Curriculum & Rotations

The Brown Internal Medicine Residency provides training at three sites: The Miriam Hospital, Rhode Island Hospital, and the VA Medical Center. By offering a multi-institutional training program, we can provide our residents with several distinct, diverse populations of patients, training environments, and complementary institutional cultures.

The curriculum provides comprehensive training in outpatient and inpatient internal medicine, medical and non-medical subspecialties, emergency medicine, critical care medicine, community-based experiences and elective rotations. Residents may also design curricular variations which meet their individual goals for training. Below are reviews of selected rotations, some accompanied by resident descriptions.

• General Medicine Wards

  • Teaching and supervision provided by both generalist and sub-specialty full-time faculty.
  • The Med B Service at Rhode Island Hospital is fully geographically based, with teams located on one floor with a single nursing team.
  • A single hospital-based faculty serve as attending of record and teaching attending for all team patients.
  • On all general medical ward rotations (the majority of inpatient experiences), interns and residents admit patients until late in the evening on every fourth day, and then go home overnight while covered by the in house Night Float team.
  • On the subspecialty ward services (Hematology/Oncology, Nephrology, and Primary Care Medicine) teams admit patients until the afternoon and return home daily.
  • The disease spectrum, ethnic and socioeconomic diversity, and accessibility to outstanding faculty make these rotations a critical educational experience for medical housestaff at Brown.
  • Our residents typically spend four (PGY1 - intern), three (PGY2), and three (PGY3) months respectively during their residency on the General Medical Wards, approximately equally divided between The Miriam and Rhode Island Hospitals. They will spend one month each in their PGY-1 and PGY-2 years at the Providence VA Medical Center. These experiences allow the residents to develop their skills in inpatient medicine, seeing a wide variety of problems, in a position of direct responsibility.

  
  

  Resident Voices - Med B Geographic Wards - Tina Zhang, MD PGY-3

  "One of the benefits of training at Brown is the opportunity to rotate through different hospitals, each with a different feel and patient population - but of all the inpatient rotations, Med B is my favorite. Not only are we exposed to a very diverse patient population presenting with both classic and rare disease pathology, we also get the opportunity to work with an amazing team of attendings and staff. Every single attending on Med B that I have been fortunate enough to work with has been compassionate, kind, and dedicated to teaching their residents. The geographic organization of Med B also fosters an environment of teamwork and camaraderie. All of your patients are located on the same floor, which facilitates more efficient rounding and communication with patients and staff. Furthermore, the nurses, case managers, CNAs, and secretaries on your floor not only become your most important allies and resources, they also become your friends (and feed you with delicious home-cooked food). I can say without hesitation that I have learned more and cultivated more relationships with fellow co-workers on my Med B rotations than any other rotation in my three years of residency."

  
  

  Resident Voices - Miriam Inpatient Wards - Jon Winkler, MD PGY-3

  "My time spent on wards rotations at The Miriam Hospital has made me a stronger resident. There is a variety and severity of illness that one wouldn't expect from a hospital this size. Furthermore, being able to follow our patients to the intermediate level of care floors allows for continuity and provides exposure to managing a sicker subset of patients not commonly found on a general medicine service. Lastly, the quality of the food in the cafeteria is without debate superior to that of any other hospital in the area."

• Sub Specialty Inpatient Services

  • While most of our inpatient rotations are intentionally general medicine in nature, we have developed a small number of highly valuable sub specialty services through which all residents will rotate during their three years.
  • Heme-Onc Services exist at Rhode Island Hospital and the Miriam Hospital. Residents work with full-time hematologist-oncologist inpatient faculty from the Brown Cancer Center and see a broad range of conditions.
  • The Nephrology and Renal Transplant Service is based at Rhode Island Hospital. Residents care for patients with chronic and acute renal,disease, electrolyte disorders and renal-transplants-related disorders. Brown has one of the leading renal transplant programs in New England.
  • The Primary Care Service is unique among inpatient services in that residents are supervised by hospital-based primary care practice faculty. Residents learn the benefits of care continuity and techniques for optimizing inpatient/outpatient transitions of care.

