Internal Medicine Residency Program

Curriculum and Program Design

Harlem Hospital Center

Curriculum

Our program curriculum is designed to provide rotation-specific educational goals and objectives through the training program for all areas, including:

  • Cardiology
  • Consultation Medicine
  • Coronary Care Unit 
  • Emergency Medicine
  • Endocrinology
  • Gastroenterology
  • Geriatrics
  • Hematology/Oncology
  • Infectious Diseases
  • Inpatient Medicine
  • Nephrology
  • Neurology
  • Otolaryngology (ENT)
  • Primary Care/Continuity Clinic
  • Pulmonary/Intensive Care Unit (ICU)
  • Rheumatology

For comprehensive information about the full curriculum, please download the Internal Medicine Residency Program Guide.

Educational Goals

Interns - PGY 1 Year

The PGY I house officers will refine their basic clinical skills and begin to develop complete differential diagnoses and treatment plans.  They will learn how to apply evidenced-based and cost-effective strategies in the diagnosis and treatment of various medical conditions in both the inpatient and ambulatory settings.  They will learn how to function effectively as part of a multi-disciplinary team.  They will begin to understand the context and system in which health care is delivered, and begin to learn how to access and utilize resources.

  • Residents will demonstrate willingness to take on primary responsibility for patient's care.
  • Residents will be able to perform a complete and accurate history and physical.
  • Residents will demonstrate the ability to communicate effectively, verbally or in writing, with patients, supervisors, colleagues, students, and multi-disciplinary team members.
  • Residents will maintain comprehensive, legible, and timely medical records.
  • Residents will be able to generate a comprehensive differential diagnosis based on the assessment of the patient’s complaint.
  • Residents will be able to synthesize and prioritize issues in the care or patients.
  • Resident will demonstrate commitment to the ideals of professionalism, ethics, respect, compassion, and altruism in all of their interactions with patients, families, and colleagues. 
  • Residents will demonstrate the ability to access and critically evaluate medical literature, and be able to apply knowledge to clinical practice.
  • Residents will demonstrate an enthusiasm for self-improvement, evidencing on-going self –learning, responsiveness to criticism, ability to learn from past experiences, and willingness to identify and improve systemic deficiencies.
  • Residents will learn to understand the system in which they work, and demonstrate the ability to access various resources, providers, information technology, and multidisciplinary team members in the care of their patients.
  • Residents will demonstrate behaviors that engender sensitivity and responsiveness to issues related patients’ and colleagues’ gender, age, culture, religion, sexual preferences, socioeconomic status, beliefs, behaviors and disabilities.

Juniors - PGY 2 Year

In addition to further refining the goals and objectives stated above for the PGY 1 year, residents will begin to take on increasing responsibilities for patient care, leadership, teaching, and administration of the ward team.  Residents will further expand their medical knowledge base and patient care skills.  Residents will also begin to finesse the skills necessary for assessment of the severity of illness, triaging, and facilitation of care in both the inpatient and ambulatory settings.  In this year, residents will continue to develop their individualized course for lifelong learning.  Junior residents will continue to develop their individual course for lifelong learning.  Junior residents will also use this year to identify goals and career tracks.  Active participation in scholarly activities is part of the expectation of this year.

  • Residents will demonstrate the ability to effectively serve as the leader and role model for the inpatient teams.
  • Residents will demonstrate the ability to triage patients based on the severity of their illnesses.
  • Residents will demonstrate the ability to offer appropriate guidance in communication of transfer of care and ensuring safe sign-outs.
  • Residents will demonstrate appropriate communication skills with the attendings, the junior house officers, the multi-disciplinary team members, and consultant staff, in the implementation of patient care recommendations.
  • Residents will demonstrate the appropriate communication/interpersonal skills, medical knowledge base, and enthusiasm for teaching students, colleagues, attendings, patients, and multi-disciplinary team members.
  • Residents will demonstrate behaviors that reflect commitment to continuing the development of professional and ethical behaviors.
  • Residents will demonstrate active pursuit of self-learning/improvement and of scholarly activities.
  • Residents will demonstrate the ability to teach and communicate knowledge effectively to others and create a nurturing atmosphere for learning.
  • Based on a more sophisticated understanding of the system, residents will identify and help to improve limitations in their work environment.
  • By refining time-management skills, residents will demonstrate efficiency and effectiveness in the care of hospitalized and ambulatory patients.

