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Description of The Program:

The Internal Medicine Residency Program is committed to provide comprehensive post-graduate training in internal medicine, maintain highest academic standards, and establish the foundations for life long self directed learning, an essential requirement of today's internist.

The Internal Medicine Residency Program at Lincoln Medical Center is fully accredited by the American Council of Graduate Medical Education - ACGME and provides comprehensive post-graduate training in all areas of the vast field of Internal Medicine with an emphasis on the skills required for primary care practice. Lincoln Medical Center is located in the South Bronx (an area experiencing remarkable development and reinvigoration) and has long tradition of providing care to the poor and the disadvantaged in the City of New York .

The Internal Medicine Residency Training provides a wealth of clinical experience in the inpatient and outpatient settings which is accompanied by diverse conferences, grand rounds and seminar series that together provide solid foundations for achieving excellence in providing primary care services.

The outpatient training includes longitudinal continuity clinics, ambulatory bloc rotations and rich experience in emergency medicine. During the ambulatory block rotation, residents have the opportunity to rotate through gynecology, ENT and adolescent medicine. Beginning in internship, all residents follow their own patients in a weekly continuity clinic. Additional ambulatory training is provided by the outpatient clinics of the different medical subspecialties. These include geriatrics and gynecology.

Lincoln Medical Center is one of the first hospitals to implement hospitalists to manage the diverse inpatient population. Over the years, the hospitalist program has grown and matured, forming the backbone of the comprehensive and extensive training in inpatient medicine.

Lincoln Medical Center is a designated level one trauma center, regional stroke center and cancer center. Conferences, seminars and novel didactic models complement the direct patient care experience. These include doctor-patient communication modules, medical informatics, comprehensive primary care curriculum, community medicine and managed care, end of live, palliative care and pain management, debate series.

Medical research is supported and mandated. There is a yearly course given by lecturers from Weill medical college on research methodology as well as noon conferences on medical statistics, ethics, epidemiology and evidence based medicine. All residents are required to work on a research project and to present their work before they can graduate from the program. Beginning in July 2004 we have introduced a research elective rotation - four weeks for the duration of the residency training.

Outstanding/Special Features:
The department of medicine and the Residency Program have achieved above national bench mark results in all core measures as defined by CMS and nationally published guidelines and recommendations (i.e. blood pressure control, use of aspirin and beta-blockers in patients with MI, hemoglobin A1C in patients with diabetes, lipid control, immunizations etc.)

1. Award Wining Electronic Medical Record The department of medicine and the residency program with the active and enthusiastic participation of our residents have been instrumental in implementing state of the art Electronic Medical Record (EMR) across the institution. Our efforts were recognized recently by the HEALTH-CARE Information and Management Systems Society who warded our institution the prestigious Davies award in 2006 (The Davies Awards recognize excellence in the implementation and use of health information technology (IT) for healthcare organizations, private practices and public health systems).

2. Comprehensive tools for teaching/evaluating the core competencies: The following innovations regarding the core competencies are implemented:
Online self directed learning modules (EKG, CXR, UA, Peripheral smears, Pain management and Palliative care, Fundoscopy, PFTs).
Communication skills module.
Personalized approach to address identified deficiency in resident's medical knowledge
System base practice Grand Rounds series.
Patient care improvement through incorporating core measures as part of the EMR - DVT screening and prophylaxis, smoking cessation, health maintenance, vaccinations, HIV screening).
Departmental and inter-departmental debates

3. Research - mandatory involvement of all residents in research and scholarly activities. Annual departmental research competition

4. Integrated fellowship in Hematology/Oncology with Montefiore Medical Center

5. Introduction of palliative care service

6. Introduction of Inpatient Geriatric Evaluation and Management Service.
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7. Faculty - dedicated board certified attendings who are full time employees of Lincoln Medical Center with very low turnover both on the inpatient side (hospitalists) and the ambulatory clinic setting. 24/7 availability of board certified internists and critical care specialists that cover the medical floors and ICU units respectively.

8. MAR rotation - During this cycle, the resident reviews all of the patients referred by the emergency department physician for admission, and makes decision regarding immediate management and triage. The MAR performs a brief assessment about acuity. Based on his/her assessment patient is either admitted to a general medical ward or referred to intensive care unit. As the Emergency Department at this institution is one of the busiest in US, the MAR gains extensive experience in making initial assessment in patients with a wide range of medical problems. During this rotation, the residents gain tremendous confidence and an ability to function independently.

9. Consultative elective - Residents have an opportunity to learn about perioperative care and provide consultations to other departments - Surgery, OB/GYN, Psychiatry etc. Consultative service is frequently involved in the management of these patients. All of the consults are initially seen by the resident who performs a history and physical examination, reviews relevant data, and formulates a management plan using evidence based approach. Residents are expected to address DVT prophylaxis, risk for perioperative complications, infections, in the consult. The case is then presented to the attending physician, who reviews the data, performs physical exam, amends resident's note if needed and makes final recommendation. In addition to bedside teaching, formal lectures are given by the attending on various topics relevant to surgical patients.

10. Cultural competency sessions and modules - these are mandatory sessions/modules for all residents.

11. Autopsies - the program has succeeded in maintaining and even increased the number of autopsies performed. Residents have the opportunity to discuss mortality cases during our morbidity and mortality morning report that is conducted every week. In addition, mortality conferences are organized once a month with pathologists and residents from Bellevue medical center who present and discuss the pathologic findings after the clinical course is presented by our residents. All residents receive personally copies of the autopsy reports.

12. Quality improvement - residents are active participants in the quality improvement program, including, data collection, analysis and presentation at the meetings. In addition, all of the residents are assigned to hospital wide committees and are encouraged to attend the meetings. Some of the successes of the PI process have been: reduction of the readmissions of Asthma patients followed in the clinics from 8 to less than 2%, through emphasis on Asthma Action Plan, use of controller medications and early referral to Home Care services; increase in colorectal cancer screening with quadrupling of the number of colonoscopies performed and an increase in number of adenomas and cancers detected; reduction in unplanned extubation rate in the intensive care unit to less than 4%; compliance with guidelines for management of diabetes, with the outcomes measures of level of A1C,BP,ophthalmologic exam, lipid control, above published data; improvement in smoking cessation referrals; and immunization for pneumococcal pneumonia and influenza. Methodology for the collection of data, analysis, corrective measures, and improvement, using PDSA (Plan, Design, Study and Assess), are reviewed at various meetings.

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