Internal Medicine Residency Curriculum Overview

In the Internal Medicine Residency program at Wake Forest University School of Medicine, our overarching goal is to promote progressive growth of medical knowledge, clinical reasoning, and procedural skills throughout the three years of training. Interns enter a collegial environment that fosters appropriate autonomy early on in training while providing comprehensive support and guidance. As residents progress through the curriculum, they develop as team leaders and are well-positioned to practice Internal Medicine independently upon graduation.

Our interdisciplinary ward teams generally consist of 2-3 interns, 1 upper level resident and 1 attending, as well as medical students, acting interns, clinical pharmacists, nursing case managers and other helpful ancillary staff. Upper levels supervise the care of 10-20 patients on the ward services.

The medical intensive care unit is staffed by two teams each consisting of 2-3 interns, an upper level resident, a critical care fellow, and an attending. The cardiovascular intensive care unit is staffed by 2-3 interns, 2-3 upper level residents, a cardiology fellow, and an attending. Rounds in both intensive care units also consist of medical students and a multidisciplinary team of nurses, clinical pharmacists and therapists.

Training Pathways

Although not required, we offer additional training pathways for residents who wish to gain more focused training. These are one to two year experiences selected by upper level residents to further skills in specific areas to better prepare for career or fellowship selection. The Primary Care Track is a separate three year opportunity for those interested in careers in primary care or subspecialties with a predominant outpatient focus. All pathways provide dedicated mentorship as well as opportunities for scholarly output and professional growth.

Clinical Scholars in Informatics

The Clinical Scholars in Informatics (CSI) pathway is a two-year program designed for residents to further develop their skills in informatics and health information technologies with the support and guidance of a mentorship team.

Global Health Pathway

The Global Health Pathway is a two-year pathway spanning the 2nd and 3rd years of residency training. In addition to dedicated educational and mentorship opportunities, the pathway offers residents a dedicated public health month in the 2nd year and an opportunity for an internally funded international health rotation in the 3rd year.

Hospitalist Training

The Hospital Medicine Pathway (HMP) is a one or two-year pathway designed for residents interested in a career as an academic or community hospitalist.

Medical Education Pathway

The Medical Education Pathway is a one or two-year pathway designed to provide an opportunity for residents to learn about traditional and novel educational techniques and practice and improve their teaching skills. Activities occur in a longitudinal fashion under the mentorship of our Educator’s Academy, which includes master teachers within the Department of Internal Medicine.

POCUS Champion Pathway

The POCUS Champion Pathway is a one or two-year pathway that provides enhanced point-of-care ultrasound (POCUS) training for upper level residents interested in further developing their bedside ultrasound skills. Resident POCUS Champions take part in a more advanced multimodal POCUS Champion training program. They work closely with POCUS trained faculty and develop into POCUS instructors within the residency program and medical school. Residents are eligible to apply for this pathway at the end of their intern year.

Tinsley R. Harrison Translational Research Scholar Pathway

The Research Training pathway is a two-year opportunity that provides protected time for pursuing translational research with the goal of training future physician-scientists. Residents apply and are accepted into the program during their intern year.

Point-of-Care Ultrasound Training

Point-of-Care Ultrasound (POCUS) is integrated into the education curriculum for all residents throughout all three years of Internal Medicine residency training. The residency program fosters a supportive educational environment that encourages the use of POCUS in the clinical setting. Residents have access to a simulation and ultrasound lab, along with top-of-the-line ultrasound equipment in both the inpatient and outpatient setting. Learn more about our unique POCUS curriculum.

Clinical Rotations

Intern Year (House Officer-1/HO-1)

The intern year offers broad exposure to direct patient care in internal medicine. Throughout the year, interns manage diverse patient populations and learn directly from subspecialists in a variety of inpatient services and outpatient clinics.

Our 3+1 model showcases three weeks on an “X” service (wards, ICU, nights, urgent care clinics, VA clinic, emergency department) followed by one week on a "Y" service (ambulatory medicine). The intern year is structured as an X+Y schedule, with 13 three-week rotations. The three-week X-rotations include the following dedicated experiences:

• 10 blocks of inpatient wards (including general medicine and subspecialty wards, night medicine, Cardiovascular Intensive Care Unit [CVICU] and Medical Intensive Care Unit [MICU])
• 1 emergency medicine block (ED)
• 2 ambulatory blocks, including the VA (categorical and primary care interns) and Acute Care Clinic

General inpatient medicine rotations are completed at both Atrium Health Wake Forest Baptist Medical Center, a traditional Level 1 Trauma Center and tertiary care hospital in Winston-Salem, as well as at Atrium Health High Point Medical Center, offering experience in both a traditional academic and community hospital setting.

The remaining ambulatory training will occur on the 13 “Y-weeks.” The Y-week features a variety of clinic experiences and educational conferences.
 

Upper-level Years (House Officer-2 and -3/HO-2 and -3)

The second and third years of residency are designed to facilitate your growth and maturation into a skilled internist. Upper-level residents manage the general medicine and subspecialty inpatient services (cardiology, hematology/oncology, leukemia, nephrology and geriatrics). Additional blocks include night float coverage and the MICU and CVICU.

Remaining blocks include:

• Subspecialty consults and clinic experiences
• Private practice internal medicine clinic
• General medicine acute care clinic and VA outpatient clinic
• Elective time tailored to the resident’s interests
• Inpatient procedures service

Elective time allows upper-level residents to tailor their schedule to their interests. Most residents schedule at least one research block.

During the HO-2 and HO-3 years, the schedule follows a general structure of alternating between four-week ward services and four-week non-ward rotations. Each of these years consists of 13 four-week blocks in this 4+4 format. Continuity clinics take place during the non-ward rotations only and are not scheduled during inpatient ward services. Resident continuity clinics are organized into practices and residents have two half-days of continuity clinic per week during their non-ward blocks that include dedicated sessions for ambulatory quality improvement. Coupling this 4+4 schedule with the 3+1 structure in the intern year allows for improved overall team continuity and full dedication to inpatient training for both upper levels and interns on ward services.

Example Upper-Level Resident Schedule

The content of the upper-level years is as follows:

On Call Duties

Our intern call system consists of a block night float system for ward services and a short stretch of nights during the MICU and CVICU rotations.

Our upper-level call system consists of a night float that covers Sunday through Thursday. Friday and Saturday nights are covered by HO2 residents on outpatient rotations (average of 5-6 shifts per year) as well as by the HO3 resident while on their block of nights.   Upper levels on ward services at High Point have a rotating night float system embedded within the rotation. The MICU and CVICU have a night float system where residents rotate through short stretches of nights throughout the rotation.

Conferences and Didactics

Conferences in the Internal Medicine Residency Program are designed to enhance the clinical and research skills of residents. They are developed each year with input from our Resident Curriculum Committee and based on resident feedback solicited each year.

Routine conferences include:

Research

The residency program and the Department of medicine supports research during your internal medicine training through both elective time for research as well as financial support for the dissemination of scholarly output. Every year, our residents publish numerous peer-reviewed articles and present many abstracts at regional and national meetings, as well as participate in our own Internal Medicine Research Symposium.

Learn more about research opportunities available to Internal Medicine residents and about Internal Medicine research at Wake Forest University School of Medicine.