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There are a number of structured and unstructured activities that provide the backbone of the educational experience of the Osler residency program. Residents have the opportunity to shape their individual learning plan through electives, research projects and choice of mentor but several key learning activities are shared by the entire program.
“Medicine is learned by the bedside and not in the classroom.” These words by William Osler still ring true a century after he revolutionized the art of bedside teaching. Interns and residents at the Johns Hopkins Hospital learn at the bedside from their patients, their colleagues and outstanding clinical mentors. Here is a brief description of the outstanding clinical service opportunities that residents experience over their three years of training.
The Osler Medicine Service
The “O” is the premiere educational opportunity of the residency program and is modeled after the bedside rounds of William Osler when he founded the program in 1889. Interns and senior residents spend almost half of the year rounding with the Assistant Chiefs of Service on the general medicine wards. Residents learn physical diagnosis and clinical reasoning skills at the bedside of their patients alongside their ACSs and master clinicians from the Firm Faculty.
The Carol Johns Service provides care for general pulmonary, cystic fibrosis, pulmonary hypertension, lung transplant and rheumatology patients. Named after pulmonologist and sarcoidosis expert, Carol Johns, this service is staffed by junior residents under the direction of subspecialty fellows and attendings. The breadth of pulmonary and rheumatologic disease is unparalleled and provides outstanding learning opportunities in pulmonary physiology, immunology and rheumatology.
The Mary Elizabeth Garrett service provides subspecialty care for general gastroenterology and liver patients under the guidance of gastroenterology and hepatology fellows and faculty. Interns and junior residents receive outstanding training in the diagnosis and management of a wide array of gastrointestinal disease and participate in management of patients pre- and post-liver transplant.
The newly created Clinical Skills Service emphasizes the importance of the bedside physical examination in clinical diagnosis and patient management. Interns and junior residents spend time at the bedside with master clinicians from across the Johns Hopkins Health System honing their physical diagnosis and clinical reasoning skills.
Interns and residents learn and practice procedures such as central line and arterial line placement, thoracentesis, paracentesis and lumbar puncture under the direction of expert proceduralists.
Interns and residents learn the latest in the management of critically ill patients with a particular focus on shock, respiratory failure and mechanical ventilation. Morning teaching conferences with experts in critical care are one of the highlights of this highly rated rotation.
Interns and residents learn about myocardial ischemia, cardiogenic shock, arrhythmia, and advanced heart failure management under the direction of leaders in the field. Along with the MICU rotation, this is one of the highest rated learning experiences in the program, in part because of the outstanding cardiology fellows and attendings.
Through their time on the various oncology services, housestaff learn about the management of malignancies and the complications of oncologic therapies. In addition to oncology training, residents utilize their critical care skills in a highly complex and sick patient population. End of life issues and palliative care are also emphasized during this rotation.
The Polk Service
Named after the father of HIV clinical research, B. Frank Polk, the Polk service was founded in 1985 and is one of the premiere inpatient HIV units in the country. Closely connected to the outpatient Moore Clinic, the Polk Service provides an unparalleled opportunity to learn about HIV, AIDS and highly active anti-retroviral treatment (HAART).
Continuity Clinic and Outpatient Electives
Housestaff learn ambulatory care under the guidance of expert general internists and subspecialists as they follow their own clinic panel through the entire three years of training. Housestaff also have the opportunity to do outpatient electives in specific areas of interest. This outstanding bedside training is supplemented by the world-renowned Physician Education and Assessment Center (PEAC) online training program which was developed by Hopkins faculty.
In addition to unparalleled bedside learning, there are a number of structured didactics that are central to the educational mission of the program.
Noon conference is a time for interns and residents to gather together for a meal and to learn about core topics in internal medicine. This daily hour long session utilizes a number a didactic formats including:
clinical talks by experts in their field
debates between master clinicians on controversial clinical topics
morbidity and mortality conference
history of medicine talks
Interns and residents present cases from the wards to their colleagues in a conference facilitated by the Assistant Chiefs of Service and other master clinicians.
Firm Grand Rounds
Senior Residents present cases from the “O” to their colleagues and firm faculty members
Firm Faculty Teaching Sessions
Each month, a firm faculty member is assigned as the “teaching attending” for the housestaff on the firm services. This faculty member leads 2-3 didactics per week with the housestaff using ward patients to illustrate key points in physiology, diagnosis and management.
Medicine Grand Rounds
Every Friday morning, housestaff attend Medical Grand Rounds, where faculty members from Johns Hopkins and from around the world present clinical cases and discuss cutting edge clinical topics. The Assistant Chiefs of Service also present the weekly “Image of Osler” using a real patient from the wards to illustrate an interesting finding and discuss its historical importance.
Subspecialty Grand Rounds
While on elective rotations, housestaff attend weekly subspecialty grand rounds in the field of their choosing. This is an excellent way to learn more about a potential career path and to meet leaders in their field of interest.