Junior and Senior Years of Internal Medicine Residency
Junior and Senior Years
Residency solidifies clinical and teaching skills by having juniors and seniors lead medical teams. Junior residents supervise interns and students on general medical services and in the medical and cardiac intensive care units, which continues with increasing autonomy in the senior year. Our culture espouses the resident as the primary leader and teacher of the medical team, and autonomy is one of the frequently cited positive attributes of our program.
The junior and senior years also provide more elective time to sample subspecialty training in areas of interest. The elective opportunities are diverse, ranging from traditional specialty rotations to primary care in Provincetown to Healthcare for the Homeless. Tracks (e.g., global health, clinician educator) are of course other chances to gain specific training and experiences, and the curricula for these tracks are more intensive during the junior and senior years.
The year is structured in a 3+3 “Alternating Call and Electives” (ACES) model, with general medicine, specialty wards, and critical care rotations alternating with elective, ambulatory, and nighfloat weeks.
Other rotations available in the junior and senior years are:
- Stoneman Quality Improvement elective: one of the first resident QI rotations in the nation to teach residents QI skills, while having them participate in meaningful projects at the hospital
- Hospital medicine elective: an experiential rotation covering the administrative, financial, and academic aspects of hospital medicine
- Medical Consult: providing medical and pre-operative consultation on non-medical inpatient services
- Procedures rotation: an intensive clinical exposure performing procedures on multiple services under supervision
- Area of Concentration: protected time to work on research (basic science, clinical, QI, or education) or other scholarly project
Teaching as a Resident
Teaching is an important privilege and responsibility of all residents; as such, they are viewed as some of the core teachers within the Department of Medicine. At the same time, observation of resident teaching by Firm Chiefs, clinical attendings, and Chief Residents is a routine aspect of the way we train residents to be better teachers. Teaching is an important privilege and responsibility of all residents; as such, they are viewed as some of the core teachers within the Department of Medicine. At the same time, observation of resident teaching by Firm Chiefs, clinical attendings, and Chief Residents is a routine aspect of the way we train residents to be better teachers.
Leading inpatient medicine rounds: Residents run ward rounds, with the attending hospitalist providing support as necessary. Medical students and interns look to the resident as the primary decision-maker for the patients on their service.
Leading teaching attending rounds: During every rotation on the medical wards, each resident will lead at least one teaching session.
Small group presentations: During ambulatory weeks, residents will lead a majority of the pre-clinic conferences, typically presenting either a challenging ambulatory case or ambulatory-based topic. Once during residency, each junior resident will also present an article at ambulatory journal club to a small group of their peers.
“Senior” Teacher Rotation: Residents may choose to do the 1-2 week senior teacher elective as junior or senior residents.
Teaching activities include:
- Weekly lectures to the 3rd year medical students rotating on the inpatient medicine wards
- Weekly lectures to the 4th year medical students rotating on the sub-internship service
- Running one intern report under the mentorship of the Chief Residents
- Precepting interns in continuity clinic, under the supervision and mentorship of the primary care faculty.
- Working with the Director of Simulation in simulation-based teaching for students and fellow residents.
Foundations of Medical Education Course
This novel week-long medical education course is designed for residents who want even more opportunities to become an exceptional medical educator. The Foundations of Medical Education Course utilizes a "flipped classroom" model to stimulate group discussions and learning on common topics such as adult learning theory, cognitive learning theory, feedback, small group teaching, bedside teaching, and ambulatory teaching. In addition, during this course, residents have ample opportunity to practice these skills and receive feedback from education leaders. Senior Talks/ Lecture: Each senior resident presents a required 20-30 minute talk to all housestaff on a clinical or basic science topic. A mentor helps the resident develop the talk to a sufficient academic rigor that it could be disseminated as a conference presentation or publication. Program leadership observes and provides feedback.
Preceptors in Practice of Medicine: This is the course for pre-clinical Harvard medical students, which lays the foundation for clinical medicine. Each year a number of our residents participate either longitudinally or during some weeks.
Tutorial Leaders for Pathophysiology: Residents can lead problem-based tutorials in the pathophysiology course at HMS for first year students.
West Roxbury VA Chief Resident: Some of our senior residents are selected each year to serve as a Primary Care Chief Resident at the West Roxbury VA Medical Center. Duties include administrative work, numerous teaching conferences including resident reports, and bedside teaching. They also help precept ambulatory care visits at the West Roxbury outpatient clinics.