Overall Structure is 6 + 2: six weeks inpatient + two weeks outpatient
Year 1: Develop superior clinical skill
|Inpatient Service||Blocks||Call Cycle||Patients||Role|
|Osler||5||Q4 call||GIM||Primary provider|
|Polk||1||Days/Nights||Infectious Diseases||Primary provider|
|Oncology||0.5||No call||BMT/Solids/Leuks||Primary provider|
|Clinic||3.25||No call||Continuity /Rheum/Endo||Primary provider|
|Vacation||1.25||‐||2 two-weeks + 7d winter|
Year 2: Explore subspecialty medicine, investigation, and clinical leadership
|Carol Johns||1||Q4 call||Pulmonary||Primary provider|
|Brancati Supervisor||0.5||N/A||GIM||Supervising resident|
|Brancati Resident||1||Days/Nights||GIM||Primary provider|
|MICU/CCU||1||Q3 call||-||Supervising resident|
|PCCU||1||Q4 call||General and Heart Failure||Primary provider|
|Polk||0.5||N/A||Infectious Diseases||Supervising resident|
|Renal Transplant||0-0.5||N/A||-||Primary provider|
|Oncology||1||Q4 call||BMT/Solids/Leuks||Supervising resident|
|Clinic||2||N/A||Ambulatory Actue Care||Primary provider|
|Vacation||1.25||-||2 two-weeks + 7d winter|
Year 3: Become a leader and educator
|Inpatient Service||Blocks||Call Cycle||Patients||Role|
|MICU/CCU||2.5||Q3 call||-||Supervising resident|
|Oncology||0.5-1||Q4 call||BMT/Solids/Leuks||Supervising resident|
|Hematology||0‐0.5||No call||Heme||Primary provider|
|Clinic||2||N/A||Ambulatory Acute Care||Primary provider|
|Vacation||1.25||-||2 two-weeks + 7d winter|
|Note: 13 Block schedule for all years (4 weeks each)|
*A variety of changes are being made for the rotations starting July 2021 to increase elective time further.
Aspects of Training
The Osler Medical Service
The “O” is the flagship educational experience of the residency program and is modeled after the bedside rounds of Sir William Osler when he founded the program in 1889. Rounds on the Firms occur at the bedside every day. The team consists of four interns, two senior residents and an Assistant Chief of Service (ACS). Interns on the O assume primary ownership of all patients, the seniors lead the team, and the ACS is the attending for the Firm most of the year. The ACS is similar to chief residents in other programs, with two fundamental differences. First, they are at least one year out from internal medicine training so they bring more experiences to the role. Even more importantly--they are the attending most of the year. This allows them to provide unique, year-long, and direct longitudinal mentorship to every intern for the year, compared to a standard model in which interns work with attendings for one to two weeks per year. In addition, the seniors on the O round everyday one-to-one with the ACS to receive personalized leadership training. Interns spend almost half the year on the O. Teaching on the O is supplemented by expert, diverse and dedicated Firm Faculty.
The goal of ambulatory training is to give Osler residents the skills to provide the highest quality longitudinal ambulatory care for patients. This is accomplished through the development of clinical expertise, leadership of multidisciplinary teams, and integration of information technology resources and data to inform clinical care decisions. Residents care for their own panel of general internal medicine patients in their continuity clinic as well as see a variety of ambulatory patients in subspecialty clinics.Residents build their panel of primary care patients over the course of three years, allowing them time to develop close relationships with their patients and experience and manage common acute and chronic illnesses.
Patients are seen either in the Johns Hopkins Outpatient Center adjacent to the main hospital or in an affiliated community clinic that is also a Federally Qualified Health Center (FQHC). In both settings, residents work with a team of nurses, medical assistants, case managers, social workers, behavioral therapists, and pharmacists to provide a team care approach.
With the X+Y schedule, following 6 weeks of largely inpatient experiences (X), all housestaff transition to 2 weeks of ambulatory time (Y). Over the course of the year, everyone will have six of these two-week ambulatory experiences. During each Y block, residents spend approximately half of their time in their own primary care continuity clinics and the other half on either quality improvement (QI) or research projects or outpatient specialty experiences.
During the first year, the initial two-week ambulatory rotation is a dedicated immersion block that blends outpatient primary care with curated didactic sessions that focus on the fundamentals of outpatient internal medicine. During subsequent blocks, in addition to continuing with their own primary care sessions, interns are embedded in outpatient endocrinology and rheumatology clinics or focus on QI projects.
All housestaff are grouped into Firm Teams of four or five residents. This system facilitates a high degree of patient-provider continuity and facilitates the management of any patient care needs that may emerge while the assigned primary care resident is on an inpatient block or vacation.
