Special Features

Internal Medicine Residency


GBMC is located in a rich environment of world class academic institutions.  Our formal affiliation is with Johns Hopkins School of Medicine, and this affiliation was further expanded several years ago with the new direction of cardiovascular services by Johns Hopkins at GBMC.  Our PGY2 residents all rotate through neurology at Johns Hopkins and Cardiology Consults at Johns Hopkins Bayview Medical Center, and many others do research and clinical electives with faculty there.  Most of the faculty and specialists have academic appointments as well.  Each year, Johns Hopkins medical students rotate through our department for various elective medical rotations. The close proximity of such sophisticated medical resources allows the residents to experience an intimate community setting while gaining competitive skills usually only acquired in a larger institution.

Ambulatory Experiences

The outpatient continuity clinic experience at GBMC provides a wonderful opportunity to learn chronic disease management and preventive health care. It also gives the residents opportunity to manage acute urgent care type visits as well. Since 2009 the program has introduced a model where the residents spend one week of dedicated time in the outpatient setting every three months without any other clinical duties. There are three residents, one from each year of training, who form a team for that week. They are supervised by a dedicated attending throughout the whole year to ensure continuity of care and better supervision and monitoring of the residents' progress. The residents have the opportunity to see their patients as needed in between their regular scheduled week of block clinic.

In addition to didactic teaching within the group, the residents have access to the internet-based Johns Hopkins Ambulatory Module as part of their learning curriculum.

The residents are also exposed to management and business aspects of primary care practice. Topics on billing, coding, legal issues, finances are taught during the clinic rotation. The residents are also involved in practiced based learning quality improvement projects to promote the quality of care being delivered by all the residents in the outpatient setting.

Ancillary Services

Comprehensive, fully-staffed, ancillary support services include 24-hour phlebotomy and IV line placement teams, respiratory therapy, EKG and portable x-ray.

Business of Medicine Curriculum

Although a majority of our graduates go on to fellowship, we do not lose sight of the fact that they all will eventually have a practice of their own.  Therefore, we augment our medicine curriculum with subjects that pertain to the business side of medicine: contract negotiation, quality assurance, coding and efficiency, and administration of a busy practice.  After quality assurance techniques are introduced, the residents are encouraged to use them to devise and initiate improvements to the residency and hospital systems.  All senior residents participate in a month long independent study dedicated to exploring the various roles that physicians are often asked to assume, the business of medicine, and the hospital quality improvement system.

Resident/Faculty Ratio

Resident to Faculty ratio is 4:1. Each resident is paired with a faculty member who serves as an advisor and mentor throughout the program. Advisors meet with their advisees formally twice a year and informally as requested for advice or support. Our core internal medicine faculty are committed to the education of our residents.

Patient Population

While some urban teaching hospitals treat a narrow range of disorders, our residents encounter and learn from patients whose illnesses represent the broad range of disorders seen in the community. Many of these patients present in the outpatient setting. Such broad experience provides the residents with the necessary competence for a successful clinical career, regardless of the practice setting.

Division of Medical and Surgical Critical Care Medicine Educational Initiatives for Internal Medicine Residents

GBMC's Division of Medical and Surgical Critical Care Medicine is a hospital-based high-intensity program responsible for the provision of care in two intensive care units. The multidisciplinary care team is led by seven physicians who are board-eligible or board-certified in Critical Care Medicine, with additional board certifications in Emergency Medicine, Pulmonary Medicine and Sleep Medicine. Supplemental coverage and instruction is provided by four additional physicians who are board-certified in Anesthesia and Critical Care Medicine. The division prides itself on providing compassionate, leading edge critical care coupled with comprehensive resident education of an intensity not typically encountered in the community hospital setting. The division embraces the GBMC vision, "to every patient, every time, we will provide the care that we would want for our own loved ones."

