Clinical

We are proud to train outstanding clinicians. We ensure that all trainees gain the knowledge, skills, and attitudes necessary to provide great care to future patients in any setting. We believe that this includes medical knowledge, the knowledge of social determinants of health and how these impact health, advanced physical exam skills, advanced diagnostic reasoning skills, evidence-based medicine knowledge and skills, a focus on high value care, and an understanding and application of science – and, most importantly, the ability to bring each of these pieces in an integrated way to the bedside in a patient- and team-centered manner.

A few highlights of our clinical training program:

  • Innovative education program – our program was one of the first programs to embrace milestone-based training in our learner-manager-teacher model. We are proud that our residents move through this transition and own their advancement as academic clinician educators by mapping their progress and building their portfolios as they go!
  • Innovative structures for training – our tandem block schedule is “one of a kind” and was uniquely designed to optimize the balance between training in the inpatient and ambulatory setting ensuring a focused, dedicated curriculum in each of these areas. Our residents have also found that it helps them to optimize their work life balancing – and better prepares them for their ultimate jobs. In addition, our program embraces new modes of education and encourages creativity in our faculty and our residents.
  • State of the art medical facilities across locations of VCUHealth and McGuire VA Medical Center where the highest quality of care is delivered (McKesson award mention?), in which we serve an incredibly diverse patient population, who present with a widespread spectrum of disease and illness. If you can read about it, you will likely see it! - and more!
  • Partnering to further innovation in the delivery of clinical care – from our recent work with structured interdisciplinary rounding to pilots in unit-based care, we partner closely with our healthcare team members to model cutting edge care.

Training Model

We are proud to be one of the first programs nationally using a competency-based advancement model for graduate medical education training. Our model is the foundation of our clinical training experience. Our residents move from phases of training as they achieve mastery of milestones for each phase. Each phase is focused on a different set of responsibilities and level of competencies.

Jane A. Cecil, MD

Learner – in the learner phase of training, an individual works on basic milestones in patient care. They are supervised directly by upper level trainees and attending physicians. They are challenged to advance their skills in history taking, physical diagnosis, diagnostic reasoning, management, teamwork, systems-based practice but always have the support of a senior to coach them. Our supervisors are trained in “supervised autonomy” as a principle so that learners are not “directed” but coached to grow.

Manager – once a learner reaches competency in all learner-level milestones, they advance to the manager phase of training. In this phase, one works to establish independence in patient care knowledge and skills. Our managers do not supervise learners, nor are they supervised by upper level residents. They work collaboratively on manager-level rotations with attending physicians to establish competence in management of common medical conditions in both the inpatient and ambulatory setting. Our residents consider this the most challenging and most rewarding phase of training as they truly grow into clinical independence in this phase.

Teacher/Leader – once a manager is considered independent in managing most common medical conditions, they advance to the teacher/leader phase of training. In this phase, they continue to gain the necessary experience over time in managing many medical conditions and they work on teaching and leadership skills. Their milestones during this phase are worded as phrases such as “can teach others …”, “leads a healthcare team”, “coordinates care across…”, “role models for others…”. It is in this level of training that our residents lead teams on the wards, in the ICUs, specialize in consultative care and serve in advanced roles in the ambulatory practice setting.

Training Curriculum


Learner

Rotation Location Blocks (4 wk)
General Medicine Ward VA or MCVH 3
Night Float VA or MCVH 1 ( 2, 2-wk)
Emergency Medicine MCVH .5
Inpatient Digestive Health MCVH 1
Inpatient Heme/Onc MCVH 1
Inpatient Cardiology MCVH 1
Medical Respiratory ICU MCVH 1
Ambulatory Block VA or MCVH 1
Electives (includes cardiology, ID) VA or MCVH 3.5 (w/ vac)

Manager

Rotation Location Blocks (4 wk)
Core Manager - combined inpatient/amb VA or MCVH 3
Cardiology Manager VA 1
ICU Manager VA 1
Emergency Medicine VA 1
Night Float VA or MCVH 1 (2, 2-wk)
Wards Supervisor - transition VA or MCVH 1
MRICU/CCU Supervisor - transition MCVH 1
Procedure MCVH .5
Electives (incl. rheum/endo/pathways/research) VA or MCVH 3.5 (w/ vac)

Teacher/Leader

Rotation Location Blocks (4 wk)
General Medicine Ward VA or MCVH 1-2
Night Float VA or MCVH 1 ( 2, 2-wk)
Inpatient Specialty blocks MCVH 1-2
MRICU MCVH 1
CCU MCVH 1
Student Health / Urgent MCVH 1
Medicine Consults / Geri MCVH 1
Quality & Safety VA .5
Palliative Care MCVH .5
Electives (includes path, res) VA or MCVH 4 (w/ vac)

Training Sites

  • VCUHealth/Medical College of Virginia Hospitals (MCVH)
  • McGuire Veterans Affairs Medical Center (VA)
  • Other – Stony Point Ambulatory Practice, Mayland Ambulatory Practice, Community-based sites, International site for Global Health track

Ambulatory Training

The VCUHS Ambulatory Curriculum is housed in several of the rotations listed above. During their outpatient blocks, our residents are challenged to develop the clinical knowledge and care coordination skills that they will need to be excellent physicians in the ambulatory setting. In addition to choosing outpatient electives and developing longitudinal patient relationships through their own Continuity Clinic, our residents also participate in several unique rotations.

