Applicants for residency positions frequently have questions
about the program that are not covered in the brochure or
other material previously provided. We have prepared
this document to anticipate and respond to the prevalent
concerns of candidates to our residency program. By
addressing these prior to the interview, our department faculty
will be able to utilize the interview process to better become
acquainted with individual applicants, appreciate the unique
strengths each applicant may bring to the program, and discuss
items of particular interest to applicants. Applicants
are invited to review this before their interview. (Hint: don’t
ask us questions answered on the website or
on information provided to applicants!)
We
are committed to the concept that the residency training
program is an educational – not a service – experience. We
expect our graduates to be caring, competent, ethical, and
intellectually curious physicians with a passion for medicine
and capable of either successfully continuing with fellowship
training or entering medical practice. We achieve this
by creating a rich, congenial, collegial educational environment
with appropriate role models for our residents, by carrying
out scholarly activities, and by representing and demanding
clinical excellence.
We emphasize high standards of ethics
and professionalism. We encourage questioning. We respect scholarship. We
want our residents to truly enjoy their experience; learning is easier when
it is fun. Read the reprints provided. Ours is a uniquely intimate
and nurturing environment.
Our residency now has
a thematic identity. We are extremely proud to have developed our special program
on humanities and medicine and the national recognition this has received.
This is described further subsequently.
Saint
Barnabas Medical Center recognizes that education – transmission
of knowledge to a new generation of physicians and development
of new knowledge – is fundamental to its role as a
major medical center in the region and in the nation. Indeed
high quality clinical medicine and excellent medical education
programs are inextricably linked and are complementary. In
many respects a community hospital, such as ours, is uniquely
able to provide clinical role models to residents, provide
expert clinical teaching, and structure successful and innovative
clinical programs. Those physicians who participate
in the educational programs of the Department of Medicine
are superb clinicians and dedicated teachers, and they do
so because of their commitment to medical education and love
of teaching. We are very proud of our programs, and
of our clinicians who teach residents; we consider them equal
to or stronger than any, regardless of setting.
We
have a relationship with University of Medicine and Dentistry-N.J.
Medical School and are a major affiliate. We maintain strong
but independent residencies in internal medicine. We
have enjoyed the opportunities to participate in the teaching
of physical diagnosis to second-year medical students and
provide rotations in medicine to third-year and fourth-year
medical students. SBMC faculty have appointments at
the medical school, and medical school faculty participates
in selected educational activities at SBMC. This has
been an important inter-relationship, as it facilitates maintaining
an environment conducive to clinical scholarship at our institution.
We are also affiliated teaching hospital for the St. George’s
University School of Medicine, a leading international center
for medical education that has provided high-quality clinical
education for more than twenty five years in more than 50
formally affiliated teaching hospitals in the United States
and the United Kingdom. The school now has over 5,500 graduates
practicing medicine throughout the world. We have established
a very successful and popular training program for the University’s
third and fourth year medical students and our faculty have
received formal appointments to the School of Medicine’s
faculty.
We
have approximately 3 dozen full-time faculty in the Department
of Medicine, including both salaried and geographic full-time
individuals. We are very pleased to have recently filled
positions for full-time medical educators with gifted individuals. Thus
we have a number of faculty members who are virtually solely
dedicated to resident education, a rather unique circumstance. These
individuals collectively have had decades of experience in
medical education at academic medical centers with splendid
records of pedagogy and distinguished scholarly achievement.
Our
residency has been consistently and fully accredited. We
received laudatory evaluation from American Board of Internal
(ABIM) site visits. And we have been fully reaccredited
with commendation and without citations by the Residency
Review Committee of the Accreditation Council for Graduate
Medical Education; our most recent accreditation was for
an unprecedented 10 years, as we are a participant in the
elite educational innovation program. Positions offered in
the match are all filled by the upper echelon of candidates. Performance
of our residents on American Board of Internal Medicine examinations
(100% passed the last four years) and annual in-training
exams are considerably above national averages, we won the
NJ Chapter of the American College of Physicians (knowledge-based) “Challenge
Bowl” six years in a row. Our graduates do very
well. Many select practice opportunities in primary
care/general internal medicine from excellent possibilities
in our own or other communities. Other graduates are
offered further training at other attractive programs. Recent
graduates, for example, have obtained fellowship offers at
the National Institutes of Health, Massachusetts General
Hospital, Brigham and Women’s Hospital/Harvard Medical
School, Johns Hopkins, Yale, Penn, Cornell, Columbia, Michigan,
Cleveland Clinic, Jefferson, Georgetown, UMDNJ-New Jersey
Medical School, UMDNJ-Robert Wood Johnson Medical School,
UCLA, MCV, Rochester, and other medical centers; our recent
preliminary interns have gone on to Brigham and Women’s
Hospital, Boston University, NYU, Albany, Vanderbilt, Mount
Sinai, Einstein, Yale, Duke, UMDNJ, and other institutions. Ours
is a program of established excellence.