  
  

  Resident Voices - Heme/Onc Inpatient Rotation - Lindsey Cilia, MD PGY-3

  "The hematology/oncology inpatient month is an experience second to none. Daily one-on-one interactions with attendings who are specialists in the field, providing care to patients who are in their most vulnerable states and establishing unforgettable relationships with these patients are just a few reasons why this experience is so unforgettable. Daily lectures on chemotherapy regimens, hematologic and oncologic emergencies and other cancer related topics are provided in order to enhance resident learning. Since these patients tend to be very sick, teamwork among the attendings, fellows, residents and nurses is stressed and you are never alone. The learning curve during this rotation is exponential and if given the opportunity, I would jump at the chance to rotate through this service again."

  
  

  Resident Voices - Med A Primary Care Team - Vidya Gopinath, MD PGY-2

  "The Med A Bristol service is unique in a number of ways as all the patients are cared for in the outpatient setting by the Bristol primary care practice. First, some of the patients have already been evaluated by the Bristol Walk-In Clinic immediately prior to admission and all of them are connected to primary care. We have easy access to their medical history and records. There is frequent communication between their PCP and the wards team. Overall, this often leads to a more complete understanding of a patient's life outside the hospital and better coordination of care upon discharge. Additionally, the attendings are Bristol PCPs and work as outpatient physicians for most of the year. They have a different perspective than hospitalist attendings, which increases our exposure to a diversity of practice patterns and didactics. I had excellent attendings who were enthusiastic about teaching and I enjoyed taking care of patients who had close positive relationships with their PCPs. My Bristol month was educational and fun, it offered a different perspective on hospital medicine."

  
  

  Resident Voices - Nephrology Inpatient Service - Chris Tuohy, MD PGY-3

  "Some of the most clinically challenging patients to care for are those with Chronic Kidney Disease and ESRD on hemodialysis. I was fortunate to have the opportunity to rotate on the Med A Renal service as an intern where I worked directly with attending Nephrologists and Nephrology fellows caring for these complex patients. I also managed renal transplant patients which allowed me to learn about immunosuppressive therapies and post-transplant care. This rotation gave me the skills and confidence to care for these patients going forward in other clinical settings including on the medicine wards and Intensive Care."

• Night Float Team

  • Housestaff at all three years are assigned to a month of Night Float rotation where they will work as a team to care for patients on the teaching services.
  • Intern night floats are responsible for the cross coverage care of patients already on the teaching service and are supervised overnight by the senior resident on the night float team.
  • PGY-2 night float is responsible for admitting patients overnight to the Teaching Service.
  • The senior resident night float is responsible for supervising the intern night floats in the care of their patients, ensuring that the "on-call" admitting teams complete their clinical tasks and leave the hospital in compliance with ACGME Duty Hour Guidelines.
  • The senior night float resident is also responsible for reviewing the Intern Night Float Curriculum with the interns so as to provide the educational underpinning of their work.
  • A web-based electronic sign-out system, fully integrated with our EMR, assures accurate and efficient sign-out among teams and night floats.

  
  

  Resident Voices - Nightfloat Rotation - Pooja Pandit, MD PGY-3

  "Being the second year resident on night float brings about more responsibility, but also more freedom. This helped me learn to make my own decisions on how to best manage patients which was a huge confidence booster. I don't think I have ever learned so much in a month! It is an incredibly challenging but ultimately rewarding experience."

  
  

  Resident Voices - Nightfloat Rotation - Rachel Rome, MD PGY-2

  "Night float 2 was such a great opportunity to realize how much I learned during my intern year. It was amazing to recognize the growth that has happened and to take care of so many patients in such a short amount of time. I was able to see so many different pathologies and was given the opportunity to learn about acuity in an independent role."

• Day Float

  • The Day Float rotation provides coverage of residents on the wards who are assigned to their continuity clinic and community-based site on a particular day. The day float resident "steps into the shoes" of the usual resident assigned to the team and is responsible for all of the activities of that resident including the supervision of interns. This assures that interns are not left without resident supervision and that residents are able to attend their continuity clinics while fully relieved of their inpatient responsibilities.

