IM Residency Program FAQ's
ABIM (‘Board’) Certifying Examination Pass Rate
Program Director - Dr. Sima Desai
Fellowships: Preparation for Fellowship Match
Patient and Program Diversity
Primary Care Track
Scholarship and Research Opportunities
Global Health Scholars Program
The Department of Medicine and Residency Program are fully committed and adherent to the ACGME duty hour standards.
The Program had long anticipated many of these changes and implemented call schedules and assignments that reduce the duration of shifts while optimizing and, where possible, reducing transitions in care (‘hand-offs’).
The residents have a strong voice in helping us design and implement any needed change to the system. We are continuing to modify our rotations as needed to address any duty hour issues that may arise.
Graduating residents from the Department of Medicine have been highly successful on the American Board of Internal Medicine certifying exam. Over the past decade, our 3-year rolling pass rate has been 90%. We attribute this success in large part to the quality of our residents, who are very bright and intellectually curious, but also credit their overall training experience and the associated curriculum at OHSU.
To assist our residents in assessing their medical knowledge and preparing for the ABIM exam, we annually administer the In Training Exam to all PGY-2 and PGY-3 residents. This exam was developed jointly by the American College of Physicians and the Association of Program Directors in Internal Medicine, and its results are used solely for self-assessment and formative feedback. The exam results provide highly detailed information that assists residents and their faculty advisor in focusing their ongoing reading and studies.
Sima Desai, MD, FACP has been the Internal Medicine Residency Program Director for the OHSU Department of Medicine since 2010. The previous Program Director Tom Cooney, MD, MACP stepped down after 26 years as Program Director in 2010 and continues in his role as Vice Chair for Education.
Dr. Desai was an Associate Program Director from 2004-2010 and was a Resident and Chief Medical Resident here at OHSU. She joined the OHSU Department of Medicine faculty in 1998 as a Hospitalist Clinician Educator in the Division of Hospital Medicine. She previously was Section Chief of the University Section of the Division of Hospital Medicine from 2005-2010.
OHSU's performance in the Fellowship Match has been excellent, with residents routinely matching in the most competitive subspecialty fellowship programs, including cardiology, gastroenterology, and hematology-oncology. While similar to other academic institutions in that many of our residents choose to remain at OHSU for their fellowship training, we strongly encourage residents to pursue specialty training at other institutions to broaden their training experience. We believe every resident desiring a competitive fellowship will be able to obtain one and achieve their long term professional goals. We have willing and capable subspecialty and generalist mentors available to assist residents navigate that path and many OHSU faculty members welcome residents who are interested in doing scholarship during their residency.
Our program offers both formal and informal mentorship and career counseling opportunities for residents. The formal mentorship structure consists of twice yearly meetings with the resident’s linked Program Director (PD) or Associate Program Director (APD). At the beginning of internship each resident is linked to one of the five associate residency program directors or the program director and will have an early meeting (Aug or Sept) to begin the process of career mentoring. The APD or PD not only reviews the resident's rotation and self evaluations, but also offers guidance to enhance their continuing development and career planning. Additionally, the APD or PD helps to connect residents with subspecialty research and/or career mentors who work collaboratively to create a balance between becoming an expert clinician and leading a healthy, fulfilling life outside of residency.
With respect to informal mentorship, the faculty at OHSU are highly invested in our residents. They are receptive to residents who approach them seeking guidance and collaboration. Many faculty have chosen to spend their careers here because of their deep interest in the education and career development of students and residents.
Diversity is a top priority at OHSU and is one of the six goals of our institution’s strategic vision, Vision 2020. Diversity at OHSU means creating a community of inclusion. We honor, respect, embrace, and value the unique contributions of and perspectives of all employees, patients, students, volunteers and our local and global communities. The President of the University created the Diversity Advisory Council (DAC) which advises the President and Executive Leadership Team on enhancing diversity, multiculturalism, and equal opportunity for all aspects of the University's missions. In addition, OHSU has a the Center for Diversity and Inclusion that supports and works in collaboration with academic units, hospitals and other communities promoting an environment that value and nurtures an inclusive environment of diversity. The center hosts among many other events all inclusive reception events to encourage all diverse groups to come together from residents to students to faculty. OHSU also sponsors OHSU Pride whose goal is the full and harmonious integration of all persons in the academic, social and professional life of OHSU regardless of sexual orientation or gender identity. OHSU for three years in a row has been recognized as a “Leader in LGBT Healthcare Equity” in the Healthcare Equality Index conducted by the Human Rights Campaign (HRC) Foundation.
Our residents have many opportunities to be exposed to a diversity of patients and healthcare delivery. Because OHSU is Oregon’s only tertiary/quaternary academic medical center, we care for a wide variety of both common and complex clinical conditions. Additionally, we care for patients from many sociocultural and socioeconomic backgrounds thus facilitating our education and awareness of different cultures and health beliefs. Given the number of diverse patients seeking care at OHSU, we have a comprehensive interpreter services providing language services for Spanish, Russian, Chinese, Vietnamese and American Sign Languages, in addition to 74 other languages. The Department of Medicine also has a number of researchers and clinicians who are interested in understanding the multiple ways that racial, ethnic and socioeconomic diversity affect health (Drs. Christina Nicolaidis, Jessica Gregg, Honora Englander, Som Saha, and Devan Kansagara to name a few faculty).
