About the Program

Our Internal Medicine residency program is a three-year training program that consists of 45 house officers and two chief residents. Our program is ACGME- and ABIM-certified as a categorical and preliminary residency program.

Our residents play a significant role in shaping the curriculum and the program. Regular resident feedback sessions (“town halls”) with the program director ensure we are meeting the educational and professional needs of our house staff. This core curriculum, combined with conferences, ensures that our residents obtain a thorough knowledge of internal medicine principles. Residents also take an active role in the annual program review.

Two hospitals serve as the principal education centers for both inpatient and outpatient clinical experiences – the Nashville General Hospital at Meharry (NGH, an urban charity facility) and the Department of Veteran Administration Tennessee Valley Healthcare System, Alvin C. York Campus (VA). The residents spend approximately 50% of their time at each facility over the course of their training. Both facilities offer training by Board certified internists and specialists. General medical floor and intensive care unit experiences are available at NGH and general medicine floor at the VA. Additional training opportunities in the medical subspecialties are available at both facilities and at Tennessee Valley Healthcare System-Nashville. Inpatient rotations are also done at The James H. Quillen VA Healthcare System at Mountain Home in Johnson City and Methodist Le Bonheur Hospital in Memphis.

The Internal Medicine residency program is closely associated with the Meharry Medical College School of Medicine. Our residents are expected to supervise and teach third- and fourth-year medical students during their Internal Medicine rotations. The school’s resources, such as an extensive digital medical library and computer system, are available to all of our residents 24 hours a day.

The Department of Internal Medicine has strengthened its commitment to performing high-quality research with an emphasis on improving the care of minority patients. Each categorical resident is required to do a research project with minimum progress requirements for each year. This renewed focus on research should allow us to cultivate among our residents an interest in careers in academia and life-long learning.

Meharry Medical College’s Internal Medicine program offers a nurturing setting for our residents to be exposed to a broad range of patients at all stages of their illness in both an outpatient and inpatient setting while participating in a stimulating academic environment.

The residency program is designed to help develop a fully rounded internist. Our objectives include, but are not limited to, development of the following:

• Ability to generate a complete and accurate differential diagnosis list;
• Ability to write proper histories, progress notes and discharge summaries;
• Skills in the management of complex disease;
• Familiarity with all phases of a patient’s care from continuity clinic to the ED to ward teams to the MICU/CCU;
• Ability to perform—and teach—a wide variety of procedures without assistance;
• Ability to work as a leader of the health care team;
• Ability to manage patients in both the inpatient and outpatient settings;
• Ability to recognize need for higher level of care (e.g. admission from clinic or transfer of patients from floor to ICU); and
• Ability to pass the ABIM Boards through an integrated series of review sessions and core lectures

Note: A passing score on USMLE Step 3 is a requirement for promotion to PGY-2 level.

Eligibility & Requirements

Interviews are required and are by invitation only from the program. Interviews will not be offered until all requirements are met and all documents received. Interviews last until midafternoon and include attendance at morning report and noon conference and a tour of Nashville General Hospital where applicants can freely and privately discuss the residency with a current resident.

Resident Responsibilities

PGY-1 (Internship)

PGY-1 residents, otherwise known as interns, have the following major responsibilities:

• Initial evaluation of all patients, including assimilation of old records and outside information
• Developing a plan for each patient to present to the resident
• Communicating with the patient and family about treatment plans, consultations, risks and benefits of procedures and medications, and other aspects of care
• Doing write-ups on charts
• Discussion of “Do-Not-Resuscitate (DNR)” orders and other end-of-life issues when appropriate
• Asking surviving family members for permission to perform an autopsy
• Working on discharge planning from day one
• Writing daily progress notes
• Interns are expected to attend all daily attending rounds (except when off duty), morning report, Grand Rounds, and all other teaching conferences. Interns work closely with medical students and assist with their education.

The PGY-1 year is organized to ensure a comprehensive clinical experience in a variety of settings. The intern “learns by doing” and must be kept at the forefront of patient evaluation and therapeutic decision making if he or she is to develop the confidence and proficiency upon which sound clinical judgment is based. The teams provide the intern with individualized supervision and the resident with time for study, case management, and teaching.

