General Medicine Wards
Our four general medicine teams are composed of one PGY2/PGY3 resident, two PGY1 residents, two 3rd year student clerks, a 4th year acting intern and one hospitalist attending. The senior resident has the role of team leader under the supervision of the hospitalist attending. Education occurs during bedside teaching rounds. We utilize a 4-day call cycle that allows for duty-hour compliance and provides adequate protected time for education and procedures. The flexibility of our call schedule enables residents to schedule their days off when it best suits them. Trainees see a wide spectrum of cases involving a variety of subspecialty medicine.
Our heme/onc team features one PGY2 resident, two PGY1 residents, a 4th year medical student acting intern, a hematology/oncology fellow, and a hematology/oncology attending. The team has daily dedicated educational time to promote resident education. Daily bedside multi-displinary rounds include an oncology pharmacist, physician assistant, nurses, patients, and families.
There are two cardiology teams, each of which have one PGY2/3 resident and one PGY1 resident. Teams provide care for general cardiology, electrophysiology, and interventional cardiology patients. Daily didactics and teaching rounds are conducted by our cardiology attendings and fellows. Our residents have the opportunity to actively manage diverse patients since our institution is the sole regional STEMI center and has a busy structural interventional cardiology program as well.
The two MICU teams each consist of one PGY2/3 resident, one PGY1 resident, and a 4th year medical student acting intern. The ICU teams have two attendings to simultaneously allow for resident education while still providing appropriate care to critically ill patients. The ICU has dedicated didactic, simulation, and radiology sessions. Residents go to the Simulation Center weekly with nursing and respiratory therapy for training on acute care scenarios and Interprofessional team dynamics. The MICU is supervised by pulmonary/critical care fellows and attendings with attendings in-house 24/7. The rotation provides practical and in-depth experience with the diagnosis and management of critically ill patients. Highlights include routine use of bedside ultrasound for diagnostics and procedures in the critically ill. The ICU rotation is a classic favorite for residents!
We utilize night float systems to ensure ICU, Heme/Onc, and Medicine teams have adequate time away from clinical duties. The night float rotations are excellent opportunities for upper level residents to work autonomously, yet still have direct attending support. For residents interested in procedures, night float is an easy way to become certified in performing lumbar punctures, central lines, paracentesis, and thoracentesis. The wards night float resident evaluates patients admitted to the general wards and hematology/oncology teams. There is a dedicated night float for the MICU. There is an attending present at night for both the MICU and the wards to provide education and support during the night float rotations.
Our Emergency Department is the only Level I trauma center in Vermont and upstate New York. During the Emergency Medicine rotation, PGY1 residents manage a wide array of diverse medical conditions but also gain valuable experience with surgical, orthopedic, and gynecological disorders. Our residents make initial assessments under the supervision of a full-time Emergency Medicine faculty member, and can quickly develop greater autonomy.
All PGY2 residents rotate on the neurology inpatient service for a month to learn to diagnose and manage a variety of neurological conditions. University of Vermont Medical Center provides multidisciplinary stroke care and has been classified as a primary stroke center by the Joint Commission.
All residents rotate on the core subspecialty services of gastroenterology, infectious disease, nephrology, endocrinology, and rheumatology which include inpatient consultative and outpatient experiences. In addition, PGY3 residents have an inpatient consultative medicine rotation and a geriatrics rotation.
Residents can design their own elective rotations to meet their specific educational goals and can pursue off site or international electives. These rotations must meet the requirements of all educational rotations (goals and objectives, supervisor, evaluation) and must be approved by the GME committee at UVM Medical Center. Residents have traveled recently to Alaska, India, and Turkey on away electives.
All residents rotate through the Process Improvement and Patient Safety Course. Additional training for a certificate in Public Heath or Health Care Administration is available for residents with an interest in these areas.
The Ambulatory Clinic
The Burlington Adult Primary Care Clinic, located near the University of Vermont and University of Vermont Medical Center campuses, is the main continuity clinic site for both categorical and primary care residents. All of our residents receive an education that is steeped in innovation, passion for primary care, and the pursuit of clinical excellence. Founded in 1971 as a model internal medicine practice, it is now a National Committee for Quality Assurance (NCQA) Level 3 Patient Centered Medical Home. Our internationally known faculty have been leaders in primary care since the 1970s with the birth of the SOAP note. The goals of this practice are to provide high quality, cost-effective medical care to patients from Chittenden County and northern New York State.
During their three years of training, residents are assigned their own panel of patients from a graduating resident who they then follow for three years. The resident is identified in the electronic health record as the primary care physician and provides care under a supervising physician. During the first two years of training, residents can take new patients from the community and patients from the hospital without a primary care physician. Residents see a diverse array of patients from Chittenden County and northern New York and provide care to those with chronic diseases, provide preventive care, provide acute care and often see New-Americans, as Burlington is a refugee resettlement center. The resident clinic is co-directed by Drs. Richard Pinckney and Halle Sobel. Nancy Blow serves as the resident clinic operations director.
The ambulatory curriculum is a three-year curriculum delivered on Tuesday's mornings from 9:30-11:30. Residents are excused from patient care duties during this time. The conference is taught by a variety of academic faculty members. An active learning format is used in keeping with adult learning theory and how learners best learn. In addition, an education session occurs on Monday from 12:15 – 1 pm, the Yale Office-Based Medicine Curriculum is used to generative interactive case-based discussions. Residents have electronic access to this curriculum as well as to the Patient Education and Assessment Center Curriculum. This self-directed ambulatory curriculum covers a variety of ambulatory topics, which are updated annually, and allows the resident to work at his/her own pace to help fill in knowledge gaps or gain more expertise in a given topic. Participating in the PEAC curriculum has been tied with improved board pass rates.
There are 5 groups of residents divided in to 5 firms of 8-9 residents who represent each PGY class. The firms remain constant for 3 years, which provides for collegiality among the group. In addition, one faculty member is assigned to each firm as the firm leader. The firm leader serves as a preceptor, mentor and evaluator. The firm leader precepts regularly so as to provide resident-centered advice on how to thrive in the clinical setting. In addition, a core group of preceptors rotate through the clinic on a regular basis and are dedicated to the teaching mission as well as primary care excellence. A second continuity clinic occurs at the Veterans Administration in Burlington. Residents spend one day or two half days at the VA during their clinic week.
In addition to a robust education series, residents are also introduced to key concepts of panel management. Panel management is a proactive approach to care for patients outside of an office visit and in conjunction with the health care team. Residents devote Â½ day a week to panel management activities while they are in clinic. The residents receive detailed instructions on how to reach out to patients who have gaps in their care and are overdue for care along with an interprofessional team. Residents learn how EHR registries can be used to identify patients who are overdue for care.
Residents are taught to keep up with important changes pertinent to practice such as prescribing acute and chronic opioids to be in compliance with state laws. This allows residents to become more comfortable with the regulations involved in prescribing controlled substances.