Rounds and Conferences
Teaching rounds on the inpatient services are conducted six days a week. A daily noon conference, with lunch, is a cornerstone of the teaching program. In July, August, and part of September the noon conferences are devoted to an acute medicine course primarily for interns. These sessions cover management issues related to commonly seen acute illnesses and also provide “how to” sessions for performing basic procedures like central venous catheterization. The rest of the noon conferences vary among specialty conferences, weekly medicine grand rounds, and a weekly ambulatory conference. Medicine Grand Rounds is generally patient based. The main presentation typically features a patient who is interviewed in front of those in attendance, illustrating an important aspect of the condition being discussed and emphasizing the importance of the patient-physician relationship. Some of our Grand Rounds presentations are featured publications in the Journal of the American Medical Association (JAMA).
Morning report is held daily. The Program Director is the faculty discussant for one morning report each week and one session each month is a Morbidity and Mortality Morning Report led by the Vice-Chairman of Medicine. This conference provides a forum for house staff to discuss morbidity and mortality on the medical service and to address issues that could improve patient care. The conference differs from the “traditional” M&M at many institutions, which often focuses on individual error (and blame). House staff and the Vice- Chairman of Medicine discuss systems of practice that, if changed, might result in better patient care. Many specific changes in practice have been initiated as a result of the discussions at M&M morning report and the conference has established a culture in which house staff feel comfortable and empowered to address systems issues to affect change.
Chief-of-service rounds occur three times a week. At these rounds, which are mostly at the bedside, ward teams present challenging cases to the department chair and vice-chair and aspects of the history and physical examination, as well as important suggestions for patient management, are highlighted. Bayview emphasizes the importance of all members of the health care team in providing optimal care to patients. Thus, the nurse caring for the patient being discussed is invited to participate in – and contribute to – chief-of-service rounds as well. Subspecialty conferences are held throughout the week by each of the divisions. A departmental morbidity and mortality conference reviews selected cases, highlighting important points for both house staff and faculty, focusing on patient safety and quality.
House Staff Support and Role in Program Development
Hopkins Bayview has been a pioneer in providing house staff with a supportive atmosphere for training. Weekly support groups are facilitated by a primary care internist who has a special interest in medical education. These sessions provide protected time and a safe environment for interns and residents to share any aspects of their training experiences or personal lives.
A residency planning meeting, in which the assistant chiefs of service and house staff meet quarterly in a relaxed atmosphere, provides house staff a unique role in the development of the training program. Over the years, these meetings have been responsible for implementing the BASIC ambulatory curriculum, a night float system, a day float system, and changes in the call schedule. The Resident Wellness Committee plans informal social events and volunteer community service activities a few times each year. The house staff meet regularly with the assistant chiefs of service and one of the program directors for feedback and career counseling. Residents benefit from close relationships with advisors and mentors to help guide them through their training and chart their future careers. Social activities, such as holiday parties and picnics, are supported by the department of medicine to foster house staff-faculty interaction.
Alternative Pathways: Shared Residency And "Short-Tracking"
At the Johns Hopkins Bayview Internal Medicine Residency Program, we are invested in trying to adapt to our learners' needs. At times, the standard 3 year residency may not be the best fit for an individual. We support both a shared residency and the ABIM Research Pathway. In the shared residency, two residents "share" a position by each working half-time, completing the program over 6 rather than 3 years. In the research "short-track" program, residents who wish to seriously pursue careers in basic science or clinical research may elect to enter the research pathway from the ABIM (see ABIM policy) after 2 years of categorical medicine training. Please note that applicants do not need to declare their intention for the research pathway before the NRMP match, but this should be discussed with the program director(s) during the PGY-1 year. Applicants interested in the shared residency should discuss this with the program director as soon as possible.