The following opportunities are available for our Internal Medicine Residency Program:

Medical Intensive Care Unit (MICU) multidisciplinary teaching rounds (mandatory)

  • Seven days/week; always conducted by ABIM board-certified/eligible Critical Care Medicine Intensivists
  • Intensivists infuse daily rounds with regular bedside teaching, which includes assessment of the critically ill patient, basics of medchanical ventilation, critical care pathophysiology, principles of resuscitation and review of evidence-based bundled care initiatives
  • Pharmacologist (RPh) provides critical care pharmacology instruction and medication safety checks
  • Registered Nutritionist (RD) provides critical care nutritional instruction, enteral and total parenteral dietary recommendations

Surgical Intensive Care Unit (SICU) multidisciplinary teaching rounds

  • Seven days/week; always conducted by ABIM board-certified/eligible Critical Care Medicine Intensivists
  • Residents have the option to participate in SICU rounds and obtain exposure to critical illness in surgical patients
  • The majority of patients admitted to SICU are admitted for medical reasons; the most common admission diagnosis to the SICU is severe sepsis and septic shock

Critical Care Medicine Core Content Lecture Series: Resident Noon Conferences

  • Lectures are presented every 2nd Thursday of each month at noon
  • Additional lectures are presented regularly after completion of multidisciplinary rounds
  • Brief "chalk talks" are often presented at evening sign-out

Interdisciplinary Monthly Mock Codes at the GBMC Simulation Laboratory

  • All residents are required to attend a series of intensive critical care and code simulations each month
  • Attendance in the simulation laboratory is mandatory and usually scheduled the week prior to the resident’s starting rotation in the Intensive Care Unit
  • High-fidelity simulations are programmed and conducted by dedicated Simulation Laboratory staff, which includes critical care nurse educators; post-simulation audio and video feedback is provided by nurse educators and critical care attending physicians in a state-of-the-art simulation debriefing room
  • Simulation is truly multidisciplinary with attendance by house staff, nursing and respiratory therapy

Critical Care 'Boot Camp' at the GBMC Simulation Laboratory

  • Five-hour intensive didactic and high-fidelity simulation training program mandatory for rising PGY-2 residents conducted in GBMC's state-of-the-art Simulation Laboratory at the start of the academic year
  • Simulations focus on common critical care emergencies likely to be encountered during the course of a clinical rotation in the ICU; also includes training in video laryngoscopy, needle decompression, tracheostomy emergencies and EZ IO (intraosseous needle) insertion

Introduction to Bedside Critical Care Ultrasonography

  • Attending critical care staff regularly demonstrate limited bedside ultrasonography assessments utilizing a state-of-the-art Sonosite X-Porte ultrasound platform
  • Sonosite X-Porte platform includes a large library of audio/video ultrasound tutorials available for house staff to view
  • Lectures on bedside ultrasonography are incorporated into both the noon core content lecture series and presented regularly after multidisciplinary rounds

Society of Critical Care Medicine (SCCM) online 'Resident ICU Course'

  • All house staff are encouraged to enroll in this 37-module online course (http://my.sccm.org/LearningSummary.aspx)
  • Director of Critical Care Medicine at GBMC administers the program and monitors enrollees’ progress via program director dashboard

Lean Daily Management (LDM) Leadership Rounds

  • House staff are offered exposure to the administrative and quality improvement facets of operations in a critical care unit by observing hospital administration engagement with unit nursing leadership at daily LDM rounds
  • One of the recently retired LDM metrics focused on resident 'read back' of all orders entered for patients in ICUs; the goal of the metric was 100% verbal notification to nursing after computerized provider order entry (CPOE) by house staff on the unit

GBMC Code & Rapid Response Teams

  • All ICU house staff fill critical roles on the hospital-wide code team; senior residents are designated as ‘code leaders’ and interns perform compressions in the roles of 'CPR 1' and 'CPR 2'
  • Residents respond to rapid responses with the Intensivist weekdays from 3 -10 p.m.

Opportunities for quality improvement committee attendance and participation:

  • CHARMS Committee (Community Hospital Action Plan to Reduce Mortality from Sepsis)
  • A-B-C-D-E-F/Early Mobility Committee
  • CAUTI, CLABSI and VAP Committees

Opportunities for hospital committee attendance and participation:

  • Critical Care Committee
  • Code/Rapid Response Committee

Opportunities for regular interaction with:

  • Gilchrist Hospice Care staff and hospital-based Advanced Disease Symptom Management (ADSM) Palliative Care Team

Arrangements with University of Maryland Medical Center for additional Critical Care Medicine training:

  • Recent GBMC residents have rotated through the UMMC Critical Care Procedure and Consultation Service
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