Internal medicine residency curriculum – Morristown

The Morristown Medical Center Internal Medicine Residency Program runs a schedule via a 6 + 2 model in which our residents have a cycle of six weeks of inpatient/elective/consult blocks followed by two weeks of ambulatory medicine. This provides a wonderful longitudinal outpatient ambulatory care experience, both for residents in training, and for patients with their residency physicians. Our preliminary interns also receive ambulatory experience, both through a core rotation and elective opportunities.

All rotation blocks are two weeks in duration.

Rotations – Morristown

The Internal Medicine Residency Program at Morristown Medical Center offers the following rotations:

Inpatient rotations

Floor Teams

Our floor teams (AMG1, 2 and 3) are organized geographically to enhance teaching, patient care and communication. We have recently created an academic hospitalist faculty group recruited for their teaching expertise who will cover all resident floor rotations to optimize learning. Each floor team consists of a senior (PGY2 or 3) and interns as well as medical and pharmacy students.

Teaching rounds usually begin at 9am with presentations at bedside, hands on teaching on physical exam, and (where relevant) point of care ultrasonography.

AMG 1 – General medicine pathology
AMG 2 – Respiratory floor where patients may require ventilatory support, tracheostomy care, with frequent collaboration with and learning from respiratory therapy and our pulmonology team
AMG 3 – Cardiac floor within the Gagnon Cardiovascular Institute, working in concert with our cardiology fellows and consulting attendings
Step-Down Unit – An intermediate care unit between general floor and intensive care consisting of a PGY3, PGY2, and several interns rounding in concert with an academic hospitalist paired with a critical care attending

Critical Care

In our critical care rotation, residents work 12-hour shifts in both the 10-bed medical intensive care unit (MICU) and the 10-bed cardiac care unit (CCU). Patients may overflow to our 22-bed Surgical Intensive Care Unit, if needed. Both units are closed units where all patients are under the teaching service. As we are currently without a critical care fellowship, our residents have full access to all procedures on their patients – providing a strength of autonomy, while supervised by our excellent attendings.

The MICU offers interdisciplinary collaboration on many levels. Residents round with a full-time intensivist and work in conjunction with respiratory therapists, pharmacists, and highly trained nurses. Patients are regularly transferred to Morristown Medical Center by helicopter for tertiary care. The CCU offers similar educational experiences in a cardiac setting, with additional rounds with cardiology fellows and a dedicated intensivist team to enhance the academic experience. Our CCU includes complicated patients with LVAD, balloon pumps and impella devices.

Medical Admitting Resident

Our Medical Admitting Resident (MAR) is a PGY-3 resident who works five to six days per week as a triage resident. The MAR evaluates patients in the emergency department and on the floors to assist in determining patient placement on a "teaching" or "non-teaching" service, as well as confirming or determining the appropriate level of care.

This rotation can also provide an opportunity for senior residents to serve as a general medical consultant for patients on non-medical services such as surgery, gynecology and psychiatry when the consult residents are not in the hospital.

Night Float Rotation

A PGY-2 Medical Admitting Resident (MAR) triages patients from the emergency department to the appropriate teaching or non-teaching team throughout the hospital. Night Float and Medical Admitting interns cross-cover Step Down Unit patients, teaching team patients and assist with nocturnal admissions. A PGY-3 covers the step-down unit, as well as assisting interns with any issues that arise on the floors. A "nocturnist" (nocturnal hospitalist) is present for resident support and supervision.

Emergency Medicine (EM)

Residents have a two-week rotation in the emergency department, where they optimize the skills needed for the next step of the journey. This rotation is supervised by full-time EM attendings, and residents are exposed to patients experiencing a spectrum of problems, ranging from simple to life-threatening.

Electives

Elective rotations are available in all subspecialty areas and are selected by personal preference and learning needs. Residents may also seek “away electives” with prior approval from the program director. For example, some residents decide to participate in away electives as an "audition" for a program to which they wish to apply for fellowship, while others seek experiences not available locally (tropical medicine, for example). During electives, residents work additional half-day clinic sessions.

Outpatient rotations

Categorical residents rotate through ambulatory medicine for two weeks during their Y blocks, and have six ambulatory Y blocks per year. Our outpatient practice, Internal Medicine Faculty Associates, is less than one mile away in a state-of-the-art private medical office building.

