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Thank you for your interest in the Lahey Internal Medicine Residency Program!

Shoulder-to-shoulder training alongside attending physicians, inspired by the hospital’s surgical roots, gives residents a unique apprentice approach to clinical skills development.  The relationships between attendings and residents often feel more intense than in a typical internal medicine residency.  Attendings spend substantial time with trainees no matter the setting–the ICU, general medical wards or primary care continuity clinic.  Each admission or bedside visit is treated as an opportunity for a “mini morning report” where many small educational points are delivered, including medical knowledge, physical exam skills, diagnostic reasoning and patient communication.  All contribute to trainees quickly acquiring expertise and independence.  Lahey’s residents are well-prepared for competitive fellowships and careers in general internal medicine.  Those who learn by doing thrive in this environment.

As a tertiary care facility, Lahey has grown tremendously in the last decade in terms of complexity of its patients.  Our residents care for patients across a wide breadth of disease processes, with increased educational and scholarship opportunities, expanded nationally and internationally recognized subspecialties, and world-class facilities.  Internal medicine residents train within a large Department of Medicine education group with fellows in nine subspecialties training alongside clinical luminaries.  These include an internationally renowned interventional pulmonology (IP) service led by Carla Lamb, MD, a pioneer in the field; and cardiologist Frederic Resnic, MD, whose department recently received the Heart Care Center of Excellence award by the American College of Cardiology.

In the Department of Medicine, we have 42 internal medicine residents, including 6 preliminary interns typically linked to the Tufts-Neurology program, and the majority of time is spent at LHMC with 1 month at the Shattuck Hospital (a safety net hospital that includes a prison ward, located in the Jamaica Plain neighborhood of Boston) and 2 weeks on the long-term care unit at the Bedford VAMC in Bedford, MA. Each year residents spend approximately 4 weeks in the MICU and 4 weeks on a CCU/cardiology floor, 10-14 weeks on general medicine, oncology and hepatology ward services, 10 weeks in General Internal Medicine resident clinic (on a 4+1 schedule), and the remaining time on night float, ambulatory subspecialty experiences, ED, geriatrics and elective. Our resident clinic weeks also include QI/patient safety didactics and projects, simulation experiences, and dedicated time for scholarship. In recent years, approximately 50-75% of residents pursue subspecialty training, with cardiology, GI, oncology and pulmonary being the most frequent choices. The other residents have generally become general internists, or hospitalists. The training program is supportive but also demanding, and we are confident that the intensity and breadth of exposure prepare our residents very well to handle any clinical challenge in the future.

LHMC is a 335-bed tertiary referral center in Burlington, MA, and one of two such centers in the Beth Israel Lahey Health System.  We are a major teaching hospital of Tufts University School of Medicine and have the highest medical student satisfaction for clinical rotations among the Tufts academic partners.  Lahey regularly has one of the highest volume liver transplant services in New England and our residents care for many end-stage liver disease patients.  Our GI service performs many advanced interventional endoscopy procedures, and there is a high volume cardiac interventional and EP service offering multiple structural interventions and advanced ablation procedures.  In 2019-2020, Lahey received national recognition from 11 organizations including Leapfrog Safety Grade A for 6 consecutive reporting periods, CMS Hospital Compare 5 Star, Healthgrades Top 50 Hospitals, Becker’s Healthcare Top 100 Hospitals, IBM Watson Top 50 Cardiovascular Programs (11-time winner),  and Women’s Choice Award 2020.

