THE INTERNAL MEDICINE RESIDENCY TRAINING PROGRAM at the University of Texas Southwestern Medical Center at Dallas is among the best in the nation. It combines superb physical facilities, an internationally known and respected faculty that is committed to teaching, and a large and heterogenous patient population. The resultant experience for internal medicine residents is outstanding in every respect.
House officers rotate through Parkland Health and Hospital System (PHHS), the Veterans Affairs North Texas Health Care System (DVAMC), University Hospital St. Paul (UHSP).
The program provides a stimulating and challenging internship during which the fundamental skills of an internist are acquired. While working as part of a team, the intern is the physician directly responsible for the care of patients on the wards and in the ICU. Interns help with plan of care, write orders and, under supervision, perform the majority of invasive procedures. Interns in the UT Southwestern Internal Medicine Training Program rapidly become adept at a wide variety of procedures, including (but not limited to) central line placement, intubation and lumbar puncture. By the end of the first year, house officers are fully confident and competent to take on the challenges of leading a team and caring for even the most critically ill patients.
The remaining two years allow consolidation of these skills, the opportunity for more extensive exposure to selected subspecialties, and more time to pursue extracurricular activities. The experience can be loosely grouped into four types: wards, consults, clinic and ICUs. The resident is the team leader on the wards, responsible not only for advising interns and working with the team to generate plans for the care of each patient, but also for educating the intern and students and working with consultants. Ward months are the heart and soul of an internal medicine training program. Our residents have a great deal of autonomy. The level of responsibility and patient ownership that comes from autonomy, when coupled with the complexity and diversity of the patients at our hospitals and excellent faculty teaching, guarantee that every graduate of our program will be fully in grasp of the skills required to be an excellent physician, be it as academician, primary care provider or specialist.
The intensive care units at UT Southwestern provide care for the sickest patients in the city of Dallas. Residents in the ICUs work closely with the fellows from our nationally renowned training programs in Cardiology and Pulmonary/Critical Care Medicine. In addition to teaching rounds, there are didactic teaching conferences given daily by outstanding clinical faculty in areas that include CHF, pulmonary hypertension and transplant medicine. Residents in the ICU are responsible for running all codes and helping ward teams manage seriously ill patients on the wards. These experiences are so positive that many of our house officers ultimately choose to pursue fellowship in Cardiology or Pulmonary/Critical Care Medicine.
Residents are assigned to a clinic at either the VA or Parkland, and have clinic at least once a week while on wards or a consult service for all three years of training. The structure is arranged to optimize continuity of care and make sure that each resident is fully trained in primary care internal medicine.
In the last two years of residency, about half of one’s time is spent on subspecialty and consult rotations. The resident handles most of the consultations on each service and staffs these with the attending physician for that subspecialty. Nights and weekends are generally free time for the resident; on consultation services residents do not have night-call. In addition to these duties in an inpatient setting, emphasis is placed on developing the skills needed to deliver expert care in an outpatient ambulatory setting.
On Call Structure
Internal medicine ward services: On call on the general medicine wards is every fifth night and in the units. Both intern and resident stay overnight and leave the hospital by 1 p.m. the next day. On the post-call day, a float resident joins the team to assist with patient needs and follow up until 5 p.m. to ensure the on-call team leaves by 1 p.m.
University Hospital St. Paul has a single ward team as well as Digestive and Liver Diseases and Hematology/Oncology subspecialty services. These teams admit daily but have no overnight call responsibilities.
There are four admitting teams on the Cardiology and Pulmonary ICU services at Parkland; University Hospital, St. Paul; and VA, each of which is on call every fourth night. Interns and residents work together throughout the shift. On all post-call days, interns and residents are required to leave the hospital at 1 p.m.
Diabetes and Geriatrics rotations: All interns will have two, call-free, two-week rotations on each of these services.