Specific to our residency program, OHSU residents rotate through Central City Concern’s (CCC) Old Town Clinic (OTC), a non-profit agency serving individuals and families affected by homelessness, poverty and addiction. Central City Concern has received numerous awards for service to the community and patients. We have a unique collaboration with OTC where our residents gain an understanding of the effects of patients’ education levels, unemployment, poverty, housing, addiction, and lack of primary care on their health and well being by working with Internal Medicine faculty who supervise the clinic. Our residents further their understanding of healthcare issues experienced by homeless youth by participating in Outside In, a facility whose mission it is to help homeless youth and other marginalizes individuals move towards improved health and self-sufficiency. Residents also have the opportunity to participate in a second clinic in multiple diverse locations including Multnomah County Clinic (providing healthcare to underserved, low-income and uninsured residents of Multnomah County), and Portland State University Student Clinic. Finally, our residents have used their elective rotations to broaden their horizon as a physician by participating in healthcare programs in a number of countries from Africa to China.
It is our program’s mission to train our residents to be outstanding general internists, both in the inpatient and outpatient arenas. We place a strong emphasis on our residents’ exposure to outpatient internal medicine training and all of our residents receive a very strong foundation in outpatient medicine. Ambulatory training occurs through multiple venues, including primary continuity clinics at OHSU, VA and Old Town Clinic; secondary continuity clinics for second- and third-year residents in an area of their choice; an extensive Ambulatory curriculum delivered during dedicated seminar half-days during the “+1 week”; Ambulatory blocks; our innovative and nationally recognized Chronic Illness Management (CIM) clinics; and a highly rated rotation at Kaiser Permanente. The outpatient training curriculum is carefully arranged to provide residents with broad exposure to a variety of primary care topics and venues including a unique social medicine curriculum through our affiliation with Central City Concern and Multnomah County clinics; an innovative Health Management curriculum through the rotation at Kaiser Permanente; training in quality improvement and population management through our CIM clinics and Practice Management/Medical Home Skills curriculum; foundational skills in evidence based medicine during our EBM Ambulatory curriculum which is linked to Ambulatory topics; and clinical experiences in orthopedics, dermatology, women’s health, ENT, geriatrics, medicine-psychiatry, HIV, and underserved care. Whether at OHSU, VA, or Old Town Clinic, our residents work on high functioning medical home teams with linked medical assistants, nurse care managers, and panel coordinators. Each of our clinical sites is designated as a medical home and is participating in medical home demonstration projects.
In 2011, our program redesigned our scheduling matrix into the “3+1”. This has effectively eliminated the tension that many internal medicine residents traditionally feel between inpatient and outpatient responsibilities. It also ensures our residents receive frequent, concentrated exposure to their continuity clinics (during each +1 week, residents have 3-5 primary continuity clinics). As a result of this change, residents report more satisfaction in their primary care clinics. They get to know their medical teams, have a better understanding of the systems of care, and are more efficient. Because our program moved to a 3+1 (as opposed to a 4+1 or 4+2+2), residents are in clinic monthly, which allows them to schedule their patients in 1-, 3- and 6- month intervals, to improve continuity and patient care.
We purposefully do not offer a separate match number for our primary care program. This allows anyone who matches at OHSU who is interested in primary care to move into the Primary Care Track at any time, which we feel is important as many residents may not have been able to commit to primary care in their fourth year of medical school. In this way, our program can flex to the needs of our residents, allowing anyone with an interest in primary care to join the track and benefit from primary care training opportunities. Typically 15-25% of our residents elect to join the primary care track and approximately 20-25% of our residents enter careers in primary care. In addition to the usual offerings, primary care track residents have a rural preceptorship in the second year (choosing to rotate for 3-4 weeks at a rural location in Oregon or with Indian Health Services in Alaska, Arizona or New Mexico) and a two month primary care block rotation in the third year (which includes opportunities to teach and precept in their continuity clinics, work at a small group or solo practice in Portland, and get “selective” experiences in primary care topics of their choice including OB-Gyn, Orthopedics, Dermatology, Office Based Procedures, HIV, etc). There is also primary care career mentorship and regular social and educational events throughout the year to build community and round out the curriculum.
Defining scholarship as the discovery, dissemination, and application of knowledge, the Department of Medicine and Internal Medicine Residency Program have had a long standing commitment to productivity in scholarship. To continue to improve resources offerings and scholarly productivity, the Residency Program wants to assure all trainees have an opportunity to contribute to areas of scholarship, by formalizing access to committed mentors, writing and presentation resources, and a catalogue of current and past resident and faculty scholarship productivity. New web-based and curricular resources are available to offer which include a list of available mentors, past resident scholarly productivity, guidance for preparation of manuscripts and posters, manuscript preparation, and potential publishing venues.