Residents
are carefully supervised by voluntary and full-time faculty
and given those prerogatives and responsibilities commensurate
with their abilities. In some instances, mature residents
will be permitted a great deal of latitude in patient care
decisions. Because ours is not an excessively large
program (34 residents), there is a pleasant degree of intimacy
within the department. Residents have ready access
to our full-time faculty, as well as to voluntary staff,
and our faculty knows the resident staff well. In today's
medicine it would be unthinkable for residents to provide
unsupervised care. It would be equally unacceptable for residents
to provide care only as directed. We therefore carefully
balance supervision and autonomy on our teaching services,
titrating this to residents' level of training, abilities,
willingness to accept responsibilities, and confidence (of
residents and attending physicians).
Virtually every clinical activity during residency is
formally evaluated and these evaluations are conveyed to
residents. Residents’ care of inpatients, outpatients,
conference attendance, conference discussions and presentation,
grand rounds presentations, research and scholarship, professionalism,
interactions with other health care team members, scores
on monthly exams, scores on annual exams, ability to evaluate
standardized patients, and results of OSCEs (objective, standardized,
clinical evaluations) are but some of the evaluative tools
employed. As ours is a small and intimate program, residents
are quite aware of their performance. Residents meet with
the program director at least twice annually to review all
performance-related issues. Thus residents are rigorously
and regularly evaluated and should be quite aware of how
their performance is judged.
Well.
We cultivate attitudes of collegiality and mutual respect. This
is facilitated by the modest size of our program which facilitates
intimacy, mentoring, and nurturing. There are a number
of social functions throughout the year. These range
from “liver rounds” at certain local establishments
after hours, to dinners with faculty, to an annual department
awards/graduation dinner, to major institutionally-sponsored
residents parties on several occasions during the year, to “Diwali” night. In
addition, we have introduced several resident-faculty functions – these
have included a tennis tournament, a baseball game, bowling
nights, ethnic dinners, receptions and the occasional resident-faculty
basketball game (which the faculty always wins). Be
sure to talk to the residents about these.
On the average, an intern is responsible
for the care of 4-10 patients on a general medical service
at any given time. The majority of these patients
suffer from a combination of cardiologic, gastrointestinal,
pulmonary, renal, neurologic, and infectious diseases. In
addition, the interns will encounter patients with rheumatologic,
hematologic, oncologic, and endocrinologic diseases. We
feel this represents an excellent inpatient medical experience.
There
are one-month, ambulatory “block” rotations for
interns, Junior Assistant Residents (PGY 2s), and Senior
Assistant Residents (PGY 3s). Assignments during the block
rotations include outpatient otolaryngology, gynecology,
hypertension, endocrinology, rheumatology, ophthalmology,
dermatology, neurology, gastroenterology, cardiology, nephrology,
pulmonology, hematology/oncology, psychiatry, hospice, geriatrics,
and others.
The Department has developed a model ambulatory
care program. This does not detract from our commitment
to excellence in subspecialty and inpatient medicine. However
ambulatory care is increasingly the predominant setting for
diagnosis and treatment in internal medicine and its subspecialties. The
number of assigned inpatient months has been decreased to
accommodate our expanded outpatient rotations. We believe
the trend to do less in the hospital and more in the outpatient
setting will only accelerate in the years ahead.
In October
1995 the Saint Barnabas Internal Medicine Faculty Practice
opened on our campus across the street from the Medical Center. This
is a new, state-of-the-art, 2,750 square foot facility which
provides residents opportunities for a model experience in
ambulatory care education. Pap
smears, vaginal wet mounts, joint fluid analysis, soft tissue
and joint injections, electrocardiography, urinalysis, and
geriatric assessment are supervised in the practice. Residents
see their patients with faculty supervision, and faculty
members supervise an on site practice that serves as a continuity
clinic for residents. Our development of a “patient-centered
home” will be another unique innovation for us and
further strengthen our program.