  
  

  Resident Voices - Dayfloat Rotation - Rachel Pyngolil, MD PGY-3

  "Dayfloat is a unique rotation, where you get to be the resident for a day for several different teams. The opportunity was unique in permitting me the opportunity to work with different wards teams throughout different services at all three hospitals and as a result I got to know more of my first year colleagues. Walking onto a team and helping to manage the patients can be daunting, but often you provide a new perspective and may even diagnose something that would have otherwise been missed. I always found it to be a fun month because I could simultaneously be on a teaching service and on a hematology oncology service and even function as a hospitalist on weekends where I cross-cover. I found these skills helpful in developing me as a generalist and helping fine tune my ability to look at the big picture for my patients. As I often dayfloat on the same teams, I was always an honorary member of the team and still have great friendships with the residents with whom I rotated."

  
  

  Resident Voices - Dayfloat Rotation - Rimsky Denis, MD, MPH, MBA PGY-3

  "I have had amazing clinical experiences during my time in residency here at Brown. One of the rotations that I have particularly enjoyed and have found great satisfaction is the Day-Float rotation. Day-Float is unique to this program and truly highlights the opportunities to engage with several inpatient hospital teams at our 3 teaching hospitals. The rotation is filled with new daily challenges and amazing opportunities for personal and academic growth. My clinical acumen and ability to manage complex cases have developed tremendously through the experiences that I have been afforded while here at Brown."

• Medical Intensive Care Unit/Coronary Care Rotations

  • In each of these units, interns and residents work as a team, sharing night as well as day shifts together.
  • There is no overnight call - rather, one of the four intern-resident teams works a stretch of night shifts in rotation.
  • Dedicated on-site faculty conduct combined management and teaching rounds as well as educational conferences, set in newly redesigned, state-of-the art facilities.
  • The CCU boasts a dedicated procedure area, catheterization facilities directly below the unit, and state of the art communication and work facilities.
  • The MICU is the setting for a busy extra corporeal membrane oxygenation program.
  • Both units participate in a variety of research programs, with the MICU serving as one of the primary study sites for the Surviving Sepsis program. All of the units utilize the latest electronic medical record and clinical data systems.

  
  

  Resident Voices - Medical Intensive Care Unit (MICU) - Jackie Shameklis , MD PGY-2

  "The MICU experience is invaluable for many reasons, including giving residents exposure to critical care, pulmonology, and palliative care medicine. The rotation allows residents to have autonomy in making critical medical decisions while being supported by excellent and highly-trained nursing staff and approachable fellows and attendings. We learn an incredible amount about compassionate end-of-life decision-making. The MICU rotation gets at the heart of what it means to take care of people at critical and vulnerable times; it highlights the humanity of medicine and reminds me of why I chose to pursue becoming a physician."

  
  

  Resident Voices - Medical Intensive Care Unit (MICU) - Sam Belok, MD PGY-3

  "The Rhode Island Hospital Medical Intensive Care Unit is an ideal place to train for residents with an interest in the critically ill patient. It is a supportive environment and there is a strong emphasis on a multi-disciplinary, team approach to patient care. The attendings and fellows are readily accessible and make teaching a priority. It is an outstanding experience and I look forward to my next rotation in the ICU."

  
  

  Resident Voices - Coronary Care Unit (CCU) - Esseim Sharma, MD PGY-2

  "The CCU was one of my favorite rotations as an intern—you really get a good grasp of managing a wide-range of cardiovascular diseases since you take care of patients in both the CCU and ICCU (step-down). You also get to work closely with the cardiology fellows and attendings, who will teach you everything you would ever want to know about the heart. Best of all, you get a chance to learn and sharpen your skills at essential procedures like central lines and arterial lines. What more could you ask for?"

