Medical Education
The Educational Mission: Nurturing the Physicians of Tomorrow
The Department of Medicine plays an essential role in the School of Medicine’s education and training programs at all levels, with thousands of DOM faculty hours devoted to teaching and mentoring medical students, residents and fellows. In addition, many faculty members serve in leadership roles and on a variety of teaching and curriculum committees in the School of Medicine. They contribute to UVA’s Continuing Medical Education programs as well, providing content and leadership for many CME-sponsored courses and conferences.
Medicine Clerkships
NxGen classroom-in-the-round
The medicine clerkship is designed to provide medical students with a basic fund of knowledge about common clinical problems and disease states encountered in the practice of inpatient and outpatient internal medicine. They learn to apply that knowledge in a wide variety of settings, developing the analytical and clinical skills necessary for the practice of evidence-based, cost-effective medicine. They gain experience in the use of consultants, the coordination of ancillary healthcare services, and the critical assessment of medical information, among many other areas. For the 2013-14 academic year, the medicine clerkship received a grade of “A” from the Mullholland Society, the UVA medical student organization that each year produces the Mulholland Clerkship Report.
Internal Medicine Residencies
The Department’s Internal Medicine residency program consistently attracts outstanding candidates from across the country. It provides a balance of hands-on patient care and cutting-edge research opportunities, with faculty who highly value their roles as mentors and teachers. The program is resident-centered and unequivocally resident-run – as evidenced by innovations such as the night float system and the current service structures that were designed and implemented by residents. The aim of the program is to guide residents in developing their individual interests and strengths, while building up their knowledge base and core clinical skills. To this end, a variety of training tracks are offered:
- Categorical: The traditional track emphasizing training in general internal medicine, with a focus on subspecialty and hospital-based practice.
- Primary Care: Designed for individuals wanting a career in general internal medicine (in either academic or clinical practice). Primary care residents spend an increasing proportion of time over their three years in the ambulatory setting, designing elective experiences to meet their training needs and interests.
- Preliminary: A one-year program that allows individuals to gain a broad experience in internal medicine before continuing in other medical disciplines. Includes inpatient rotations on the General Medicine services, Medical Intensive Care Unit, Coronary Care Unit, Hematology-Oncology, and Digestive Health.
- ABIM (American Board of Internal Medicine) Research Pathway: For individuals with extensive research interests and academic subspecialty career goals, this pathway consists of two years of training in the categorical track followed by one or more years of clinical training in a subspecialty, and at least five years of research training. It is offered in the subspecialties of cardiovascular disease; endocrinology, diabetes & metabolism; infectious diseases; and nephrology.
Over the last five years, approximately 75% of residency graduates have gone on to subspecialty fellowships, while the remainder have pursued careers in general internal medicine. Of those, more than half are working as hospitalists; another 45% work in outpatient primary care settings.
Of graduating residents who pursue subspecialty fellowships, the highest proportion are in cardiology and gastroenterology (about 27% each), followed by hematology-oncology (12%), infectious diseases (10%), and pulmonary-critical care (9%), as shown in the pie chart.
For the 2014 match season, over 2700 applications Electronic Residency Application Service files were received—an 11% increase over the previous year—and more than 1,000 were screened. It was one of the most successful matches in recent years, for the categorical, primary care, and preliminary tracks; the match cohort had impressive scores and excellent geographic distribution.
Chief residents for the 2013-14 academic year were Clayton Allen, Justin Gomez, Kate McManus, and Andrew Shaw. For 2014-15, chief residents are Michael Devitt, Trish Gordon, Elizabeth McKinney, Brad Weinbaum.
Transition to Firm System and 3+1 Scheduling System
A major undertaking in FY 2014 was the reorganization of the resident training program, including the implementation of a “firm” system and the transition to a 3+1 scheduling model (three blocks of inpatient rotations alternating with a dedicated block in the outpatient setting). The changes are intended to enhance both the quality of patient care and the overall educational experience for residents.
The firm system helps create better group cohesion among groups of residents, with a stronger sense of community and accountability and more consistent clinical care. Firm leaders, drawn from Department of Medicine faculty, are responsible for providing overall direction and maintaining high standards of teaching and clinical care. The four firms—named for illustrious Department of Medicine faculty from its 100-plus-year history—and their leaders are:
- Atuk Firm: Jennifer Kirby, MD (Division of Endocrinology and Metabolism)
- Beckwith Firm: Benjamin Sneed, MD (Division of General Medicine, Hospital Medicine section)
- Hook Firm: Joshua Eby, MD (Division of Infectious Diseases & International Health)
- Wheby Firm: Brian Uthlaut, MD (Division of General Medicine)
The 3+1 scheduling plan was mapped out by a team that included the 2014-15 chief residents, Vice Chair for Education Gerald Donowitz, key clinical faculty, and education program administrators; it became operational on July 1, 2014. One important goal of the transition was to maintain the values and characteristics that distinguish UVA’s program: resident-designed training, a 1:1 resident-intern inpatient team, a curriculum customized to the needs of each resident, and maintenance of a healthy work/life balance.
Subspecialty Fellowships
In the 2013-2014 academic year, 79 clinical fellows and 10 postdoctoral research fellows were enrolled in 11 ACGME-accredited subspecialty programs, and 5 sub-subspecialty programs, including:
- Allergy & Immunology
- Cardiology:
- cardiovascular disease
- cardiovascular imaging
- clinical cardiac electrophysiology
- interventional cardiology
- heart failure
- Endocrinology, Diabetes & Metabolism
- Gastroenterology & Hepatology
- Geriatric Medicine
- Hematology and Oncology
- Hospice and Palliative Medicine
- Infectious Diseases
- Nephrology
- Pulmonary Disease and Critical Care Medicine
- Rheumatology
During FY 2014, DOM fellows and residents produced an impressive 62 publications in peer-reviewed journals. The annual Carey-Marshall-Thorner Scholars and Research Day, held each May, provides a forum for fellows, residents, and faculty mentors to present their research, cultivate collaborative relationships, and celebrate the breadth and depth of scholarly exploration in the department. Associated events include Grand Rounds, oral presentations by trainees and new faculty members, a poster session open to all, an awards ceremony, and reception. This year’s awardees are listed in the sidebar.
Education Administration
During FY 2014, Director of Education Joy Hilton and Senior Residency Coordinator Terry Bennett developed milestones for those serving in education-related administrative roles at the division level. The milestones, modeled after the ACGME’s six competencies for physicians from its “Next Accreditation System,” will be used to mark an administrator’s progress, from novice to seasoned professional. The six competencies are:
- Personal care
- Medical education knowledge
- Professionalism
- Interpersonal and communication skills
- Practice-based learning and improvement
- Systems-based practice
Hilton and Bennett presented the group’s project at a national conference in spring 2014.