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Residency Environment

Patient Population

Johns Hopkins Bayview's house staff and faculty cite the patient population as one of the great strengths of our program. The patients are a wonderful mix of individuals from the immediate vicinity of the medical center and people referred to Hopkins for specialized care. The Medical Center's patient population is diverse, reflecting the multiple cultures and socioeconomic classes of Baltimore. Many patients come from the surrounding neighborhood which is a predominantly blue collar working class community. Bayview's backyard consists, in part, of harbor-centered-factories such as Bethlehem Steel and General Motors. Many of our patients either work currently for, or are retired from, these companies. The patient population provides house staff a unique opportunity to see a range of medical conditions as they present to the medical system -- something our house staff universally appreciates. One of the unique features of the training program is that residents provide first contact care for patients with a broad spectrum of medical conditions from the common to the unusual. While some patients are referred to the medical center for highly specialized care, others seek general medical care, preventive care, and health maintenance here. Visiting house staff also value their education here because many rotate from hospitals that principally treat patients referred for care after the acute presentation. The house staff become the primary care physicians on both the inpatient units and in the MHSP, enjoying the important doctor-patient relationships that result.

Teaching Environment

Johns Hopkins Bayview's teaching environment also is unique and the campus is a center for state-of-the art patient care, teaching and basic and clinical research. The modern medical-surgical facility includes all 150 beds of the department of medicine, the emergency department, imaging center, cardiac diagnostic laboratories and 64-slice CT scanner, EP lab, state-of-the-art education center and Harrison Medical Library. The Johns Hopkins Care Center John R. Burton Pavilion houses a nursing home, rehabilitation units, a chronic hospital and chronic ventilator unit, and an ambulatory care center. The campus also is the home of two branches of the National Institutes of Health (the National Institute on Aging and the National Institute on Drug Abuse). The Asthma & Allergy Center is a state-of-the-art research facility that is home to the divisions of clinical immunology and pulmonary medicine and also houses ambulatory clinics for some of the medical subspecialties. The Mason F. Lord building is the site of magnificent state-of-the-art basic research programs in endocrinology, pulmonary medicine, rheumatology, and the cardiovascular proteomics center in addition to the clinical sites for the Hopkins Elder Plus (PACE) Program and the Comprehensive Care Program, tailored particularly to the needs of people with substance abuse and HIV. The MHSP, the faculty general medicine practice, and subspecialty clinics are located in the 301 Building, a brand-new ambulatory care center adjacent to the acute hospital. This allows house staff to practice side-by-side with faculty in a modern and comfortable setting.

Ambulatory Training

As house staff training nationwide focuses increasingly on ambulatory care, the Bayview program leads the way. The three-month BASIC rotation is one example of this, training residents in important aspects of outpatient subspecialty medicine that are not part of a typical inpatient curriculum. Residents learn primary care in a Patient Centered Medical Home setting in the RBMG, where they are mentored by faculty in the divisions of general medicine and geriatrics. Residents from our program have an active affiliation with Primary Care Progress, a national initiative to promote primary care.

Each clinic session begins first with a team huddle. Resident teams are organized into a firm system to enhance continuity of care and mentorship. In addition, house staff and faculty meet monthly at noon conference to discuss various aspects of ambulatory care; once a month, morning report is dedicated to a didactic, patient-focused topic in ambulatory medicine.

Inpatient Training

Inpatient rotations occur on the Zieve Medical Service, a 72-bed general medical ward. There are four house staff teams each with a junior or senior resident, two interns, two medical students from the SOM, a full-time teaching attending and, at times, one or more subinterns. Each team has a night team member who admits and manages the care of that team’s patients overnight and participates in rounds in the morning. Both generalists and subspecialists from the full-time faculty attend on the Zieve Medical Service, providing unique perspectives and approaches to patient care. Hospitalists, physician assistants, and nurse practitioners staff the Collaborative Internal Medicine Service (CIMS) taking care of many patients without house staff involvement, thereby enriching the learning environment for the house staff (see “Hospitalist Service” section below).

The cardiac intensive care unit (CICU) and progressive care (“step down”) unit provide house staff experience caring for patients with acute cardiac disease. Two cardiology teams include eight house staff, two of whom are residents from JHH, two cardiology fellows and two attending cardiologists. There are 12 CICU and 16 monitored cardiac progressive care beds. House staff become experienced managing patients with acute myocardial infarction, unstable angina, pulmonary edema, and cardiac arrhythmias; in addition, CICU house staff carry the hospital code beepers. Teaching rounds are held seven days a week, along with morning didactic sessions and daily study rounds where house staff learn to interpret echocardiograms, stress tests and coronary angiograms. Call is every third night for residents in the CICU, while the interns work day and night shifts.

The Medical Intensive Care Unit (MICU) provides experience evaluating and treating patients with a variety of acute pulmonary and critical care diseases. The pulmonary progressive care unit (PCU) cares for non-critically ill patients who are hospitalized for the treatment of asthma, COPD, interstitial lung disease, or newly diagnosed lung masses. A team of 6 house staff, a pulmonary fellow and a pulmonary critical care attending physician care for patients hospitalized in the 12-bed MICU. A separate team of physician assistants, supervised by an attending physician and fellow in the division of pulmonary medicine, care for patients hospitalized in the 12-bed pulmonary PCU.

Relationship With The Johns Hopkins Hospital

The Johns Hopkins Hospital-based faculty and residents and the Johns Hopkins Bayview-based faculty and residents enjoy a close relationship. The Johns Hopkins Bayview Medical Center is a major teaching, clinical and research facility of the SOM and is a member institution of the Johns Hopkins Health System. Our faculty are full-time staff of the SOM. Internal medicine house staff are fellows of the SOM. House staff in the departments of anesthesiology, gynecology and obstetrics, pathology, psychiatry, radiology and surgery are shared by Hopkins Bayview and The Johns Hopkins Hospital (JHH). Medical students of the SOM train on our inpatient wards, and residents rotate from the JHH training program in internal medicine through our cardiac and medical intensive care units and ambulatory clinics. Hopkins Bayview medicine residents rotate through the Acute Leukemia Service at JHH during their PGY-2 and PGY-3 years. As a result of the close relationship between the hospitals and programs, our house staff often participate in subspecialty electives at JHH.

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