Residents gain broad experience in all aspects of primary care including management of chronic disease, evaluation and management of new complaints, transitions of care, coordination of care, addressing barriers to health and issues with social determinants of health, learning how to effectively communicate with patients whose preferred language is not English, preoperative evaluations, advanced care planning, and preventive health.

As they progress through the 3 years, residents gain more autonomy in managing their patient panel, and have dedicated primary care faculty attending preceptors who review and discuss their cases.

A wide variety of ancillary services are available, including on-site social workers, patient navigators, nurses ,and medical assistants, a dedicated clinical pharmacist, collaborative behavioral health care, and a nutritionist, and we have been awarded designations including CPC-Plus and Patient Centered Medical Home Level 3. We use the Epic electronic medical record to facilitate management of care across out- and in-patient spectra.

During their Y blocks, residents have sessions dedicated to their continuity panel of patients (4 sessions per week), administrative time (for panel management), POCUS curriculum half-day and other subspecialty clinical experiences such as HIV, cystic fibrosis, TB, hematology and oncology, endocrinology, neurology and diabetes and more.

Residents are permitted one half day per week to choose a “second site” clinic in a field of their choosing, which allows them to have longitudinal experience in an outside ambulatory practice of their choice and gain stronger mentorship.

Preliminary interns rotate in the resident IMFA practice for two weeks where they have dedicated sessions for patient care, and also attend academic half days, sports medicine subspecialty clinic, POCUS half-day sessions, have administrative time and wellness time, and work on an ambulatory medicine or quality improvement topic of interest. After rotating with us in IMFA, preliminary interns then have two weeks of ambulatory elective time where they may rotate in an outpatient office practice of their choice in any field or subspecialty.

Internal medicine residency conferences

Conferences at the Internal Medicine Residency Program at Morristown Medical Center include:

Inpatient

Morning resident report We have two parallel resident report series; one for our interns and one for our PGY2 and PGY3 residents. These are dynamic conferences and the format varies from case-based review to simulation-based teaching.

Noon conferences The noon conference series is based on subspecialty content covered by the American Board of Internal Medicine's (ABIM) certification examination. We begin the year with a resident survival series to help ensure all trainees feel comfortable managing the most common scenarios they will encounter.

Department of medicine grand rounds This high caliber weekly lecture series is attended by residents and attending staff. Lecturers are experts in their fields and may have regional or national prominence. Topics run the gamut of internal medicine and are selected based on audience preference. Included in the schedule are ambulatory grand rounds, hospital grand rounds, PGY3 resident presentations and quarterly M&M conferences.

Evidence-based medicine journal club Our journal club series is designed to accomplish two goals: development of residents’ essential skills for the critical appraisal of medical literature, and participation in reviews of important articles in internal medicine. They not only learn the techniques for the practical application of evidence from medical literature, but also develop an in-depth understanding of major studies that have become part of the “language” of evidence-based patient care.

Joint Internal Medicine (IM) and Emergency Medicine (EM) conference This joint conference focuses on topics of interest in IM and EM. The goal of the conference is to improve team communication and facilitate understanding of the different directions each discipline may take in the assessment and management of various patient presentations.

Radiology rounds Residents and attendings on the three teaching services meet with radiology residents to review interesting radiographical studies and discuss their clinical impact.

Outpatient

Academic half-day conferences Wednesday mornings include 3.5 hours of protected time dedicated to a rotating 3-year curriculum of ambulatory learning topics and workshop-style small group sessions during the Y-block rotation in the outpatient practice setting. Attending physicians cover IMFA office appointments while residents spend time in a variety of didactic sessions during this dedicated outpatient experience.

Simulation and point of care ultrasound sessions Every ambulatory block will have a simulation session at center to practice emergent scenarios with your peers and session to learn and practice point of care ultrasound on the inpatient floors with an accompanying video curriculum to reinforce skills learned.

Research & scholarly activity

The Accreditation Council for Graduate Medical Education (ACGME) wants to ensure that medical residents have the opportunity to participate in scholarly activity during their training. The ACGME’s definition of scholarly activity is broad, including scholarly discussions (journal club, grand rounds, noon conferences, etc.) or other “scholarship of discovery” activities (QI projects or research projects, for example).

To meet these goals, the Internal Medicine Residency Program at Morristown Medical Center offers the following opportunities:

Scholarly activity project

All residents are required to complete an annual scholarly activity project to become familiar with the research process and learn how to apply the results to improve patient care and personal performance. The project has graded levels of responsibility for each academic year.

