The University of Florida Internal Medicine program is an innovative program and is constantly developing new programs which are increasingly being emulated by other internal medicine programs. Some of the unique features which distinguish it from other programs include:
Transparency and Cooperation
The hallmark of the Internal Medicine Program is collegiality and cooperation. This attitude permeates the entire Department of Medicine and is the reason why so many of our residents stay for fellowship and for their career. The administration regards the residents as essential members of the staff and has several ways to get their input on important issues for the residency program and the hospital as a whole. The Housestaff Advisory Committee (HAC) is made of elected representatives from each year, the chief residents, the program director and associate program directors which discusses upcoming changes to the program and issues of concern for the residents. All major changes to the program are vetted in this setting and tweaked to be suitable for all parties. The chief residents also meet with the residents monthly without any administrators to hear concerns and explain recent changes to the program at “breakfast with the chiefs.” Dr. Hromas, the Chairman of Medicine, and Dr. Edwards, the Program Director, also meet with all the residents in a town hall style meeting at noon conference to discuss issues that impact residents. These avenues assure that the voices of the residents are always heard and their input is incorporated into systems changes at all levels.
Green Medicine Team
This is a teaching team at Shands Hospital intended to simulate life as a hospitalist as most traditional teaching teams. It consists of two upper level residents and a attending hospitalist, with only occasional presence of 4th year medical students. The two residents function largely independently including rounding separately with the attending. They are also free of outpatient clinical duties during this rotation in order to further simulate the hospitalist experience. This is a highly desirable rotation for the hospitalists, therefore only the very best are allowed to staff this service.
All categorical interns rotate through this service in order to prepare them to perform standard internal medicine invasive procedures including paracentesis, thoracentesis, lumbar puncture, central line placement, and joint injections. It consists of supervised time in a state of the art simulation lab at the VA as well as a consult based service which assists all services at the VA with invasive procedures. As a result, at the start of their second year of residency all PGY-2s are competent, confident and ready to supervise these procedures.
All interns rotate through the Oncology, Cardiology, and GI/Hepatology services during their first year. These are ward teams staffed by attendings from their respective subspecialties giving the interns an opportunity to learn how to manage complex medical problems from the experts themselves, making them more prepared to handle these problems as upper level residents. This exposure to the 3 most competitive specialties during their intern year helps many interns decide on a career path and lets them cultivate research opportunities and relationships with faculty early in their training.
In addition to the excellent clinical experience provided at UF, there is also a longitudinal and multifaceted approach to preparation for the American Board of Internal Medicine (ABIM) exam. Noon conferences are divided into organ system blocks according to their representation on the boards. Topics are then assigned to faculty who have demonstrated superior commitment to education and have given excellent lectures in the past. In addition, on Thursdays after Grand Rounds, PGY-2’s and PGY-3’s are required to attend an hour long board review session. Interns are also welcome to attend if they do not have other responsibilities during that time period. During these sessions, residents work through MKSAP board review questions with the guidance of a faculty member from the specialty being covered that day.
Gator Rounds is an evidenced based rounding system which centers on efficient, patient centered, and interdisciplinary rounds developed right here at the University of Florida. All team members, including attendings, are expected to have reviewed labs and vitals prior to rounds allowing rounds to focus only on the pertinent objective information rather than reciting all of it on rounds. Nurses, case managers, pharmacy, as well as the medical team are expected to be at bedside rounds allowing for better communication between care providers and a team based approach to care. Teaching is also problem focused allowing teams to finish with rounds by 11:15am allowing time for more in-depth discussion of topics to occur later in the day. If patients are stable for discharge they often seen by the attending and discharge prior to rounds, making rounding more efficient.