• Emergency Medicine

  • PGY-2 residents are assigned to rotations in the Emergency Department at either Rhode Island Hospital or The Miriam Hospital.
  • Both ER settings are state-of-the-art facilities which are comfortable for patients, physicians and nurses.
  • Orders, laboratory testing, x-rays and medical records are completed as part of our integrated EMR.

  
  

  Resident Voices - Emergency Department - Megan Geary, MD PGY-3

  "The highlight of my ED rotation was the opportunity to work up a high volume of undifferentiated patients. I very much enjoyed getting to work with the ED residents; they were smart, fun, extroverted and happy to help me learn procedures."

• Senior Medicine Consultation Rotation

  • All senior residents will spend one month on the General Medicine Consultation rotation. This rotation provides senior residents with the opportunity to act as general medical consultants to non-medical services such as surgery, psychiatry, orthopedics, and neurology.
  • A unique Obstetric Medicine Service is part of the rotation, where residents learn to care for medical conditions in the setting of pregnancy under the supervision of specialized internists.
  • Working with a faculty preceptor, residents learn preoperative assessment and perioperative management of non-medical patients through a structured curriculum.

• Neurology

  • All Categorical and General Internal Medicine/Primary Care interns rotate on the Neurology service. This is a combined inpatient and consultative service where interns are supervised by dedicated Neurology faculty
  • Interns work alongside neurology residents, most of whom are graduates of our Preliminary Internal Medicine program, this forming a close alliance between our two departments.
  • A conference series and specific instruction on neurologic examination is carried out over the course of the month.
  • Rhode Island Hospital is a certified Neurotrauma and Stroke Center.

• Ambulatory Curriculum

  The ambulatory curriculum consists of seminars, conferences, and rotations which address three major areas in ambulatory medicine:
  

  • The diagnosis and management of important general medicine problems (e.g. hypertension, headache, dyslipidemias)
  • Common non-medical disciplines (e.g. office gynecology, orthopedics, ear, nose throat, allergy/immunology)
  • Non-clinical topics including statistics, ethics, critical appraisal of the literature, medical informatics, and the behavioral sciences.

• Categorical Ambulatory Block

  All Categorical Residents participate in a three-month ambulatory block rotation in which they are scheduled for one month per year.
  

  • During the intern year, the Ambulatory Block rotation for Categorical residents is a month on the Geriatric service.
  • In years two and three, Ambulatory Block consists of a series of didactic and clinical experiences in Internal Medicine and related fields.
  • Content areas such as clinical teaching seminars, clinical epidemiology, evidence-based medicine, medical ethics, professional development, behavioral medicine, and others round out the experience for residents. Clinical rotations in dermatology, Rheumatology, ENT, Allergy and Immunology also provide a well-rounded exposure to specific ambulatory topics. An ECG Course is run by our cardiology faculty during the PGY-2 Ambulatory Block Rotation. An airway management/intubation skills program is also integrated into the PGY-1 year.

• Quality Improvement and Continuity Clinic Block

  • All residents spend one month during their PGY-2 year focusing on improving their skills in ambulatory medicine and well as performing a quality improvement project with a faculty preceptor.
  • A large portion of the month is focused on designing and implementing a quality improvement project within continuity clinic. This process is undertaken with the help of Mark Schleinitz, MD, MS, Director of Resident QI Programs.
  • Previous projects have focused on improving the clinics efforts at diabetes care, AAA screening, and mammography rates. Important improvements have resulted from the residents efforts, and the month is highly regarded by residents and clinic staff.

  
  

  Resident Voices - Quality Improvement/Continuity Clinic (QICC) - Jamar Slocum, MD PGY-2

  "As a resident at Brown University, I am overjoyed at the efforts the Internal Medicine department makes to help us develop into providers who deliver high quality, safe, and efficient health care to our entire community. We are provided an entire month as second year residents to develop projects with the goal of reducing the risk of harm from health care services by using evidence-based research. With the assistance from the committed house staff, faculty and administration, I undoubtedly improved as a health care provider who delivers the best possible care."

