University of North Dakota School of Medicine & Health Sciences
Internal Medicine Residency Program

Required Rotations and Other Required Learning Experiences
Revised December 8, 2006

The curriculum for the Internal Medicine Residency Program of the University of North Dakota School of Medicine & Health Sciences is based upon requirements of the American Board of Internal Medicine (effective July 2006) and the ACGME Program Requirements for Residency Education in Internal Medicine (effective July 2003).

ABIM Requirements

To be admitted to the Certification Examination in Internal Medicine, physicians must have satisfactorily completed 36 calendar months of graduate medical education accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada, or the Professional Corporation of Physicians of Quebec, including vacation time, by August 31 of the year of examination. Residency or research experience occurring before completion of the requirements for the MD or DO degree cannot be credited toward the requirements for certification.

The 36 calendar months of full-time medical residency education:

(1) Must include at least 30 months of training in general internal medicine, subspecialty internal medicine, critical care medicine, geriatric medicine, and emergency medicine. Up to four months of the 30 months may include training in areas related to primary care, such as neurology, dermatology, office gynecology, or office orthopedics.

2) May include up to three months of other electives approved by the internal medicine program director.

(3) May include up to three months of leave for vacation time, parental leave, or illness. Vacation or other leave cannot be forfeited to reduce training time.

In addition, the following requirements for direct patient responsibility must be met:

(1) At least 24 months of the 36 months of residency education must occur in settings where the resident personally provides or supervises less experienced residents who provide direct care to patients in inpatient or ambulatory settings.

(2) At least six months of the direct patient responsibility on internal medicine rotations must occur during the R-1 year.

The Board requires documentation that candidates for certification in internal medicine are competent in: (1) patient care (medical interviewing, physical examination, and procedural skills); (2) medical knowledge; (3) practice-based learning and improvement; (4) interpersonal and communication skills; (5) professionalism; and (6) systems-based practice.

Through its tracking process, the Board requires program directors to complete clinical competence evaluations each spring for internal medicine residents. A candidate may be excluded from an ABIM examination if the required components of clinical competence are not satisfactorily documented by the training program.

All residents must receive satisfactory ratings in overall clinical competence and moral and ethical behavior in each year of training. In addition, residents must receive satisfactory ratings in each of the components of clinical competence during the final year of required training. It is the resident's responsibility to arrange for any additional training needed to achieve a satisfactory rating in each component of clinical competence.

ACGME Program Requirements for Residency Education in Internal Medicine

These requirements include, but are not limited to:

Minimum 1/3 training time in ambulatory sites, 1/3 in inpatient sites

Minimum ½ day per week in continuity clinic (minimum of 108 weekly continuity clinic sessions during the 36 months of training).

Minimum 4 weeks of emergency medicine, maximum of 3 months

Minimum 6 months inpatient internal medicine teaching services as R-1

Minimum 6 months inpatient internal medicine teaching services over R-2/R-3 combined

Minimum 3 months critical care , maximum of 6 months required

Clinical experience in geriatric medicine

Structured clinical experience in consultative medicine.

Required Clinical Rotations:

The following clinical rotations are required:

R-1

6 months Inpatient General Internal Medicine (MeritCare IMTS)

1 month Critical Care Medicine (MeritCare Critical Care Unit)

1 month Geriatrics (MeritCare TCU/nursing home/PCU/Home Health/clinic)

1 month Cardiology (MeritCare)

R-2

3-4 months supervision of Internal Medicine Teaching Service at MeritCare

1 month Critical Care Medicine at MeritCare

1 month Ambulatory Medicine at  VAMC

1 month night float (two 2-week assignments)

1 month Internal Medicine Consultation Service at MeritCare

1 month Cardiology at MeritCare

2 weeks Women’s Health (Cass County Public Health/MeritCare)

1 month Emergency Medicine

R-3

2-3 months supervision of Internal Medicine Teaching Service at MeritCare

1 month Critical Care Medicine at MeritCare

2 weeks Internal Medicine Consultation Service at MeritCare

1 month Cardiology at MeritCare

1 month Community Medicine

2-4 weeks night float (one or two 2-week assignments)

Required Educational Conferences

Core lecture series will consist of defined lectures based upon the blueprint of the ABIM board exam.  This includes the medical content areas and cross-content areas listed below:

cardiovascular disease

endocrine disease

gastrointestinal disease

hematologic disease

infectious disease

oncologic disease

renal disease

respiratory disease

rheumatologic disease

allergy and immunology

dermatology

neurology

obstetrics and gynecology

ophthalmology

otolaryngology

psychiatry

critical care medicine

geriatric medicine

prevention

In addition, there will be lectures on a yearly basis on consultative and adolescent medicine.  The following educational requirements will be topics of core resident conferences:  (1)  clinical ethics, (2) quality assessment, quality improvement, risk management, and cost effectiveness in medicine, (3) preventive medicine, (4) medical informatics and decision-making skills, (5) law and public policy, (6) pain management, (7) end-of-life care, (8) principles of managed care, (9) violence, (10) substance use disorders, (11) sports medicine and school health.

The residents are required to participate in the following conferences:

Journal Club:  Each resident, over the course of the year, will present at Journal Club.  The Journal Club will be based upon an evidence-based process.  It will utilize techniques developed by Dr. David L. Sackett to evaluate articles (please see Journal Club guideline).

Peer Review Committee Case Conferences

PROCEDURES

The following procedures are required for completion of the residency:

Abdominal paracentesis (3)

Arterial puncture for blood gas analysis (5)

Arthrocentesis of the knee joint (3)

Central venous line placement (5)

Lumbar puncture (5)

Nasogastric intubation (3)

Thoracentesis (5)

Critical life saving procedures (ACLS)

Breast exams (5)

Rectal exams (5)

Pelvic exams and Pap smears, including wet mount (5)

These procedure skills can be achieved on (1) inpatient ward, (2) ambulatory clinic, (3) specific rotations to include (a) anesthesiology, (b) procedure elective, and (c) women’s health month.  In addition to required procedures, residents will have opportunities to learn the following procedures:

Flexible sigmoidoscopy

Treadmill testing

Arterial line placement

Electrocardioversion

Swan-Ganz catheterization (Right Heart Catheterization)

Skin biopsies

Temporary placemaker placement

Instruction will occur in a variety of settings to include ICU, procedure elective, gastroenterology, and cardiology rotations.

INTERPRETIVE SKILLS

Our residents will receive instruction in the following interpretive skills:

EKGs

Chest X-rays

Gram’s stain and sputum

Microscopic examination of urine

Spirometry

KOH and wet prep examination of vaginal discharge

REQUIRED CONFERENCES

There are two sets of conferences that are required:

Morning Report.  Morning Report occurs at MeritCare from 7:30 – 8:00 a.m., Monday through Friday. The minimum requirement is 60% attendance.

Noon Conference.  Noon conferences will include core conferences, journal club, peer review committee case conferences, and occasional other topics.  It is of paramount importance that residents attend Noon Conferences on a daily basis.  The minimum requirement is 60% attendance.