OHSU scientists brought in $359 million in research funding in fiscal year 2012. The National Institutes of Health is OHSU's most significant source of funding, providing over $226 million last year. OHSU ranks 19th nationally in NIH funding. There are 1,131 principal investigators at OHSU, working on 3,045 research projects. Within the Department of Medicine there are robust research programs distributed among its subspecialty Divisions that received over $22 million in NIH research funding last year. In addition, fellowship programs in the Divisions offer both outstanding clinical training and strong research opportunities, many funded by NIH Training Grants.
The rich and diverse research culture in these divisions, and their joint research efforts in collaboration with strong basic science departments, as well as with the Oregon Clinical and Translational Research Institute (OCTRI), not only provide outstanding research experiences for fellows, but also extend to residents’ research and scholarly opportunities. Training in clinical and translational research is also available through the well-established Human Investigations Program (HIP) and Master of Clinical Research (MCR) program, both directed by Dr. Cynthia Morris. These programs offer outstanding combinations of coursework, mentored projects, and academic survival skills aimed at training the next generation of clinical and translational researchers. While residents infrequently find time to complete full HIP or MCR during training, residents may participate in a more “A la Carte” function, where they may select individual curricular offerings. At present the appeal of the HIP and MCR programs have resulted in some oversubscription of learners, thus for non-faculty applicants availability is on an individual basis.
Additionally, OHSU is also particularly strong in the area of clinical epidemiology and evidence-based medicine. OHSU is the home of the AHRQ supported Pacific Northwest Evidence Based Practice Center under the direction of Roger Chou, MD. Since its inception, the EPC has been awarded over $60 million in funding and has produced systematic reviews for the US Preventive Services Task Force, the National Institutes of Health, the American College of Physicians, the American Pain Society, and other governmental agencies and professional societies to develop national and local health policy.
Some Academic Divisions within the Department may accept residents through the ABIM Research Pathway. This is well suited to highly motivated residents with a strong commitment to a career in academic medicine and research. Please let us know if you have this interest and we can help guide you in the process.
Applicants with an interest in research opportunities may contact Dr. David Jacoby, Vice-Chair for Research, Department of Medicine, or Dr. Alan Hunter, Associate Program Director, Scholarship Portfolio Director, Department of Medicine.
Many programs offer a wide variety of 'Electives', but for many, these are really opportunities to 'select' sub-specialty rotations (‘selectives'. Thus, while our program routinely offers 'Selectives' so that residents can rank their desired subspecialty experiences, we also assign an elective block to every PGY2 and PGY3 during their training (4 weeks of elective time per upper level training year). Residents may choose to fill this time with either local, national, or international clinical or research experiences.
On-campus elective opportunities range from general internal medicine and sub-specialty consult experiences to rotations in other OHSU or affiliate departments (such as radiology or orthopedics). Many residents who are pursuing sub-specialty training will decide to use their elective month to conduct research. Faculty from each Medicine sub-specialty are available for current residents to serve as research contacts and mentors. Residents have been extremely successful in their research endeavors, often presenting at national meetings.
Off-campus opportunities include a wide variety of options. Some residents choose to take advantage of OHSU IM residency alumni, and travel to other states to complete clinical electives in unique health care environments such as the Indian Health Service. Additionally, many residents use elective time for international experiences, both to hone clinical skills and develop language skills as well as lay groundwork for research opportunities. While advanced planning is needed, OHSU residents have completed international electives in Argentina, Cambodia, China, Costa Rica, Ecuador, Ethiopia, India, Kenya, New Zealand, Peru, Spain and Tanzania.
The mission of the OHSU Internal Medicine (IM) Global Health Scholars Program is to supplement and enrich a robust internal medicine curriculum with opportunities in global health. In this regard, the OHSU IM Global Health Scholars Program endorses a broad definition of Global Health rooted in interdisciplinary collaboration to promote better health for all (Koplan, et al. 2009). To this end, curricular offerings will provide a strong foundation in transnational health issues to include the health of refugee and immigrant populations, public health, infectious and noninfectious disease prevention, recognition and management in resource limited settings, and interdisciplinary collaboration.
Kaiser Permanente - is a not-for-profit HMO where residents rotate both inpatient and outpatient. For the outpatient clinics, residents see patients in both internal medicine clinics located throughout Portland as well as medicine and surgical subspecialty outpatient clinics. The hospital at Sunnyside in Southeast Portland is a 233-bed hospital where residents are on call with a hospitalist for a few selected shifts.
Old Town Clinic/Central City Concern - is a county-funded clinic that sees uninsured and Medicaid individuals, and OHSU internal medicine faculty supervise the clinic. Residents rotate through this low-income clinic in downtown Portland on NE Burnside St (‘Downtown’) during their ambulatory rotations or for a second primary care clinic. Residents also rotate at Hooper Detox Clinic in NE Portland, where they learn about inpatient detoxification.