Seniors - PGY 3 Year

PGY-3 resident will further refine their patient care, supervisory, and teaching skills.  They will continue to expand their medical knowledge base, as they apply evidence-based and cost-conscious strategies in patient care.  Under the supervision of teaching attendings, residents will develop progressive independence in their various responsibilities.  As the most senior house staff members, residents will recognize the important part they play as role models, counselors, and teachers to the more junior members of the teams.  The senior residents will also serve as consultant to other services in the hospital.

  • Residents will demonstrate the ability to be independent in initial patient assessment, triage, and development of patient care plans.
  • Residents will demonstrate the communication and interpersonal skills necessary for fostering the growth and development of the more junior residents.
  • Residents will demonstrate effectiveness and continual enthusiasm for self-learning and teaching of colleagues.
  • Residents will demonstrate sophisticated understanding of the various practice settings, maximizing the delivery of health care by recognizing the resources of the system.
  • Residents will understand their own limitations as senior residents, and know when to defer to the advice of others.
  • Residents will participate actively in quality of care assessment and improvement.
  • Residents will provide timely, professional, evidence-based, educational, and helpful consultative advice to colleagues from other services.
  • Residents will continue to vigorously pursue career development, self-education, and scholarly activities.

Rotations

General Medicine

At the heart of the residency program at Harlem Hospital are the 13 months spent on the general medicine ward service. The three 30-bed wards are staffed by five teams. Each team is composed of 2 interns, 1 junior resident and 1 attending physician. Interns and the junior resident are on call every fourth day and are responsible for the initial management of all admissions with supervision of faculty. A night float relieves residents on call of added responsibility after 9:00 PM. All new admissions are presented to the ward attending, who interviews and examines each patient the following day.

In this setting, key elements of the history, pertinent physical findings, and laboratory data are incorporated into the development of a complete differential diagnosis. Basic pathophysiology is reviewed, and a rational and cost-effective treatment plan is devised. Work rounds are held six days a week. Each patient is briefly presented by the intern in charge. The patient's problems are discussed, and a management plan is determined by the team.

Primary Care

Residency training in Internal Medicine at Harlem Hospital Center is based on practical experience. The Primary Care rotations add to the training experience and provide a way for residents to prepare in a very practical way for the practice of Primary Care Internal Medicine. The patient population includes people of all ages with a wide variety of acute and chronic illness. This offers a tremendous opportunity to learn about the evaluation and treatment of complex problems and to apply the principles of preventive medicine and health promotion in a community that stands to benefit from this more than many others. The resident who trains at Harlem Hospital is making a significant contribution to this effort.

The Primary Care rotation offers a concentrated experience in ambulatory care in a continuity setting, as well as special emphasis on physician-patient communications, psychosocial problems, epidemiology and community health. During this rotation residents also receive special instruction in the evaluation and treatment of common problems in ophthalmology, otolaryngology, dermatology, gynecology, and orthopedics.

ICU

The ICU rotation is designed to give house staff experience in the management of patients with a constellation of acute problems. Residents learn to handle "multi-system" disease through a systematic approach, using the latest available technology under the guidance of the appropriate specialists.

Critically ill patients are cared for in the 12-bed Intensive Care Unit (ICU). Every bed is equipped with facilities for invasive monitoring and mechanical ventilation. Comprehensive nursing care is provided around the clock. A 32-bed ICU is planned as part of the ongoing hospital renovation project.

