The OHSU Internal Medicine curriculum provides training leading to qualification for entry to the certifying exam of the American Board of Internal Medicine (ABIM). Graduates of our programs have achieved a 100 percent first attempt pass rate over the last three years. See the ABIM site for data on the board pass rates for all internal medicine programs.
The major focus of our residency program is train future physicians to be outstanding clinicians, responsible learners and mindful practitioners in a rigorous training environment that supports outstanding scholarship in teaching and research. 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 hospital medicine, subspecialty and 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 and ambulatory blocks. 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.
Finally, as part of our scheduling system, all residents spend one week in clinic each month. This innovative approach to ambulatory medicine allows residents more consistent exposure in ambulatory medicine with a wide variety of exposures to not only the primary continuity clinic but various other clinics including dermatology, musculoskeletal clinic, gynecology etc. Our curriculum in this +1 week has also been restructured to provide a cohesive set of learning objectives each month.
Most residency programs have 4-week rotations, culminating into 13 block rotations for the year with clinic time taken out of the wards and consult time primarily. Given our focus on resident education and the need to train in a new and ever-changing healthcare environment, we made an innovative change in how we deliver education and training.
- Our inpatient rotations – wards, ICU and some consults – are almost always 3 weeks in duration.
- Every fourth week is dedicated to outpatient medicine consisting of primary care continuity clinics, specialty clinics, and ambulatory seminars.
- The week-long clinic block also has two half-day educational seminars that focus on primary care ambulatory topics, practice based learning and improvement, ambulatory report, and evidence-based medicine.
- The second and third year residents also have the option of choosing a secondary continuity clinic, usually focused on post-residency career plans.
- Residents almost always have the weekend off prior to starting a clinic week. This allows for recovery time on a consistent basis.
This is an innovative schedule design that allows many exciting educational opportunities to occur:
- Clinic is a valued rotation and, since most physicians' lives are spent in the clinic (subspecialist and generalists), it is important to focus time in this area instead of inserting it into different rotations where the resident is unable to completely focus on the clinic experience.
- Inpatient and outpatient experiences are separated so residents are allowed to fully immerse themselves in patient care and education.
- The clinic week allows dedicated time to learning outpatient medicine in a consistent and focused manner.
- The residents are divided into firms so the patients have consistent care by a group of physicians. The firm system also allows the residents to know exactly which residents will be in clinic on the following + 1 week, which facilitates a more organized and patient focused transition of care.
- Firms also allow residents to develop a team based interprofessional practice model approach to outpatient care.
- Three weeks of a rotation appear to be an ideal amount of time to spend on any given service.
- There is now a guarantee of having a weekend off at the end of 3 week rotations and before beginning the clinic week which allows recovery time before beginning the clinic week.
Inpatient Concepts & Operations
- We have developed as much symmetry as possible for wards in each system in order to reduce transitions for residents and interns.
- Both systems function in a drip model approach; our prior system was a bolus model which we felt was not as conducive to learning with the highs and lows of patient numbers.The drip model approach also allows more consistent care of patients over time which is important in the era of duty hour restrictions.
- Both systems have face to face sign-out between the teams and night float with an attending present for morning sign-out, which decreases transitions of care, improves overall quality of transmitting information, and provides feedback on admissions from the night float team.
- Elimination of educational and emotional pull of clinic during wards
- Restructuring of educational conferences to improve process and flow of care for the patients and the teams (see educational conference changes section).
- Increased opportunity for coordinated case management rounds with all members of the healthcare team (physical therapy, pharmacy, nutrition, social work, nursing)
Click here to view information on our inpatient operations using the 3+1 model.
At OHSU we are cultivating the next generation of Improvement Science leaders through curricular training, project-based learning and scholarship. We offer residents a strong foundation in quality improvement and patient safety through dedicated educational time and committed faculty mentors. Develop the skills to understand, participate and lead projects through our myriad of inpatient and outpatient opportunities.
A Culture of Advocacy
Beyond curriculum, we embrace a culture of advocacy. Many of our residents are drawn to medicine on because of their commitments to human welfare and social justice. There is no doubt that they honor those commitments through excellence at the bedside. At the same time, bedside medicine has limitations. The consequences of social determinants like systemic racism, housing insecurity, hunger, and poor access to healthcare are all around us. Advocacy can offer solutions to these ills where clinical medicine falls short. Our residents have organized community fund-raisers, written letters to the editor, and participated in legislative advocacy at the state and national level, among other advocacy activities.
Starting in the 2020-21 academic year, our health advocacy curriculum empowers each of our residents find their voice as healers and leaders for the health of communities. We are truly excited to offer the new curriculum. But more than this, we are excited to support our residents in finding purpose and fulfillment through physician advocacy.
PGY-1 Specific Advocacy Curriculum
The social medicine block includes lessons in community advocacy through the use of an advocacy project planning tool. This tool teaches residents how to partner with a community member to lead change in their communities. In addition, the +1 week for interns includes workshops on legislative advocacy and media advocacy, among other topics.
PGY-1/2/3 - Advocacy Education Opportunities
For all residency classes, a series of advocacy training opportunities are offer on an ad hoc basis. Residents receive updates about these and other opportunities about these via e-mail from the chief residents.
Upcoming education opportunities for 2020-21 academic year
- September 2020: Portland Advocacy Training Event – Offered to residents in pediatric, internal medicine, and family medicine programs.
- The Oregon chapter of ACP will also hold an advocacy day this winter.
- In addition, several of our noon conferences throughout the year will be dedicated to advocacy topics.
Noon Report is held Monday and Wednesday at both OHSU and the VAMC and lasts 60 minutes. The discussions are directed by the program director at the OHSU and the Medical Chief Residents at the VAMC. Residents, fellows and faculty participate in the discussion of a single patient chosen and presented by a designated 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, there is a separate resident report. At OHSU, residents from both the OHSU and VAMC general medicine teams meet with the Department Chair, Dr. David Jacoby, as well as invited guests from various subspecialty divisions.
On Friday, there is a separate intern noon report where interns meet with the Chief Residents 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 on Tuesday, Thursday and Friday. 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.
In addition to the core curriculum, the noon conference series includes additional content such as a monthly interactive EKG conference, clinical problem solving challenges, Fireside chats with the Program Director, fellowship advice and much more.