Internal Medicine/Pediatrics Residency Curriculum

Residents in the Internal Medicine/Pediatrics program follow a curriculum designed to meet the combined guidelines established by the American Boards of Internal Medicine and Pediatrics. Half of each new class of residents begins training with Department of Medicine rotations, and the other half begins with Department of Pediatrics rotations. The groups switch between departments about every four months.

Internal Medicine/Pediatrics residents learn to be an advocate in disease prevention, early detection of disease, and health promotion within the community, and they become competent in the management, consultation and resource utilization of patients with undifferentiated or advanced illness and diseases of several organ systems. The program trains physicians to be effective primary care providers, delivering comprehensive, continuous patient-centered care utilizing the Medical Home and Advanced Medical Home models.

Program Progression

Residents in the combined program spend 16 blocks as PGY1 interns; each block lasts four weeks. During this time, residents are introduced to rotations on inpatient services at Riley Hospital for Children, IU Health University Hospital, IU Health Methodist Hospital, Eskenazi Hospital and Roudebush VA Medical Center. Inpatient training is interspersed with ambulatory and elective assignments to provide a solid, well-rounded foundation in clinical decision-making.

During the second-, third- and fourth-year of the program, residents continue to switch between departments every four months, allowing for exposure to illnesses with seasonal variation in both adult and pediatric patients. Residents also gain increased supervisory responsibilities during this time, growing as both a clinician and teacher and preparing for a variety of future career options. Elective choices are tailored to individual career needs. Residents can attend conference series in both the internal medicine and pediatrics departments as well as a weekly series specific to these two areas of medicine that includes a lecture, journal club and two board review sessions.

Continuity Clinic

Continuity clinics are located in several community health centers, which are easy drives from the Indianapolis campus hospitals. Internal Medicine/Pediatrics residents provide clinical care in a health center for one half-day per week, where they follow their own patient panel of both children and adults. They are encouraged to participate in the telephone management and inpatient care of their patients. Faculty supervision is also longitudinal and provided by internal medicine/pediatrics-trained faculty who precept in the resident continuity clinics.

Senior Project

Each Internal Medicine/Pediatrics resident must present one grand rounds-style conference in the third or fourth year of residency, utilizing skills in literature review, case presentation and/or research. In addition, residents make presentations during the ambulatory, geriatrics and community pediatrics rotations and for at least one Medicine-Pediatrics Journal Club.

Sample Call and Overnight Schedule

Call for first-year residents occurs as a short call until 9 pm every four to six days, with the structure of the short call varying depending on the hospital and the service. For senior residents, night call varies from every fourth to sixth night. First-year residents are scheduled for two blocks of night float—one each on the medicine and pediatric services—to gain experience in typical overnight call activities. Senior residents may also be scheduled for night float blocks. Residents have a minimum of four days off during inpatient service blocks. There are a number of ambulatory blocks that are call free. The program strictly adheres to current residency training guidelines.

Sample Rotation Schedule

Each program year contains 13 four-week block rotations.

Key	Internal Medicine		Pediatrics

	PGY – 1	PGY – 2	PGY – 3	PGY – 4
1	Normal Newborn – Eskenazi	Elective – Nephrology	Elective – Research	ICU – University
2	Pediatric Hospitalist Nights – Riley	Night Float – VA	Med-Peds Career Exploration	Rheumatology
3	Ambulatory – Pediatrics	General Medicine Wards – VA	NICU – Eskenazi	General Medicine Wards – Methodist
4	Elective – Infectious Disease	ED – Eskenazi	Community	Medicine Ambulatory Advanced
5	General Medicine Wards – Eskenazi	PICU	Night Float – Eskenazi	ED – Riley
6	Hepatology Ward – University	Adolescent Medicine	Geriatrics	Elective – Med/Peds Office Practice
7	Ambulatory Medicine	Gastroenterology	General Medicine Wards – VA	NICU – Methodist
8	ICU – Methodist	ED – Riley	Elective Dermatology	Developmental – Behavioral Peds
9	General Medicine Wards – VA	General Pediatric Wards – Complex Care	Hematology Ward – University	UVC – Eskenazi
10	Hematology/ Oncology	ICU – VA	Elective – Allergy	Pulmonary Wards – University
11	Hospitalists nights – Riley	Elective – Adult/Peds Endocrinology	Cardiology	Patient Safety – VA
12	General Wards – Pulmonary	General Medicine Wards – Eskenazi	General Peds Ward – IU Health North	General Medicine Wards – Eskenazi
13	NICU – Methodist	Cardiology Ward – Methodist	Elective – Neurology outpatient	Elective – Infectious Disease consults