Experienced preceptors support the resident practice at each clinical site: teaching, supervising, and mentoring. In addition to preceptor-resident teaching interactions, there is a multifaceted comprehensive longitudinal curriculum, where each two weeks is focused on a particular theme within outpatient medicine. Twice per day while on ambulatory blocks, there are brief, digestible, high-yield teaching sessions that comprise of resident-led presentations or case-based diagnostic reasoning sessions. These are paired with independent learning through a Hopkins-developed nationally recognized online curriculum. Further content is delivered during traditional noon-conferences led by our faculty.
Quality measures for each resident's panel is available live as a custom-built dashboard that is completely integrated into our electronic medical record. This instantly allows residents to see which patients may need to be targeted for outreach whether to improve the management of their chronic conditions, complete cancer screens, or receive vaccinations.
Carol Johns (Pulmonary Medicine)
The Carol Johns Service provides care for general pulmonary, cystic fibrosis, pulmonary hypertension, lung transplant and rheumatology patients. Named in honor of a pioneering 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.
Brancati (General Medicine)
The Brancati Service is a set of two teams managing general medicine patients under the supervision of an academic hospitalist. One team has two juniors and four interns. This serves as an opportunity for our juniors to develop sophisticated teaching and leadership skills. The second is a four junior resident team. This allows greater ownership over patient care and often includes sub-intern medical students. These teams are named in honor of Dr. Fred Brancati, a renowned General Internist and former Director of General Internal Medicine at Johns Hopkins.
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. The 24-bed unit has a diverse patient population that includes general medical critical care to highly complex critical care. This is the opportunity for our residents to lead a complex team and also direct codes and RRTs across the Johns Hopkins Hospital. The MICU resident is the team leader in these events. There are two MICU teams which are interprofessional with physicians and advanced practice providers combined. This integrated structure enables enhanced training and collaboration in teaching and patient care. Morning teaching conferences with experts in critical care are one of the highlights of this highly rated rotation. Junior residents will also rotate through the Bayview MICU as team leader.
Interns and residents learn about myocardial ischemia, cardiogenic shock, arrhythmia, and advanced heart failure management under the direction of leaders in the field. The 12-bed unit cares for a patient population which is highly diverse with a wide breadth of pathophysiology. The intern in the CCU will join the MICU resident in codes and RRTs across the Johns Hopkins Hospital to learn how to manage acute events. Along with the MICU rotation, this is one of the highest rated learning experiences in the program. Junior residents will also rotate through the Bayview CCU as team leader.
Through their time on the various oncology services, housestaff learn about the management of malignancies and the complications of oncologic therapies. The services include solid cancer, leukemia, and BMT. 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.Through their time on the various oncology services, housestaff learn about the management of malignancies and the complications of oncologic therapies. The services include solid cancer, leukemia, and BMT. 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.
Residents will rotate through our unique combined inpatient and consult benign hematology service. They will be led by expert clinicians and researchers treating patients with a wide breadth of hematologic diseases including bleeding and clotting disorders, thrombotic microangiopathies, autoimmune cytopenias, bone marrow failure syndromes, myeloproliferative disorders, and sickle cell disease.
The Polk Service (Infectious Diseases)
Named after a pioneer in 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 Bartlett Clinic, the Polk Service provides an unparalleled opportunity to learn about HIV, AIDS, and anti-retroviral treatment (ART), as well as other infectious diseases.
Progressive Cardiac Care Unit (Advanced Cardiology)
The PCCU has two teaching services for our residents. One is a cardiomyopathy service on which we care for patients with advanced heart failure. This includes substantial exposure to mechanical circulatory support devices and continuous inotropic therapies. The second is a general cardiology service, which cares for patients with complicated cardiac conditions other than heart failure. This service exposes residents to management of complicated ischemic heart disease, arrhythmias, and valvular diseases.
Our program places a premium on academic pursuit. Each resident has up to 8-weeks designed to provide unique opportunities to actively engage in research projects with accomplished physician-scientists and clinical researchers within and outside the Department of Medicine. By promoting research and scholarly activities amongst the housestaff, our goal is to cultivate a curiosity and thrill for discovery. Recognizing expert mentorship is essential in these endeavors, we ensure each resident builds a personalized effective network of mentors from across our university. These relationships are facilitated by one-on-one meetings with the Chair of the Department and the Program Director. Our faculty are always excited when an Osler Resident chooses to spend their research time with them. Finally, we are fortunate to have many resources for our residents to pursue research. The Osler Fund for Scholarship assures every resident enough funds to pursue research and to attend national conferences, ideally to present their research. Additionally, we have the Molina and Grasmick Scholars programs which offer funds to residents during their fellowships to pursue fundamental science. More information about this is available on our Physician Scientist Pathway site.