The
Emergency Medicine rotation is one month in the second year. Residents
work from 9:00 a.m. to 7:00 p.m. for ten shifts per month. During
this rotation, they learn valuable triaging skills, the art
of rapid patient assessment and procedures like intubation,
lumbar puncture, suturing, and joint aspiration. Additionally,
they have opportunities to evaluate trauma patients and those
with orthopedic and gynecologic problems.
We have a wide range of medical electives encompassing virtually
any reasonable opportunity in medicine. For example,
three of our residents spent a month each at a public health
clinic in Kathmandu, Nepal, which proved to be an extraordinary
and valuable experience for those individuals as well as
for the program. SBMC offers all of the traditional
medical subspecialty electives as well as others outside
of medicine (radiology, pathology, psychiatry, office orthopedics,
ENT, and others). In addition there are a variety of
outpatient rotation blocks available for residents to chose
from, i.e. pain management, otolaryngology, urology, ophthalmology,
and infectious diseases. Our residents may request
selection of occasional electives at other institutions,
as it is healthy for individuals in the program to benefit
from experiences elsewhere. These will usually be at other
medical centers in the Saint Barnabas Health Care System,
the UMDNJ-NJMS, and Newark Beth Israel Medical Center. We
have a monthly exchange of PGY-1s with Newark Beth Israel
Medical Center, to offer our residents an experience at an
urban institution.
We now have two hospitalist groups who care for more than
50% of the medicine inpatients and provide most of the daily/monthly
teaching on one of the inpatient teaching services. These
hospitalists are here virtually full time and most have been
members of our residency and/or faculty. Residency education
has been entrusted to them because of the excellence of their
clinical and pedagogic abilities, and because of the obvious
attractive advantages of having most patients on specified
teaching services under the care of attending physicians
who are responsible not only for patient care but also the
concomitant teaching.
Largely in the context of caring for patients in the hospital
and the continuity experience. We are not an "ivory
tower" isolated from the exigencies of modern medicine.
Our faculty and voluntary faculty practice and teach today's
medicine. We supplement practical, supervised experiences
with didactic conferences throughout the residency addressing
topical issues, such as billing and coding, discharge planning,
charting, dictating, to name but a few. Third-year residents
now spend 1 month with those physicians at our medical center
responsible for utilization, which is an enlightening and
valuable experience. All residents will spend time in private
offices too.
We
believe that capable and motivated residents in a sound educational
program will learn to be good doctors and have no difficulty
documenting this in a quantifiable fashion. We want
our residents to develop a consistently scholarly approach
to clinical medicine and lifelong study patterns. However,
we know too that passing internal medicine boards is important
and that residents perform better on the exam when properly
prepared. We have therefore incorporated into our overall
educational program a board review-oriented, programmed reading
conference with monthly tests that continue throughout the
year. This conference emphasizes material of educational
value in the context of residents learning to be good internists;
it does not narrowly address test-taking skills. We
believe this is a satisfactory balance of necessary and desirable
educational objectives for our program. Our residents’ performances
reflect this.
Yes. Indeed it is a requirement of
our program that residents complete a scholarly project in
order to graduate from our program. This “scholarly
project” may consist of original research but may also
be a case report, literature review, chart review, or other
effort. For those residents who wish, an experience
in laboratory research can be arranged; most elect to carry
out a clinical scholarly project. Our department faculty
serve as preceptors, guiding the residents appropriately
through this effort. The purpose of this, of course,
is to enable our residents to gain experience with scientific
method and learn to develop critical analytical skills so
that they may apply these abilities to clinical medicine. We
are very proud of the considerable success that our residents
have had with these efforts. For example, our residents
have presented abstracts or papers to the meetings of the
New Jersey Chapter of the American College of Physicians,
to national meetings, to subspecialty meetings, have received
several awards, and have published in well-regarded peer-reviewed
journals. We invite residency applicants to examine
our listings of resident and faculty publications in the
department office. These reflect and document the
excellence of our commitment to clinical scholarship. Our
residents have published/presented over several hundred papers
over the past years.
We seek individuals from any background
with (i) adequate liberal arts and scientific educational
preparation for a medical residency, (ii) appropriate humanistic
attributes – empathy, compassion, maturity, concern,
responsibility, and recognition that doctors care for the
sick and that the sick never inconvenience the well, and
(iii) intellectual curiosity and a commitment to develop
a scholarly approach to clinical medicine. (iv) Modern
medicine is a "team" activity. We therefore also
seek people who understand this and are committed to fit
well and work well within the residency; individual excellence
is necessary but no longer sufficient to be a good resident
or good doctor.
