Attending Rounds for inpatient ward teams and the critical care units take place every morning. There is an emphasis on bedside rounds, integrating didactics with clinical skills.
Senior ward residents are expected to round with their interns, one at a time, prior to attending rounds to provide supervision and education to the interns, and to nurture clinical leadership of the patient. The clinical plan can be initiated when appropriate, and completely presented at attending rounds.
Signout rounds happen in the residency room for ward teams, with interns and residents signing out to their respective night float residents. This insures that any potentially active patients overnight will be known to both the intern and resident night float.
Critical care signout rounds happen in the evening with the fellows. In addition, the senior in one unit will provide written signout to his or her peer in the other unit.
Morning Report is held on Mondays, Wednesdays and Thursdays from 11:15-12:15. All residents are invited. The conference is mandatory for residents on outpatient rotations, and 70% attendance is expected for ward residents. Night float, vacation and critical care residents are excused.
This is a case-based conference led by the chief residents. The resident’s present inpatient or outpatient cases, and the chief residents lead the discussion and didactics. A subspecialty or general medicine guest attending provides clinical expertise and aids the educational component. The program director and associate program directors are often in attendance, as are the ward attendings.
In addition to clinical cases, some sessions may dedicated to ECG reading and board review.
Examples of recent cases include:
Papillary muscle ruptures presenting as respiratory failure
Inflammatory bowel disease
Acute kidney injury
Fever of unknown origin
General internal medicine conference occurs once a week with a focus to general topics commonly seen in a primary care practice. This year the format has changed to include small group learning instead of lectures.
Midday Conferences occur from 12:30-1:30 on Mondays through Thursdays. This is a traditional presentation of core internal medicine topics from all specialties of medicine as well as neurology and psychiatry.
Intern report occurs for the first 6 months of the year on Fridays from 12:30-1:30. Senior residents cover the interns’ pagers. The chief residents or a program director leads the session. Emphasis is on fundamental clinical skill development and core medical knowledge. Later in the year there are sessions on clinical teaching.
Medical Knowledge/Board Review
Medical knowledge/board review occurs Fridays from 12:30-1:30 for senior residents, with the interns joining in the second half of the year. This is organized by a core faculty member, with various specialty physicians joining each week. Twice yearly exams allow residents to track their progress.
Grand rounds for the entire Division of Internal Medicine is Fridays from 7:30-8:30.
Radiology rounds occur about once a week, and are centered on internal medicine cases, and taught by the radiology chief residents. The goal is to build basic radiology interpretation skills.
Visting professorships occur at least once per year. A nationally recognized physician is invited and presents at grand rounds, as well as smaller sessions specifically for the house staff. A dinner and luncheon also occur, allowing residents a less formal opportunity to talk with the physician.
Evidence-based Medicine (EBM)
Evidence-based medicine (EBM) occurs weekly, except in the summertime. Emphasis is on basic epidemiology concepts and the critical analysis of the medical literature.
Simulation sessions occur weekly. Emphasis is on procedural skills in a simulated environment. The education includes on-line didactics, faculty didactics and hands-on practice. Other sessions include patient scenarios to train clinical, leadership and communication skills. The Simulation Center at Lahey Clinic has several mannequins, including a heart/lung model, to enhance the experience.
Residents on ambulatory rotations have a protected academic afternoon for simulation and EBM training.
Themed weeks, such as HIV/AIDS week and Nephrology week, occur periodically. All of the didactics that week are focused around a particular specialty. This provides reinforcement of key concepts and clinical skills in a particular area. These sessions are done annually, so if a resident is unable to attend one year, there will be additional opportunities in the future.
CME conferences are organized by various departments and divisions at Lahey, and occur at various sites around New England. Residents are encouraged to attend when they are able to, and there are opportunities for residents to present as well. Registration fees are waived, and often stipends are available to defray the cost of attending. Presenters have all expenses paid.
The residents informally socialize outside of work. This is a result of the great camaraderie of our house staff. Formal events include a welcome cookout for incoming interns and a graduation celebration for all house staff and faculty in the spring.