Each Spring, residents may present their scholarly work at the Atlantic Health Quality Improvement symposium for all residents and fellows across our system, providing both a poster session competition as well as an oral presentation section. Although the ultimate goal is the development of an independent research project, some residents feel more comfortable working with clinical vignettes.

Atlantic Health’s annual Regional Research Symposium provides a larger forum for faculty and resident research presentations.

Regional Research Symposium

Atlantic Health hosts its system-wide Research Symposium each Spring. Submissions are accepted from all disciplines and professions for poster and oral presentations. The most highly-rated abstract submissions are selected for oral presentation. Authors not selected for oral presentations prepare posters for a juried competition.

A distinguished speaker gives the keynote lecture to conclude the event; past speakers have included renowned author and physician Mehmet Oz, MD, of Columbia College of Physicians and Surgeons.

Our residents and faculty are highly encouraged to submit their work for this prestigious and competitive event. Each year, a large number of our residents are chosen for poster or oral presentations.

Clinical research

Morristown Medical Center has robust research opportunities. Residents are encouraged to seek out mentors and immerse themselves in projects of their own, as well as submit their work to national meetings and for publication.

In recent years, Morristown Medical Center residents have presented their research at the Society of Critical Care Medicine, the American Thoracic Society, the Associated Professional Sleep Societies, Regional and National American College of Physicians, the American Geriatrics Society, and the Society of General Internal Medicine, among other academic organizations.

Our graduate medical education office provides financial support to residents to enable them to participate in this important, career-building opportunity. Our Atlantic Center for Research provides excellent statistical support, and residents are encouraged to participate in Atlantic Health’s graduate medical education core research lecture series.

Post-graduate fellowships - Morristown internal medicine

Approximately 50 percent of residents in the Internal Medicine Residency Program at Morristown Medical Center pursue fellowship training at the conclusion of their residency training.

The annual Fellowship Workshop provides a timeline and materials to facilitate the applications process for residents. The many subspecialists at Morristown Medical Center who completed their fellowships at highly-regarded institutions provide residents with excellent letters of recommendation, as well as important contacts.

Here is a list of some of the programs to which our recent graduates have been accepted for fellowship in the past five years:

Endocrine
- SUNY Upstate Medical Center
- Rush University Medical Center
- Virginia Commonwealth University
- Temple University Hospital
- Jackson Memorial Hospital
- Eastern Virginia Medical School
- Sidney Kimmel School of Medicine at Thomas Jefferson University
- Ohio State University
- University of Missouri
- Westchester Medical Center
Hematology and oncology
- Westchester Medical Center
- Penn State
- SUNY Upstate Medical Center
- Baystate Medical Center
Infectious disease
- Jackson Memorial Medical Center
- Beaumont Medical Center
Nephrology
- Wake Forest University
- New York University
- University of Michigan
- Mayo Clinic, Jacksonville
- Cleveland Clinic, Ohio
- George Washington University
Pulmonary and critical care
- Newark Beth Israel Medical Center
- Icahn School of Medicine at Mount Sinai
- Lenox Hill Hospital
- Mayo Clinic, Jacksonville
- Drexel University
- Cleveland Clinic, Florida
- University of Missouri
- University of Nevada at Las Vegas
Cardiology
- Atlantic Health
- University of Alabama
- Baylor University Medical Center
- University of Pittsburgh
- Guthrie Institute/Robert Packer Hospital
- University of Cincinnati
- Marshall University
- Christiana Health Center
- University of Arizona
- Georgetown University/Medstar
Geriatrics
- University of Pennsylvania
- Icahn School of Medicine at Mount Sinai
- Boston University Medical Center
Rheumatology
- University of South Florida
- George Washington University
Genetics
- Baylor University Medical Center
- NIH/Johns Hopkins University

Graduates within the past five years have also completed fellowships in research (such as cardiac electrophysiology, gastroenterology, and stem cell), palliative care, general internal medicine, rheumatology, sleep medicine, heart failure and sports medicine. In addition, one of our graduates completed his aerospace medicine fellowship at National Aeronautics and Space Administration (NASA), and another has fulfilled requirements for qualifications in bariatric medicine

Internal medicine residency at Morristown

Awards & accreditations

Additional resources