• Electives

  • Elective rotations, available locally, nationally or internationally, allow a resident to develop a program tailored to his or her individual interests and to gain experience in problems not commonly managed in the hospital environment
  • Ambulatory electives can be chosen from a wide variety of fields in an equally wide variety of settings and include: office gynecology, allergy, geriatrics, physical and rehabilitation medicine, adolescent medicine, ophthalmology, ear, nose, throat, office orthopedics, dermatology, and the traditional medical subspecialties.
  • Elective months can also be utilized for extended mentored research projects, many of which result in publication or presentation at national meetings.
  • Residents have a wide variety of opportunities at any of the individual institutions and programs affiliated with the Medical School, School of Public Health or State agencies like the Department of Corrections or State Health Department.

  
  

  Resident Voices - Research Elective - Katherine Scovner, MD PGY-3

  "When I decided that I would apply to nephrology fellowship, I wanted to explore whether I would want to make bench research a part of my career. My program director immediately set me up with a very productive lab. During my time there, I was given guidance and resources to perform my experiments but I was allowed to explore and make my own independent discoveries. The opportunity to work self-sufficiently with the support of so many fantastic attending research physicians at Brown was invaluable to my pursuit of an academic career in nephrology."

  
  

  Resident Voices - Research Elective - Ralph Rogers, MD PGY-3

  "Having an elective month dedicated to independent research allowed me to complete a project during residency that otherwise would have been to big to tackle. I am looking to pursue a career in an academic setting after residency, and the unique opportunity to spend a month working primarily on research has been invaluable in positioning myself to achieve this goal. Demonstrating an ability to start and finish a significant research project has given me a leg up in applying for fellowship positions, and the month set aside to devote to work on the project was a key factor in making it possible."

  
  

  Resident Voices - Research Elective - Sehrish Jamot, MD PGY-3

  "One of the advantages about being at Brown for residency is the autonomy you receive. Along with a range of pre-designed electives there is an option to take research elective months. During research block, you submit a proposal and make your own schedule. During my research month I was able to write an IRB for a project looking at the use of thrombolytics for submassive PE in our medical ICU.  I spent my month collecting data, regularly meeting with my PI and was able to eventually create a poster that I presented at Research Day at Brown Medical School."

• Community Based Sites

  • During the Junior and Senior years, residents spend an additional one-half day per week in another site, designed to complement their longitudinal clinics at the Miriam or Rhode Island Hospital and broaden the residents' ambulatory exposure.
  • Faculty volunteers are carefully selected for this effort based upon their interests and teaching ability. Residents and community based faculty are carefully paired in a one-on-one relationship based on resident interests.
  • Training sites include private offices around Providence and nearby communities, Providence Ambulatory Health Center Network (a nationally recognized consortium of neighborhood health centers), the VA Firm clinics, Brown Student Health Services, as well as selected subspecialty office practices.

  
  

  Resident Voices - Community-Based Teaching/Second Site - Eddie Nunez, MD PGY-2

  "I have my second site at the pulmonary VA clinic and during clinic I they usually schedule me with new patients.  The pulmonologist will prepare me for the visit beforehand and then afterwards I will precept with the pulmonologist, with extensive time for teaching.  They will also try to re-schedule those same patients with me so that I can have continuity and see the progression of my management.  Overall, it's been a great learning experience.  I am very invested and much more responsible for sub-specialty patients than I thought I would be.  I also get to learn a lot and having more responsibility motivates me to learn more about the field that I am interested in."

  
  

  Resident Voices - Community-Based Teaching Site - Matthew Murphy, MD PGY-2

  "My community clinic site is actually within the confines of the Rhode Island Department of Corrections. Both my clinical as well as research interests involve vulnerable populations and I had previously worked with incarcerated individuals before starting residency at Brown. Here, I work with one of the prison's primary care providers helping to manage the population's chronic medical needs and preventive care along with urgent care needs. Additionally, I have helped to manage the response to a Varicella outbreak within the prison and started to work towards establishing a transitions program to promote continuity of care for inmates who are being released into the community at the end of their sentences. It has already been an incredibly eye opening experience where I have been able to work with national leaders within the prison health care movement and develop research projects with the possibility for publication."