First-year residents gain hands-on experience in all of the procedures of critical care medicine, while learning the day-to-day management of cardiovascular and respiratory parameters, fluids and electrolyte balance, and metabolic support of critically ill patients. Junior residents function as teachers and co-leaders of the ICU team. Senior residents are responsible for evaluating patients for admission to the ICU and, in conjunction with the attending staff, for all major patient management decisions. A Pulmonary Medicine Fellow supervises work-rounds. Rounds with the Medical Director of the Intensive Care Unit or an attending physician for the pulmonary/critical care division are made every day.

CCU

The Coronary Care Unit provides interns and residents intensive experience in managing patients with a variety of critical cardiac disorders. Each of the 6 CCU beds is equipped with facilities for Swan-Ganz and intra-arterial pressure monitoring. The cardiac catheterization suite, the echocardiography, exercise testing laboratories, and the cardiology conference rooms are adjacent to the CCU.

Attending rounds are held six mornings a week. Housestaff members are given ample opportunity to master the technique of Swan-Ganz catheter and intra-arterial line placement and interpretation. They may also participate in other procedures, such as pericardiocentesis and pacemaker placement.

Neuro

On the neurology services, interns and residents work with Board Certified Neurologists caring for patients with a wide spectrum of acute and chronic neurologic problems. Weekly conferences include neuroradiology, neurosurgery, EEG, EMG review, and neuropathology.

ER

Harlem Hospital Center is a designated New York City Cardiac Care, Trauma, and Burn Center, with over 100,000 patient visits per year, the recently renovated Emergency Room of Harlem Hospital Center is one of the busiest in the country. Attending physicians certified in medicine, surgery, or emergency medicine, provide 24-hour on-site teaching and supervision, and subspecialty consultations are readily available for unusually complex medical problems.

When assigned to the Emergency Room, medical residents work one shift a day with two days off per week. Residents are encouraged to see a variety of patients, including surgical and OB/GYN cases, with appropriately qualified attending support. Physician's Assistants, registered nurses, and paramedics work closely with medical and surgical residents in a team approach to patient care. Decisions regarding the admission or referral of patients are made by residents in the Emergency Room with the agreement of the attending physicians.

Conferences

Morning Report

Morning Report is conducted between 8:00AM and 9:00AM four days a week in the 13th floor conference room. This session involves junior and senior residents who were on call the previous day/night and a pre-assigned attending. Cases admitted during the last 24 hours are discussed and usually one case is presented for a more detailed discussion of an interesting clinical finding or a diagnostic/therapeutic challenge.

The first 15 minutes of Morning Report is used for “Harrison’s Club” which is a resident-led slide presentation of a chapter from the Harrison’s Text Book of Internal Medicine.

Grand Rounds

Grand rounds are conducted at 8:00 AM in the 6th floor conference room for all residents and faculty. This conference usually features guest speakers presenting timely reviews of important clinical and research developments.

Journal Club

Journal Club is held at 11:30AM in the 13th floor Medicine Conference Room. This is presented by senior residents under the direct supervision of a pre-assigned attending. These sessions are geared towards teaching residents how to critically review the literature. Issues pertaining to study design and statistical analysis are discussed at length.

Journal club articles are distributed ahead of time to allow residents the opportunity to read the study before the presentation. This allows us to have an active discussion on the study being presented.

Morbidity and Mortality

Morbidity and Mortality Conferences are held at 8:00AM in the 6th floor conference room on the last Tuesday of every month. Mortalities from the previous month in the Department of Medicine are presented and the focus is on performance improvement and quality of care.

Clinical Case Conference

Clinical case conferences are weekly interactive conferences presented by residents under the direct supervision of one or more attendings of a recent interesting case. Cases presented usually represent diagnostic or therapeutic dilemmas or unusual medical conditions. Residents are encouraged to work directly with the attendings who were directly involved in the care of the patient.

Chief of Service

Chief of service rounds are an opportunity for small groups of residents to discuss unique cases with various faculty from the CUMC campus. These conferences are held on a biweekly basis currently.

Other

Residents are also encouraged to attend subspecialty conferences when on the respective electives or whenever their schedules permit this.