Every weekday morning, the chief residents present and/or preside over morning reports for residents rotating at the University of Illinois Hospital, Jesse Brown VAMC and on our ambulatory care rotation. Morning reports are highly interactive with participation by medical students through. The cases selected are either an unusual presentation of a must-know diagnosis or a classical presentation of a rare disease. These patients are still under our care giving these discussions a high degree of relevancy and emphasizing that practicing medicine is a collaborative process. Attending physicians from a variety of specialties are present to help guide the discussion and provide teaching points for the residents and a review of the disease is presented at the end.
Intern Morning Report is a special 8 AM conference given by the Chief Residents once a week for the first 2 months of intern year. These lectures cover a wide range of high yield topics including Pain Management, Inpatient Diabetes Management, offerings at the School of Public Health and How to Get a Research Project Started.
Core Conference Curriculum
Every weekday at noon residents have protected time to attend the Internal Medicine noon conference series. These conferences are curated by the Chief Resident for Research and Education and cover the majority of topics tested on Internal Medicine Boards. Attendings from every Internal Medicine specialty, with the addition of Neurology and Radiology, are invited to discuss high yield topics with an emphasis on physical diagnosis and patient management. The smartphone-based Polleverywhere system is used for anonymous Q&A to facilitate audience interaction.
The topics in the first half of the academic year are commonly encountered diseases or clinical scenarios to deliver high yield information to our new trainees. These lectures are repeated annually. The topics in the latter half of the academic year are less common clinical entities.. The entire curriculum repeats on a 3 -ear cycle so every trainee enters the Boards Exam with a well-rounded knowledge base of basics, plus the finer points of the medicine specialties.
In addition to the lecture series noted above, we hold a monthly ‘Residents’ Meeting’ led by the Program Director and Chief Residents. Topics include everything from resident recruitment to ‘state-of-the-residency’ issues to research and educational opportunities. Items of change are discussed, and when implemented, feedback is obtained in this and other settings.
Multidisciplinary Conference and Journal Club
During the third year of internal medicine residency, all graduating seniors conduct either a Multidisciplinary Conference (MDC) or an Evidence-Based Medicine (EBM) presentation during the noon conference hour.
For MDCs, the cases discussed revolve around currently or recently admitted patients who had a complicated hospital course due to their multiple co-morbities, requiring the input of numerous specialists. Faculty from each of the specialties are in attendance. This conference creates a forum in which residents can hear attending faculty from the internal medicine subspecialties discuss their thought processes related to a complex case and how diagnostic and therapeutic interventions were chosen when it was not immediately obvious what the best choice would be. Our graduating residents find that working on this presentation and guiding the discussion strengthens their clinical decision-making skills.
For EBMs, residents work in pairs and select a topic that has rapidly evolved, or one in which there is excellent evidence guiding management. They read the primary literature and then walk the audience of faculty, residents and students through the studies, assessing the strengths and weaknesses of each one. Take home points at the end provide a summary of how we can translate the data into excellent patient care. Evaluating evidence is a key aspect of academic training and our residents find constructing these presentations to be an excellent teaching tool.
Morbidity and Mortality
Every month the residency program conducts a Morbidity and Mortality conference in place of the noon conference. The purpose of these conferences is to dissect a patient’s chart, documentation, decision-making and hospital course in hopes of learning what we could do better next time. A senior resident puts the presentation together and an attending from Pulmonary and Critical Care Medicine leads the discussion along with specialty consultants who contributed to the patient’s management.
Our weekly Grand Rounds lectures are organized by the Program Director, working in concern with the Division Chiefs. Each Internal Medicine specialty is assigned a month in which to invite guest speakers to discuss rapidly evolving aspects of their specialties. There is an emphasis on discussion of recent advances in medical therapeutics that have a high likelihood of changing the standard practice of medicine over the next few years. These conferences are attended by the entire Department of Medicine faculty.
We hold a monthly autopsy conference in which a case with instructive pathology findings is presented by the house staff for discussion by several invited consultants, including members of the Pathology Department. These conferences provide a forum for a fruitful multi-disciplinary discussion in cases where the cause of death or final diagnosis was unclear.
Boards Preparation Tools
Our excellent Boards pass rates are due in a large part to the commitment of our faculty in providing high yield didactics throughout the year. We recognize, however, that studying is an individualized process and what is effective for one resident may not be for another. To that end, we provide a variety of preparation tools and materials. Using the results of the In-training Exam (ITE), the Chief Resident for Research and Education prepares Boards study plans for residents who need long term approaches to preparedness. Generalized study plans are available to residents of every year, broken down into blocks based on degree of clinical responsibility. During the last 2 blocks of the academic year, noon conference is routinely replaced by resident-led MKSAP review sessions in which the smartphone-based Polleverywhere system is used to answer MKSAP questions and review why the selected answer is correct, but perhaps equally importantly, why the other answers are wrong. All residents attend these sessions, getting the PGY1s in the habit of answering Boards-style questions early on. Additionally, we purchase a video-based Boards preparation course every year and arrange coverage of clinical duties for PGY3s who wish to attend.