  • To educate our residents in providing unsurpassed care for patients with routine as well as high-acuity, complex conditions whether as a generalist or subspecialist.
  • To support the professional development, personal growth and specific goals of residents and medical students.
  • To educate our residents in becoming well-rounded physicians, with a strong understanding of the fundamentals of internal medicine, evidence based practice, physical diagnosis, and quality improvement.
  • To encourage the development of leadership skills that position the residents to become agents of change in the present and future.
  • To ensure residents are well-prepared for outpatient and/or inpatient general internal medicine practice, or subspecialty fellowships.
  • To insure our residents have regular opportunities throughout training to focus on their personal well-being, work-life balance and personal development.
  • To work within our institution to educate ourselves and to drive innovations to insure that we create and maintain a community committed to equity, fairness and diversity so that all in our institution feel welcome, supported and respected.
  • Support trainees as they learn how to deliver the highest quality and safest patient care using evidence-based medicine, quality improvement, patient safety tools, and a team-work approach.
  • Outline and implement specific learning objectives of an educational curriculum that ensures the broad knowledge and clinical skills required of qualified physicians to provide excellent patient care, and to advance medicine through research and education.
  • Promote a culture of mutual learning, respect, and education.
  • Acknowledge diverse views that foster healthy discussions among residents, clinicians, colleagues, patients and families.
  • Utilize transparent systems for timely, meaningful and constructive resident evaluation and feedback in professionalism, patient care, medical knowledge, practice based learning, communication and systems based practice that are aligned with Lahey’s mission statement of providing superior health care to our patients.
  • Support, guide and educate residents to provide ethical and patient-centered care and fulfill professional obligations.
  • Nurture residents to become lifelong learners.
  • Support residents as they work to master the skill of self-care, and to avoid burnout over their career. In addition to Lahey-wide wellness initiatives, residents are given regular “What I Need” (WIN) days to provide them the time to do this important work.
  • Recruit and retain exemplary residents and faculty.
  • Maintain a balance of education, service and research, while adhering to Lahey’s internal GME Committee guidelines and maintaining ACGME accreditation.
  • Promote scholarly activities and opportunities for research projects while providing mentoring and supervision by faculty. During the 2020-2021 academic year the Lahey GME community is creating a research curriculum and mentoring program for all trainees.
  • Create a robust curriculum to support diversity, equity and inclusion efforts.
  • Expand our evidence-based medicine curriculum

At least twice a year residents receive written feedback on their road to mastery of the ACGME Internal Medicine Milestones and Competencies, along with any other pertinent feedback related to their professional growth and development.  They also meet with one of the program directors to review this progress, as well as their career aspirations, scholarship goals, access to mentors, and anything else of concern. The summative feedback is based on written evaluations, direct observation, nursing input, patient feedback, and other faculty input to our Clinical Competence Committee (CCC). The CCC is charged by the ACGME to review resident performance, professional development, and accrual of clinical competence as assessed through the lens of the ACGME internal medicine “milestones.”  Input from multiple sources provides robust information to residents, and allows us to tailor support in particular areas if needed.   The committee consists of the program directors, chief residents, program coordinators and key clinical faculty from all of the medical subspecialties. There are no fellowship directors on the CCC.  The goal is to make sure everyone is on a path to success and excellence while trying to identify areas in which we can optimally support residents.

 

We additionally ask that faculty and residents sit down at the end of each week’s assignment to discuss successes and opportunities identified that week.   While the faculty member will document progress towards mastery of the Internal Medicine competencies in their written evaluations, the verbal feedback allows for more nuanced and personalized feedback, and can be particularly helpful for professional development, mentorship and coaching.

 

We also advocate that residents pro-actively seek out feedback.  Our environment is supportive and constructive, and we aspire to be a place of learning where all of our trainees and faculty embrace working in a “culture of safety”, engaging in honest self-reflection, and incorporating constructive comments into our career-long growth.

 

Additional resources and activities to support residents in their professional development:

  • Quarterly “Connect and Reflect” sessions for each class. These sessions are led by junior faculty members, and are intended to provide a safe place to discuss challenges and successes, with the goal of easing burnout and fostering resilience.
  • Residents elect class representatives to facilitate sharing resident concerns and proposing changes, as needed.
  • Chief residents and program directors are always available, including by cell phone, for any concerns or questions.
  • Lahey-wide housestaff meet regularly, and have the opportunity to raise institution-wide concerns which can be brought forward to the hospital-wide GME Committee to be addressed.
  • GME leadership, including our Designated Institutional Official and Chief Academic Officer, hold periodic GME “town halls”.
  • Lahey-wide faculty ombudsmen are available to all house officers with concerns they are uncomfortable bringing to their chiefs residents and program leadership.

What Sets Us Apart

When asked to describe the culture at Lahey, our housestaff universally say that it is one of camaraderie and support. As a smaller program, we have the opportunity to develop deep working relationships – not only with one another, but other physicians and allied healthcare professionals in the hospital. Residents are able to stand out and thrive professionally and personally***

With the addition of Sheri A. Keitz, MD, PhD, as Department of Medicine Chair in 2019, the program’s Evidence-based Medicine (EBM) curriculum will be maximized.  Dr. Keitz is a pioneer in the EBM field and co-directs two national/international EBM workshops.  Under Dr. Keitz’ leadership, Lahey residents are expanding their skills to critically appraise the literature in both interventional and diagnostic studies and to more seamlessly incorporate evidence into clinical decision-making.  This is particularly powerful when paired with residents’ deep shoulder-to-shoulder clinical training alongside attendings.

