“To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all”.
–Sir William Osler
This often quoted aphorism of Osler’s truly describes our emphasis on the primacy of the patient in the process of learning medicine. We passionately believe that learning of medicine is an active process at the bedside and, to that end, our residents find themselves in a supportive environment caring for an ethnically diverse population of patients and encountering as wide a spectrum of illness as can be encountered anywhere. We supplement these clinical experiences and “hands-on” learning with a didactic curriculum that covers important facets of internal medicine and that allows for in-depth discussion with our faculty. A comprehensive inpatient didactic curriculum is used at each of our inpatient training sites. Similarly, a comprehensive ambulatory medicine didactic curriculum occurs during ambulatory block rotations and in the continuity clinic.
Inpatient Didactic Curriculum
Report takes place Monday through Friday at noon at Yale New Haven Hospital Saint Raphael Campus (SRC). This interactive case-based discussion led by the chief residents with guidance and participation by faculty. We emphasize clinical reasoning and pathophysiology of disease in these discussions. Indications and accuracy of diagnostic testing, medical management and the literature supporting the most appropriate options are reviewed, and key concepts are summarized as “take home” learning points. Case-based reports will periodically be interwoven with more traditional lectures such as case-based Firm conferences, Morbidity and Mortality conferences and topic based lectures.
Intern Didactic Series
Each Monday interns on the inpatient services at SRC participate in an intern only two-hour case-based lecture series delivered by our core faculty. These interactive leaning sessions focus on common inpatient topics experienced by interns.
Medical Grand RoundsMedical Grand Rounds takes place weekly at both campuses of Yale New Haven Hospital. The Department of Internal Medicine prides itself in the quality of its Medical Grand Rounds and the diversity and range of speakers. The following are broad categories of subjects generally selected:
- Dilemmas in diagnosis or management
- Interdisciplinary discussions of patients on the medical service
- Scientific advances and implications for patient care, current and future
- Clinical updates
- Medical ethics
- Healthcare Policy and Healthcare access
- Global health
- Medical errors and quality improvement
- A writer’s workshop
- Clinical epidemiology
Firm RoundsDaily on the inpatient services at SRC, residents from the night team present patients to the day team for a warm hand-off and teaching encounter at the patient’s bedside. Our core faculty participate in this activity to highlight physical findings, historical clues to diagnosis and diagnostic reasoning. Residents provide brief teaching points for their peers.
Core Conference Series
A series of noon conferences are interspersed with noon report at SRC. These conferences cover a wide range of common internal medicine topics using a variety of formats. The emphasis is on core clinical concept, evidence-based care and clinical reasoning. Sample conferences include:
- Core topic seminars led by faculty (e.g., common conditions in all areas of medicine for example, atrial fibrillation, acute kidney injury, COPD exacerbations)
- Master Clinician Rounds
- Peer teaching led third-year residents returning from Global Health Electives
- Firm conferences and Morbidity and Mortality conferences led by the Firm chiefs. These conferences are held twice monthly depending on the service and focus on a recent case from the inpatient teaching service. Firm conference is centered on interesting and complicated cases, while Morbidity and Mortality conference focuses on medical errors, near-misses and systems-related issues in an attempt to identify these and prevent them from happening again. Both conferences enlist the active participation of the medical teams and specialists involved in the patients' care. A resident involved in the care of the patient is asked to prepare and present the case, under the supervision and guidance of the Firm chiefs.
A noon conference series and report are also available at Yale New Haven Hospital York Street Campus for residents rotating at these sites.
Ambulatory Medicine Lectures
The ambulatory medicine didactic curriculum of the Yale Primary Care Residency is among the most comprehensive and effective seminar series offered in any training program. Details regarding the weekly Yale office-based medicine curriculum (now used by over 100 internal medicine residency programs nationally) and the ambulatory block core seminar series is described in the ambulatory medicine section of the website. These interactive seminars cover all major topics in outpatient general internal medicine with an emphasis on standard of care, clinical decision making, communication skills, physical examination skills, and psychosocial aspects of medicine.