In recent years our residents have
averaged c. 90% on both parts of the USMLEs. We seek
people who will benefit from the educational environment
we provide and who will challenge us. We consider all
applications and all applicants. We may occasionally
sponsor H1B or J1 visas. We
prefer residents who do not need visa sponsorship. We seek
balance in the program between residents planning careers
in medical subspecialties and careers as generalists.
We
hope our preliminary residents wish to invest in a busy year
learning about internal medicine, wish to belong to a cohesive
program and department, and appreciate the value of teamwork
(a distinctly more challenging and different experience
than a transitional year, for example), and do not apply
for a preliminary year in medicine as a default choice.
Yes, although once our interns “matriculate” to
our program they are all the same – young men and
women who are graduate physicians anxious to learn internal
medicine and become good, caring physicians.
We feel honor-bound not to subvert the
match or to encourage any candidates to withdraw from the
match. This is a process that brings order to what
would otherwise be chaos. It is designed to match applicants
to the highest ranking program of their choice to whom they
are acceptable. However we recognize that not all PGY1
applicants are compelled to participate in the match or will
wish to participate in the match. Such candidates should
discuss this candidly with us; in such circumstances we consider
offering out-of-match positions.
Many come from the region; we have had
residents from Livingston and Short Hills (NJ), from Washington,
DC, Massachusetts, Florida, Texas, and California, for example. Many
come from abroad. We welcome diversity among our residents,
and consider this healthy for our program.
We are actively (re-)developing these. We share a pulmonary-critical
care fellowship with our sister institution, Newark Beth
Israel Medical Center (NBIMC). July 2007 heralded resumption
of our Nephrology fellowship, also in conjunction with NBIMC.
Others are expected to soon follow. We have subspecialty
programs that have sponsored fellowships in the past and
are prepared to do so again. Our institution has the
resources and commitment to see a rich complement of fellowship
programs in medicine.
We considered this for several years before implementing
a night float system in July 2007. There is no perfect or
ideal structure to a residency; different approaches work
better in different programmatic and institutional cultures.
Night floats are currently popular and many programs
utilize such rotations. There are certain advantages to night
float systems, largely in terms of call and convenience;
there are disadvantages related to continuity of care and
educational content. We, and our residents, are presently
pleased with our present system and plan to continue it.
We have elsewhere (following) in this document discussed
the Educational Innovation Project (emphasizing humanism)
and our reconsideration of fellowship programs at SBMC
(preceding). We have staffed our ICU with a complement of
4 full-time intensivists, and plan to develop more robust
patient education programs in the internal medicine faculty
practice, expand our home visit program, and improve the
safety, quality, efficiency, timeliness, and patient-centeredness
of our care.
Yes. We are very pleased with and proud of our program as
it is. All our residents pass boards and our accrediting
body, the Residency Review Committee for Internal Medicine,
has had NO critical or adverse comments
about our program for over 10 years. Indeed
we were honored with selection as a participant in the Educational
Innovation Project. However we are never satisfied or complacent
and are committed to make our program still better. We changed
our complement of categorical residents from 33 to 30 and
of preliminary residents from 1 to 4, and provided first-year
residents more in-hospital educational opportunities, as
we implemented a night-float system. Each year our faculty
and residents together critically review our program
and identify opportunities for improvement. We surely
do not intend to revamp or overhaul a successful program
but rather improve next year’s program to be even better.
As is detailed in the descriptive brochure
in our program, lovely and convenient housing is available
to our residents across the street, on our “campus”. This
is one of many attractive aspects of our institution and
our location. Consistent with our commitment to the
residency being an education – not a service – experience,
resident coverage of inpatients on the medical services is
circumscribed as mandated by the Residency Review Committee
and is facilitated by the constant availability of IV teams,
phlebotomists, respiratory therapists, EKG and ECHO technicians,
and other ancillary personnel.
Approximately
60% of our graduates have gone on to fellowships as enumerated
preceding; the other 40% have entered practice. Many
remain in the area and have been able to identify fine situations. The
department is committed to support our graduates, and this
is evidenced by our success in placing our graduates into
excellent fellowship and practice opportunities.
Since 2006, 60% of our residents have applied for subspecialty
fellowships, and >80% of these were successful vs. 60% in
2007 national fellowship match. 87% of our IMGs were successful
vs. 44% in the 2007 in the national fellowship match, and
100% of our USIMGs were successful vs. 38% in the 2007 national
fellowship match. This experience has been consistent for
us. Our record of success surpasses national averages
for this period. Our residents entered fellowships in virtually
all medical subspecialties and have obtained positions at
elite institutions such as the NIH, Hopkins, Harvard hospitals,
Yale, Cornell, Columbia, etc. All those entering fellowship
programs performed well and many stayed in academic medicine.