The link below shows Lahey interns participating in orientation through simulation, teamwork and a cookout…

https://youtu.be/h_-ZiPzirEc

We understand that Interns may have variable levels of experience when starting in their new role. To make the transition as seamless as possible, we offer a rigorous orientation program prior to the start of the year, where Interns engage in simulation and shadowing sessions that acclimate them to clinical duties. Once they begin working, we maintain 1:1 supervision for the first three months, to ensure that interns receive appropriate support.

The Internal medicine program operates on a 4+1 schedule, and it has been met with great satisfaction. This model separates inpatient clinical duties from every 5th week in our general internal medicine (GIM) outpatient primary care practice. GIM outpatient care allows residents to foster longitudinal relationships with patients.

Because this week functions as an opportunity for reflection, recuperation and includes dedicated time for personal care, preliminary year interns have a schedule which follows a similar cadence, again providing an elective week every 5th or 6th.

Lahey Hospital & Medical Center’s reputation for excellence comes from our innovations in care, our exceptional patient outcomes, our research and more.

We are committed to maintaining our high standards and giving our patients the best care possible. A number of organizations track our progress and help us continuously raise the bar. In 2019-2020, Lahey received national recognition from 11 organizations including Leapfrog Safety Grade A for 6 consecutive reporting periods, CMS Hospital Compare 5 Star, Healthgrades Top 50 Hospitals, Becker’s Healthcare Top 100 Hospitals, IBM Watson Top 50 Cardiovascular Programs (11-time winner),  and Women’s Choice Award 2020.

QI training is a core component of our teaching. Residents complete quality and safety education, activities and projects during their ambulatory block, under the direction of a dedicated QI Associate Program Director. For residents who want further experience in QI, there is an opportunity to join Lahey’s Housestaff Quality Council (led by the hospital’s Chief Quality Officer) and engage in institutional level projects.

Lahey Hospital makes use of the EPIC EMR, streamlining access to patient information, and minimizing time spent on administrative duties.

Residency can be a challenging time, both professionally and personally. At Lahey, we take in pride in fostering an environment that allows our residents to maintain a healthy work-life balance.

Our program directors and chiefs routinely audit the program during regularly scheduled business meetings with the residents to assess how they are doing, and whether any system changes need to be made to daily operations. Resident satisfaction is paramount – recent changes include reducing patient caps, and minimizing 24h call in the units to one day in 2 weeks. On an institutional level, Lahey GME conducts regular Housestaff town hall meetings and lectures, where wellness and burnout are addressed.

Our schedule is created in a thoughtful manner, accommodating most vacation and golden weekend requests, as well as ensuring that each resident gets at least one major holiday off during the year. PGY3 residents are given a more flexible schedule during fellowship interview season, to reduce the need for coverage. We also incorporate WIN (What I Need) days on every Monday of our longitudinal clinic week (and elective weeks for preliminary interns), to allow residents time for personal appointments, errands, etc.

We have a “sick call” system that all residents participate in.

When not working, our residents enjoy socializing together. Group activities include a resident soccer team, and scheduled game nights. Program organized events have included a “Friendsgiving” potluck dinner, “Movember” to raise awareness about men’s health, Boda Borg night, and a wellness activity at the Museum of Fine Arts.

Covid-19: as has been the case around the world, the Covid-19 pandemic has challenged healthcare systems. The Boston area was affected in the spring by a surge in patients.  Our hospital, including our housestaff, worked hard to manage both Covid and non-Covid patients, and we are incredibly proud of the care we gave in the face of an unprecedented crisis.  Program leadership, Department of Medicine leadership, and the residents worked closely to insure that the schedule and structure during the surge was manageable.  For future surges an alternative approach will be taken, in which housestaff will have their schedule changed in a less impactful manner, unless we are facing another unprecedented public health emergency.  However, Massachusetts has done a tremendous job of controlling Covid infections, and it is our hope that we will not be faced with the challenges we saw in the spring.