PGY-2, PGY-3 (Residency)

The primary roles of the PGY-2 and 3 residents are supervision and education. This includes:

• Seeing every patient on the day of admission and writing a note
• Reviewing and approve diagnostic and treatment plans with the interns
• Reviewing patients’ progress daily, giving feedback to the intern on progress notes, order writing, and discharge planning
• Organizing and planning attending rounds, meetings with consultants, and other teaching opportunities
• Setting time aside for teaching medical students, including reviewing write-ups and giving timely feedback
• Creating an atmosphere such that the intern is encouraged to ask for help when appropriate
• Supervising procedures
• Dictating discharge summaries
• Interacting with nurses and other personnel in a way that respects all members of the healthcare team and encourages their input
• Being certain all members of the team are familiar with the current literature regarding their patients
• Attending teaching conferences including Grand Rounds, Morning Report, Noon Conference, and Journal Club

The upper-level resident is responsible for all aspects of patients’ care. As such, this resident is ultimately responsible for requesting consultations and interacting with consultants, for keeping the attending fully informed of changes in status, and for overall supervision of the intern(s) and student(s).

Rotation Curriculum

PGY-1 Residents:

• General Medicine—24 to 26 weeks
• Electives (including multispecialty block rotation)—6 to 9 weeks
• Continuity Clinic – 13 weeks
• ICU—6 to 7 weeks
• Vacation—3 weeks

PGY-2 Residents:

• General Medicine—11 weeks
• Electives— 14 weeks
• Continuity Clinic – 13 weeks
• ICU—9 to 11 weeks
• Vacation—3 weeks

PGY-3 Residents:

• General Medicine—9 weeks
• Electives— 18 to 21 weeks
• Continuity Clinic – 13 weeks
• ICU— 6 to 9 weeks
• Vacation—3 weeks

Night Float/Swing Shift

• Three out of four inpatient interns have one week of night float per rotation.
• Upper levels do not have night float blocks but rather have one or two swing shift calls per month.

Inpatient Rotations

The Department of Internal Medicine operates on the thesis that the best patient care is rendered when major responsibility rests with the intern and resident under the purview of the chief resident with all having ready access to attending faculty and consultants.

Emergency Medicine Training

All residents are assigned a rotation in the Emergency Department under the supervision of full-time academic faculty in emergency medicine. This is a well-organized rotation with excellent teaching.

Continuity Clinic

All residents have continuity clinic one week per month where they see their own panel of patients.

The program strictly adheres to all ACGME mandates, including work hour restrictions. Our program operates on a 3+1 block schedule, resulting in 13 blocks annually. Direct and indirect resident supervision is available at all times by attending physicians.

Rounds and Conferences

Attending Rounds

Bedside teaching rounds are conducted on the inpatient clinical services seven days per week. The emphasis is on developing fundamental clinical skills, diagnostic reasoning, pathophysiology, and professionalism. Our department has a written policy that teaching rounds are to be conducted “at the bedside.” Emphasis is on evidence-based medicine and on creating an environment that optimizes learning and patient care.

Case Presentations

Case presentations take place once or twice per week. During case presentations, senior residents present a challenging case and focus on a particular aspect of patient management.

Grand Rounds

Medicine Grand Rounds occur Wednesdays at noon from September through May at the S.S. Kresge Learning Resource Center. Residents rotating at the Alvin C. York VA attend Grand Rounds via teleconference. During Grand Rounds, local and national speakers present clinically relevant and cutting-edge topics.

Intern Didactics

The first block of noon conferences is geared towards interns and includes introductory topics, such as CXR, EKG, and acid base disorders.

Journal Club

Journal Club occurs monthly during noon conference. One resident from each training site leads the discussion aimed at appraising one landmark research paper pertinent to the assigned block. Research appraisal is a key component of evidence-based medicine, and as such, it plays a critical role in clinical decision making.

Morning Report

Morning report takes place three times per week at both Nashville General Hospital and Alvin C. York VA. All residents at each site meet for an hour to discuss a recently admitted patient. Each case is presented by the admitting team (intern and resident). As the case unfolds, other residents engage in discussions regarding differential diagnosis, work-up, and management strategies. Morning reports are facilitated by the chief resident at each training site. The program director and faculty members also participate in the discussions.

Mortality & Morbidity

M&M happens monthly. Faculty members select a case that prompted discussion of a medical error or a near miss that impacted medical care. The goal of this conference is to identify areas for medical improvement without judgement.

Noon Conference

Noon conferences take place each weekday. The academic year is divided into 13 academic blocks. Different internal medicine sub-specialties are assigned to each block (i.e., Cardiology block). Relevant topics related to each subspecialty are discussed in the form of lectures, resident directed learning, jeopardy, journal club, virtual diagnosis and ambulatory clinic modules. In addition, during every block high-value care and research curriculum lectures are provided. Once a month, noon conference is a town hall meeting where residents discuss issues and concerns with the chief residents and program directors. Once every other month a potluck is held while playing jeopardy.