Successful resident applicants won awards, were chief residents,
had advanced degrees, and participated on (NJACP) “challenge
bowl” teams.
We are now involved with something very special and exciting—the
Educational Innovations Project. We were one of 51 medicine
residencies (of 388 programs) invited to submit an education
innovations project proposal to the Internal Medicine Residency
Review Committee (RRC-IM) of the Accreditation Council for
Graduate Medical Education, our accrediting body. The RRC-IM
has developed this bold new initiative to facilitate
innovations in graduate medical education. They wish to integrate
improvements in medical education, improvements in resident
educational outcomes, and improved quality and safety in
patient care, and to advance competency-based education
and outcomes-based assessment. The RRC-IM unveiled a pilot
study designed to enhance the flexibility of successful programs
in charting the future of internal medicine graduate medical
education. Programs with track records of success in accreditation
and ABIM outcomes were given the option of entering, by competitive
application and review-- a new, alternative pathway to accreditation – The
Educational Innovations Project. Based on our excellent accreditation
record, and programmatic achievements, we were among those
select medicine residency programs invited to submit an education
innovations project (EIP) proposal. Our eligibility was based
on our excellent recent accreditation record, programmatic
achievements, and an approved letter of intent.
We were delighted to learn that that we were selected to
participate in the EIP. Participants
are a very elite group of 21 programs (~ 5% of medicine residencies)
including Mayo, Duke, Henry Ford, University of California-San
Francisco, University of Wisconsin, Ohio State University,
Beth Israel Deaconess (Harvard), North Shore-Long Island
Jewish/Einstein, Scripps, New York Medical College, Indiana
University, University of Pittsburgh, and the University
of Cincinnati, among others. EIP programs are accredited
for as long as (an unprecedented) 10 years and enjoy special,
different, relaxed program requirements to facilitate educational
and clinical innovations. At the recent meeting of the Alliance
for Academic Internal Medicine, medicine, organizational,
and RRC leadership repeatedly lauded the EIP effort and programs,
referring to participants as the “crème de la
crème”, the “best and the brightest”,
and those who will rewrite medicine’s future in education,
care, and accreditation processes. Our proposal focuses on
humanism-- "Humanism for Residents. Using Humanities--
Poetry, Art, Literature, Film, and History (And Perhaps Talmud)
-- To Create Better Doctors. Development Of A Humanism-Based
Curriculum, Implemented By Multidisciplinary Team-Based Patient-Centered
Care, Leading To Measurably Improved Resident Competencies
(Assessed By Novel Evaluation Tools) and Measurably Better,
Safer, Higher Quality, Patient Outcomes (Assessed by Novel
Outcomes Instruments). A Controlled Innovation". We
are very excited about this potential opportunity to improve
our program and contribute generally to better residency
education and patient care. Beginning with the July 2007-08
academic year our educational program has been enriched by
a humanities-based curriculum intended to train more humanistic
residents who will perform better, provide better patient
care, and have great opportunities for personal growth. This
has received national attention and has been featured in
the New York Times and newsletter of the prestigious Association
of American Medical Colleges.
Ours
is a program of established excellence, affirmed by our invitation
to participate in the very selective, elite EIP, with a unique
thematic identity (medical humanities/bedside humanism). Residents
come here because of the attractiveness of our suburban location
in the New York Metropolitan area, the excellence of our
faculty and educational staff, the reputation of our institution
for community and tertiary care, ambiance and intimacy of
our program, the superb mix of patients encountered, the
high quality of medical care provided by our state-of-the-art
facilities, our superb and nurturing educational environment,
our individualized attention, our ability to integrate exemplary
patient care with sound academics, and the documented successes
of our residents and residency.
Of course. How could we not? We are selfish in that we want
to succeed; our success is defined by our residents' performance.
We understand that. That is why we do what do. That is why
we are so committed to developing and maintaining an environment
where everyone has fun learning and caring for patients together,
and does it as well as possible. That is why we are so committed
to helping our residents flourish. That is why we expend
so much effort talking with residents about life decisions,
life after residency, practice situations, fellowships, preparing
resumes, writing applications, conducting mock interviews,
and otherwise supporting residents as they move into new
phases of their careers.
We hope this information
has provided some additional insights and perspectives about
our program. We would
enjoy hearing from you and wish you well.
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Internal Medicine
Residency Program
Saint Barnabas Medical Center
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