During the learner phase of training, our residents have a four week block dedicated to the delivery of primary care. Our learners spend time reviewing their own patient panel, investigating the community that surrounds VCUHS and interacting with our various non-MD specialists who provide critical services to augment the care of our patients.

As managers, our residents spend a total of six weeks in the primary care rotation (part of Core Manager) that incorporates exposure to Adolescent Medicine, Geriatric Medicine, Women’s Health and/or two weeks in one of our community health clinics.

Finally, during their time as manager/teacher, our more senior residents gain independence as providers in the Student Health Clinic and learn to handle the graduated responsibility of Urgent Care, accompanied by at-home call.

Advising/Coaching

Each resident who enters VCU’s Internal Medicine Training Program is assigned a dedicated core faculty advisor who serves as a mentor and coach to partner with residents from the first lunch they share at orientation to the final review of their evaluations at the end of their residency training. Each advisor mentors a cohort of six advisees of PGY1, 2 and 3 residents who serve as a buddy system for their years of training. These dedicated core faculty are trained specifically in competency-based assessment, evaluation, feedback and coaching. They meet with residents regularly throughout the year for retreats, to provide career coaching, identification of potential research mentors and formal semi-annual year review of performance amongst others. Advisors interact with residents regularly when they attend on inpatient services and in the ambulatory setting as well as facilitate conferences.

Conferences

  Monday Tuesday Wednesday Thursday Friday
7:30 am Ambulatory MR   Ambulatory MR Journal Club Ambulatory MR
11:00 am Inpatient MR   Inpatient MR Inpatient MR Inpatient MR
noon     Intern Report Grand Rounds  
3:00 pm  

Core Conference
3-6pm

     
midnight   Didactic Didactic Midnight report Midnight report

Conference Descriptions

Conference Location Required of Content focus Format Facilitators
Ambulatory Morning Report Simultaneous, VAMC and MCVH All residents on ambulatory rotations or in clinic that day Ambulatory curriculum, skills Case-based, active learning General Internists, Specialists, Chief medical residents
Journal Club Video-conferenced VA, MCVH-based All residents on ambulatory rotations or in clinic that day Evidence-based medicine skills and literature review Active-learning, flipped classroom EBM-trained facilitators
Inpatient Morning Report Simultaneous, VAMC and MCVH All residents on inpatient rotations, inpatient consults Common and uncommon inpatient presentations, diagnostic reasoning, physical exam, pathophysiology, EBM Case-based discussion Core educators, Program directors, Chief medical residents
Intern Conference Simultaneous, VAMC and MCVH All interns on inpatient rotations, consults Diagnostic reasoning, physical examination, presentation skills Case-based discussion Core educators, Program directors, Chief medical residents
Grand Rounds Video-conferenced VA, MCVH-based (VA has independent on Friday am) All Department Conference, Updates   Faculty, visiting professors, nationally recognized speakers
Core Conference 3-5pm Video-conferenced VA, MCVH-based All except those on nights and ICUs, away rotations Core curriculum Active learning-based – may include case-based, audience response, team-based learning, more Faculty, rotates monthly through specialties
Core Conference 5-6pm Varies All

Rotating series over four week block:
-housestaff meeting
-pathway conferences
-Morbidity and Mortality

-wellness/ resilience

Small group, discussion format  

Tandem Block Schedule

Our unique tandem block schedule was designed by our residents with the following goals in mind:

  • Separate inpatient/ambulatory responsibilities with dedicated curricula
  • Provide opportunity for continuity in continuity clinic
  • Provide excellent coverage for continuity patient panel when on inpatient
  • Keep inpatient teams together for evaluation, teamwork purposes
  • Maintain four-week experiences for learning purposes

The tandem block schedule pairs four-week direct patient care inpatient experiences (wards/icu/specialty services – designated as “I” in schematic below) with other experiences (ambulatory, consults, research, electives – designated as A) in an alternating eight-week block schedule. The “A” designation indicates that the resident has continuity clinic five ½ days per week during that rotation. The residents are partnered together in practice partnerships so that one of the partners is always in clinic that week and manages outpatient responsibilities for the patient panels during that time. Residents do not have clinic during “I” blocks.

The schematic below represents two residents’ schedules for the first 26 weeks of a year. Each column is two weeks.

A sample intern schedule from this year (during the intern year, block 7 is always inpatient):