Internal Medicine Rotations

Internal Medicine rotations include 20 months of direct patient care where the resident serves as the primary decision-maker. Two-thirds of residents’ time is spent providing inpatient care across four hospitals totaling 750 beds, with the other one-third of time devoted to outpatient care. Resident teams gain extensive experience providing both specialized and primary care at the adult hospitals on the Indianapolis campus, each having a distinct patient population and providing a broad educational base. Training includes three months of intensive care units and time in two very busy emergency departments where residents treat a variety of urgent and emergent conditions and determine patients’ need for hospitalization. Ambulatory blocks offer opportunities in areas such as gynecology, neurology, sports medicine, occupational medicine and the range of internal medicine subspecialties. A one-month rotation in geriatrics addresses care for the elderly at home and in long-term care facilities.

Residents choose five internal medicine electives. Options include Anesthesiology, Bone Marrow Transplant, Cardiology, Cardiac Treadmill Testing, Critical Care, Dermatology, Endocrinology, Gynecology, Hematology/Oncology, Hospitalist Medicine, Infectious Disease, International Health- Kenya, Office Medicine, Nephrology, Neurology, Patient Safety, Pulmonology, Radiology, Rehabilitation, Research, Rheumatology and Women’s Health.

Pediatrics Rotations

Residents deliver pediatric primary care across three hospitals on the Indianapolis campus and provide specialized care at Riley Hospital for Children that includes training in critical care, emergency care and all other pediatric subspecialties. Residents develop skills in the evaluation and management of well-child care in addition to common pediatric problems such as respiratory illness, infectious diseases, behavioral concerns and minor trauma. Pediatric residents attend high-risk deliveries and provide care to newborns across all hospital nurseries. Almost half of pediatric training occurs in the ambulatory setting, with residents attending to patients in the hospitals as well as a network of urban, suburban and rural sites.

Each resident may choose four pediatric electives. Options include Adolescent Medicine, Allergy/Immunology, Anesthesiology, Behavioral Pediatrics, Cardiology, Child Advocacy, Dermatology, Developmental Pediatrics, Endocrinology/Diabetology, Gastroenterology, Genetics, Hematology/Oncology, Infectious Diseases, Metabolism, Nephrology, Neurology, Ophthalmology, Orthopaedics, Otolaryngology, Psychiatry, Pulmonology, Radiology, Rehabilitation Research, Rheumatology, Sports Medicine, Surgery, and Toxicology.

Combined ambulatory Med-Peds rotations may be scheduled on both medicine and pediatric block month. An ambulatory Med-Peds rheumatology block as well as a combined Med-Peds career exploration block are required. Additional combined Med-Peds choices include office practice, endocrinology, neurology, dermatology, gastroenterology and a community hospitalist elective.

The Med-Peds didactic series occurs weekly. This includes one or two Med-Peds lectures, one journal club and one board review session per month. The lectures focus on a wide variety of topics, including communication skills and resident wellness.

Private practice rotations with community-based medicine-pediatric physicians are available in urban, suburban and rural settings. IU School of Medicine partners with four local Med-Peds practices that regularly assist in the training of residents in this combined program.

Faculty Mentors

Each resident is assigned either an internal medicine or pediatrics faculty advisor, often based on the resident's career interests. The role of the faculty advisor is to meet regularly with residents to review their progress, assist in educational, career and/or personal counseling and provide faculty mentorship.

Evaluations

Each month, residents receive an electronic evaluation on their performance by faculty with whom they have most recently worked alongside. Residents' progress is reviewed regularly through an evaluation committee and residents meet semi-annually with one of the program directors to chart their progress and set future goals. Residents also evaluate their rotations and faculty monthly, providing feedback that helps advance and improve the program.

Training Outcomes

When residents complete this training, they are competent in the ambulatory, hospital and extended care environments. Graduates have the training to perform as a manager of the biomedical and psychosocial aspects of care within the framework of the patient’s socioeconomic environment and is an expert in growth, development and adaptation across the lifespan of the individual.

By the end of residency training, an Internal Medicine/Pediatrics residency graduate is:

An effective primary care provider, delivering comprehensive, continuous patient-centered care utilizing the Medical Home and Advanced Medical Home models
A manager of the biomedical and psychosocial aspects of care within the framework of the patient’s socioeconomic environment
An expert in growth, development and adaptation across the lifespan of the individual
An advocate in disease prevention, early detection of disease, and health promotion within the community
Competent in the management, consultation, and resource utilization of patients with undifferentiated or advanced illness and diseases of several organ systems
Competent in the ambulatory, hospital and extended-care environments
A skilled participant caring for patients within the larger health care system and within diverse cultural environments