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Curriculum

     Year 1: Develop superior clinical skill 

ServiceBlocksCall CyclePatientsRole
Osler5Q4 callGIMPrimary provider
Mary Elizabeth Garrett1Night floatGI/LiverPrimary provider
Brancati1-2HybridGIMPrimary provider
MICU0.5VariablePrimary provider
CCU0.5Q3Primary provider
ED0-0.5Shift workPrimary provider
Oncology0-1No callBMT/Solids/LeuksPrimary provider
Neuro0-0.5No callPrimary provider
Clinic1.5No callContinuity /Rheum/EndoPrimary provider
Vacation1.252 two-weeks + 6d winterPrimary provider

Year 2: Explore subspecialty medicine, investigation, and clinical leadership

ServiceBlocksCall CyclePatientsRole
Osler0-1N/AGIMTeaching/admitting
Mary Elizabeth Garrett0.5-1N/AGI/LiverSupervising resident
Carol Johns1‐1.5Q4 callPulmonary + RheumPrimary provider
Brancati0.5-1N/AGIMSupervising resident
MICU/CCU2-3Q3 callSupervising resident
Cardiology1‐1.5Q4 callGeneral and heart failurePrimary provider
Polk1-2Q4 callInfectious diseasesPrimary provider
Renal Transplant0-0.5N/APrimary provider
ED0-0.5Shift workPrimary provider
Oncology0-1Q4 callBMT/Solids/LeuksSupervising resident
Neuro0-0.5Q4 callGeneral neurologyPrimary provider
Research Clerkship2N/A-
Ambulatory Block0-0.5N/AAmbulatory acute carePrimary provider
Elective1-1.25N/AVariable
Vacation1.25-2 two-weeks + 6d winter 

Year 3: Become a leader and educator

ServiceBlocksCall CyclePatientsRole
Osler2-3N/AGIMTeaching/admitting
MICU/CCU2-3Q3 call-Supervising resident
ED0‐0.5Shift workPrimary provider
Oncology1.5Q4 callBMT/Solids/LeuksSupervising resident
Neuro0‐0.5Q4 callGeneral neurologyPrimary provider
Hematology0‐0.5Q4 callHemePrimary provider
Overnight Supervisor0‐0.5Q4 callSupervise overnight interns
Ambulatory Block0-1N/AAmbulatory acute carePrimary provider
Ambulatory Elective1.5N/AVariable
Elective1.5-2.5N/AVariable
Vacation1.25-2 two-weeks + 6d winter 
Note: 13 Block schedule for all years (4  weeks  each)InpatientOutpatient

The Osler Medicine Service

The “O” is the flagship educational experience of the residency program and is modeled after the bedside rounds of 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 one fundamental difference—they are the attending almost all year. This allows them to provide unique longitudinal mentorship to every intern for the year, compared to a model where interns have attendings for one to two weeks at a time. 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. 

Continuity Clinic

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 learn about chronic disease management. Clinics are either adjacent to the main hospital or at the nearby Johns Hopkins Community Physicians Site, East Baltimore Medical Center. In both settings, residents work with nurses, medical assistants, case managers, social workers, behavioral therapists, and pharmacists to provide a team-based approach to patient care.

Interns have three, two-week ambulatory blocks dedicated to developing outpatient skills in general medicine. During this time, they also are immersed in subspecialty care with rheumatology and endocrinology. In the Complex Patient Clinic, interns assume the role as primary care provider for a number of patients with significant multimorbidity and high medical utilization. Between ambulatory blocks, weekly afternoon continuity clinic continues while on oncology rotations and the O. Second and third year residents devote one or two half-days per week to continuity clinics, depending on their clinical rotation. They also may have outpatient general medicine blocks where they provide urgent care, assist with residency panel management, as well as run teaching sessions for the interns.

In addition to preceptor-resident teaching interactions, an ambulatory medicine curriculum is delivered through didactic sessions during noon conference, resident-led case discussions, and independent learning with a nationally renowned online case-based curriculum. Focusing on population health education, quality measures for each resident's panel are updated in real-time and visible on an EMR-integrated ambulatory dashboard.

Outpatient Subspecialty Electives

Elective outpatient rotations are available in every subspecialty. In addition, many of the core inpatient subspecialty rotations include time with the attending physicians in their ambulatory clinics. These rotations provide the housestaff with the opportunity to work one-on-one with senior faculty to master subspecialty skills.

Carol Johns

The Carol Johns Service provides care for general pulmonary, cystic fibrosis, pulmonary hypertension, lung transplant and rheumatology patients. Named after 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.

Mary Elizabeth Garrett (MEG)

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 are the primary providers and junior residents are able to learn team leadership and management skills overseeing the service delivery. The team receives 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. 

Brancati / Clinical Skills

The newly formed Brancati Service is a set of four small teams, each with one intern, one junior resident and one hospitalist attending. The team accepts patients from overnight admitting interns and manages them throughout the day. Interns rotate as both the admitting night intern and as the accepting day intern. The small team size nurtures highly personalized training and mentoring relationships between the housestaff and teaching hospitalists. 

This rotation includes a structured clinical skills curriculum which has been demonstrated to effectively improve bedside physical exam skills.[1]  All Brancati interns go to the bedside every weekday for 30 minutes with a bedside medicine faculty member. Each session focuses on the importance of physical exam technique, accuracy, and interpretation. Sessions include cardiac, pulmonary, gastrointestinal, and neurology exam techniques. One session each week integrates point of care ultrasound to improve physical exam technique and to provide trainees with fundamental training in this evolving bedside clinical exam skill.

Procedural Services

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.

MICU

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.

CCU

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.

Oncology

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 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 Moore Clinic, the Polk Service provides an unparalleled opportunity to learn about HIV, AIDS, and highly active anti-retroviral treatment (HAART).

[1] Garibaldi BT, Niessen T, Gelber AC, et al. A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training. BMC Med Educ. 2017 Oct 6;17(1):182.