology housestaff and are supervised by Neurology faculty. The Geriatrics services are based at the VAMC and its associated extended care programs in Vancouver, Washington, just across the Columbia River.  This service focuses on ambulatory and long-term-care and includes a nursing home care unit with a rehabilitation emphasis, a home care program, as well as the Geriatric assessment clinic. Interns and resident work directly with the Geriatric and Rehabilitation Medicine faculty on this service.

 In the PGY-2/3 years, elective blocks of four weeks are available. During this time residents may plan their own educational activities, with approval from the program director. Activities in past years have ranged from basic science research, to epidemiology at the Oregon Health Department, and clinical rotations in third world locations.

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Ambulatory Training

Considerable emphasis is placed on the ambulatory training of residents. During the PGY-1, PGY-2 and PGY-3 years, all residents rotate through four-week ambulatory block rotations at the VAMC and OHSU, for a total of three months of dedicated ambulatory block time. These block rotations include outpatient training in behavioral medicine, dermatology, gynecology, optometry, pre-operative clinics, adolescent medicine, social medicine, occupational medicine, office-based psychiatry, and geriatrics.

Those residents focusing on careers in primary care have an additional four-week primary care block rotation during the PGY-1 year and an eight-week primary care block during the PGY-3 year.

All housestaff attend an internal medicine continuity clinic one half day each week during their PGY-1 year and two half-days during their PGY-2/3 years. Residents focusing on primary care have their first clinic at OHSU and categorical residents at VAMC or the OHSU. A second practice site is selected for the PGY-2/3 years from a menu of options, including OHSU, Multnomah County, Kaiser, Portland State University Health Service, HIV, Chronic Care and the Virginia Garcia (migrant health) clinics. In recent years, some residents have selected a second clinic with our subspecialty faculty. In continuity clinic, interns and residents evaluate new patients and provide follow-up care. Faculty preceptors work closely with the residents. During clinic sessions, the attending physicians in clinic have no other responsibility but the teaching and supervision of housestaff. Between sessions, faculty preceptors assist residents in the ongoing care of their patients and provide back up when residents are not available to their patients.

The continuity care curriculum is taught through a comprehensive web-based ambulatory curriculum. An interactive 30-minute clinic conference, based on the web curriculum, precedes each afternoon clinic session. All residents participate in the development and editing of this innovative 3-year curriculum.

Chronic Illness Management

During either the second or third year of training, residents participate in a four-week ambulatory block rotation designed to introduce residents to the Chronic Care Model. During this rotation, residents learn about population management, a quality improvement approach to improving clinical outcomes, setting self-management "action plans" with patients, and team work in the ambulatory setting. The clinical experiences include a diabetes practice, a behavioral health practice, women's health practice, and providing care to homeless persons with chronic conditions.

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Primary Care Track

Selection of residents to Primary Care track

The Department of Medicine at OHSU is committed to practice and training in primary care internal medicine. Newly matched interns are invited to complete a career planning survey before arriving for internship. Information from this survey determines which residents are given a primary care track schedule. In the spring of each academic year, all residents complete this same survey, indicating their evolving career plans. Thus, residents may "track" in or out of the primary care track, creating an opportunity to better tailor rotations and experiences to meet their future goals and plans. We have found that a maximum of 6-8 residents per year seems to give everyone a good experience without overcrowding the track.


Training as a PGY-1

We stress training in ambulatory settings, especially continuity of care, as well as the acquisition of skills in certain non-internal medicine disciplines. Because we believe that the transition to becoming an internist requires considerable acute care experience, the internship year is similar for both primary care and categorical residents. We emphasize primary bedside care during this year. In addition, each resident has a weekly half-day continuity practice at either the OHSU or VAMC teaching practice sites. In addition to the 4-week ambulatory block rotation for all interns, primary care track interns receive an additional 4-week primary care rotation. The primary care block in the PG-1 year focuses on office-based psychiatry and geriatric clinical experiences. Both groups of residents rotate four weeks in the emergency departments of OHSU and VAMC.

The primary care block rotation incorporates several innovative aspects of primary care training. During this rotation, interns spend an average of four half-days per week in their primary continuity practice site seeing patients and learning utilization management in primary care. Our goal is to help the primary care track interns establish their own continuity practice and master the processes of care in this setting early in training. A dedicated group of experienced outpatient clinician-educators support the interns during this rotation, providing direct precepting, guidance, and mentoring.

Preceptorships

During the second year, primary care track residents serve in a community-based preceptorship of four weeks duration, usually in a rural Oregon community. During this rotation, the resident works side-by-side with an experienced general internist in practice, seeing the broad scope of practice in that setting, including hospital coverage. Primary care residents often report that this rotation is pivotal in confirming their career choice in primary care internal medicine.

Senior Primary Care Training

In the third year of training, primary care residents have an eight-week block of outpatient medicine. The focus of this rotation is consolidation of ambulatory-based clinical skills in continuity practice in addition to other selectives. The key components of the primary care block as a PGY-3 include office-based psychiatry, geriatrics, musculoskeletal, and women’s health.

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Program Resources

Research

Residents are encouraged by the faculty to participate in research.  The faculty of the Department of Medicine has substantial funding through extramural grants. Laboratory and technical personnel are available to direct and assist residents with basic science, clinical, health services, or informatics research. Over the years, residents have been highly productive, often completing projects that led to abstract presentations at national society meetings and subsequent publications. In the past several years, residents have presented papers at the AFCR, the International AIDS meeting, the American Gastroenterology Association, American Society of Microbiology (ICCAC) and the American College of Physicians national meetings and have won national abstract competitions sponsored by the American College of Physicians.

Click here to view OHSU & VAMC research grant awards.

Libraries

OHSU’s Biomedical Information and Communications Center (BICC) and the VAMC library are all available for residents and interns. Both libraries provide computer access to bibliographic searches and extensive on-line resources. The BICC is a modern facility that serves as a paper and electronic library and a center for research in medical informatics. Its database resources are accessible 24 hours a day both on and off campus.

Ethics

The university has established a nationally regarded Center for Ethics in Health Care, which is directed by a senior faculty member in the Department of Medicine. The center’s faculty contributes regularly to the department’s conferences in addition to the center’s own conference and lecture series, which are open to all members of the university community. In addition, the center offers an ethics consultation service.

Palliative Care

OHSU and the VAMC have both established Palliative Care Programs that provide consultative care. The OHSU-VAMC fellowship in Palliative Care is one of 32 programs accredited by the American Academy of Hospice and Palliative Medicine.

Fellowships

The Department of Medicine offers fellowship training in Arthritis & Rheumatic Diseases, Cardiovascular Medicine, Endocrinology, Gastroenterology, General Internal Medicine, Geriatrics, Women's Health, Hematology & Medical Oncology, Infectious Diseases, Nephrology & Hypertension, Pulmonary & Critical Care Medicine, and Palliative Care. Most of these programs use clinical, diagnostic and research facilities at both OHSU Hospital and VAMC.

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Program Development

The Department of Medicine has a residency advisory committee that meets monthly throughout the year to examine and evaluate the residency program. The committee is organized into two subcommittees that have responsibilities for specific portions of the residency curriculum: inpatient and subspecialty medicine and ambulatory medicine. In addition to faculty members, the chief residents and residents from each training level serve as voting members.  These subcommittees advise the Department of Medicine on the structure of schedules, night call, and the organization of educational and patient care activities for the various housestaff rotations. They review all components of the curriculum in a structured manner on a scheduled basis. In addition, the Department periodically assembles Task Groups for specific projects.

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Sample Schedules