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Program Structure

First-year residents spend the majority of the year providing primary care for Internal Medicine patients admitted to one of the geographic medical units. Residents also gain critical care training in the Medical Intensive Care Unit, ambulatory care experience in block outpatient rotations, and acute experience in the Emergency Department. There are opportunities to care for patients in underserved areas. For more information:

First Year

9-10 inpatient months

Typical PGY-1 Schedule (combination of 13 modules)
  • Cardiology Teaching Service: 0-1 module
  • Consult/Outpatient Clinic: 2-3 modules
  • Emergency Department: 0-1 module
  • General Medicine Teaching Services (Kimball, Tucker): 3 modules
  • GI/Hepatology Service (Green): 0-1 module
  • Hematology/Oncology Service: 0-1 module
  • Longitudinal Continuity Clinic 1 module in addition to one ½ day per week
  • Medical Intensive Care Unit: 1-2 modules
  • Neurology: 0-1 module
  • Nephrology Inpatient Service: 0-1 module
  • Palliative Medicine: 0-1 module
  • Vacation: 1 module, includes a float week
Second Year

6-7 inpatient months

Typical PGY-2 Schedule (combination of 13 modules)
  • Consult Services: 3-4 modules
  • Coronary Intensive Care Unit: 1 module
  • Emergency Department: 0-1 module
  • Longitudinal Continuity Clinic: 2 week block every 3 months
  • Medical Intensive Care Unit: 0-1 module
  • Medicine Night Float: 0-1 module
  • Nephrology Night Float: 0-1 module
  • Outpatient Clinics/Research Elective: 2 modules
  • Supervisor Subspecialty and/or General Medicine Services: 3-4 modules
  • Vacation: 1 module, includes a float week
Third Year

- 5-6 inpatient months

Typical PGY-3 Schedule (combination of 13 modules)
  • Attendance at CCF I.M. Board Review Course in June (1 week)
  • Clinics, Consults, Electives or Research: 4-6 modules
  • Medicine Night Float: 0-1 module
  • Longitudinal Continuity Clinic: 2 week block every 3 months
  • Medical Intensive Care Unit: 1-2 modules
  • Nephrology Night Float: 0-1 module
  • Supervisor Subspecialty and/or General Medicine Services: 2-3 modules
  • Supervisor Medical Intensive Care Unit: 1-2 modules
  • Vacation: 1 module, includes a float week
Program Structure

Click on the thumbnail to view a larger image.

Longitudinal Continuity Clinic

All categorical residents are responsible for ambulatory outpatient clinic either for 2-week blocks every 3 months or on half a day per week throughout the three years of training. Residents have clinic either at the Cleveland Clinic main campus or at a Cleveland Clinic Family Health and Surgical Center. These Family Health and Surgical Centers are located throughout the greater Cleveland area and make up the Division of Regional Medical Practice. These Family Health and Surgical Centers provide an excellent setting in which to experience the delivery of primary care to the community.

IM Residency Requirements
  • Emergency Department - at least 1 month during 3 years, no more than 3 months
  • Gastroenterology Hospital - at least 1 month
  • General Medicine Consults - 1 month
  • General Internal Medicine Ambulatory (at LCC) - at least 1 month
  • Geriatrics
  • Infectious Disease Consult - at least 1 month
  • Intensive Care Unit - at least 3 months during 3 y ears, no more than 6 months
    • Critical Intensive Care Unit
    • Medical Intensive Care Unit Jr. and Medical Intensive Care Unit Sr.
    • Nephrology (clinic, consult, hospital) - at least 1 month
    • Neurology
    • Night Float - at least 1 month
    • Pulmonary Clinic/Consult - at least 1 month
    • Rheumatology - at least 1 month

Hospital Medicine is a growing and dynamic field of Internal Medicine. Expertise in inpatient medicine includes efficiency of care for hospitalized patients, broad-based knowledge in the management of acute medical conditions, and the ability to manage and succeed in a team environment to improve patient care. 

In order to meet these goals, the Internal Medicine Residency Program offers an Inpatient or Hospital Medicine Track to give this increased focus to your training. As an adjunct to the Categorical medicine training, you will have a dedicated 2 month Inpatient Medicine block in both your second and third years (similar to the structure of the Primary Care Track). You will be exposed to concepts of quality and patient safety, care transitions, risk management, infection control, and effective consultative practice. You will also be exposed to concepts of  leadership training and be introduced to medical business practices. 

This track is designed for residents who are interested in Hospital Medicine careers as well as those who plan fellowship training (particularly fellowships with a strong inpatient focus).

The clinical Hospital Medicine rotation will include one-to-one mentorship with a Hospitalist, following a Hospitalist work schedule.  These rotations are done at Fairview Hospital, Hillcrest Hospital, or Medina Hospital, three excellent community hospitals in the Cleveland Clinic Health System.  These experiences provide a unique opportunity to learn and practice Medicine in these community settings.  Residents will learn clinical medicine, transitions of care, and compare the various hospital systems of care.  In addition, patients in the community hospital setting often present with more “bread and butter” medical conditions, compared to many patients seen at the Main Campus tertiary care center who are admitted with more complex situations.

The non-clinical portion of the track is comprised of a variety of educational programs and sessions.  Problem Based Learning (PBL)cases are used to guide learning about several areas of systems based practice. These sessions are supplemented with directed seminars about topics important to the practice of inpatient medicine.  HMT residents spend time learning the basic concepts of Quality Improvement and Patient Safety; this experience includes the opportunity to interact with leaders in the Cleveland Clinic’s Quality and Patient Safety Institute as wells as the designing a QI/PS project.  HMT residents also learn the fundamentals of perioperative medicine through a dedicated curriculum of case-based, didactic, and clinical experiences.  A graduated experience is provided to residents in the second year of the track to build on knowledge and skills learned during the first year.

Program Details

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. The Hospital Medicine track is designed to help physicians become effective agents of change in the complex hospital environment by training them to be leaders in coordinating and participating in the assessment, development and implementation of system improvements. Residents will also become proficient in the care of complex hospitalized patients.

  • Increased experience in both consultative general medicine and perioperative assessment and care.
  • Palliative medicine experience.
  • Dedicated experience in hospital system-based competencies such as patient safety, quality improvement, and risk management.
  • Dedicated experience in leadership skills including team approaches, multi-disciplinary care, management practices, and professionalism.
  • Exclusive one-on-one time spent with experienced academic hospitalists. 
First Year

Introduction

Residents will choose to enter the Hospital Medicine Track during their PGY-1 year. General part of the Hospital Medicine Track include Palliative Medicine experience, General Internal Medicine Consults, Emergency Department experience, and a 2 module Hospital Medicine block in both PGY-2 and PGY-3 years.

Typical PGY-1 Schedule (combination of 13 modules)

  • Cardiology Teaching Service: 1 module
  • Consult/Outpatient Clinic including Longitudinal Clinic Block: 3 modules
  • Coronary Intensive Care Unit: 0 – 1 module
  • Emergency Department: 0 – 1 module
  • General Medicine Teaching Services (Kimball, Tucker): 1 – 3 modules
  • GI/Hepatology Service (Green): 0 – 1 module
  • Hematology/Oncology Service: 1 module
  • Longitudinal Continuity Clinic (1/2 day per week; clinics for Primary Care Track residents vary in frequency)
  • Medical Intensive Care Unit: 0 – 1 module
  • Nephrology: 0 – 1 module
  • Neurology (or in GL-2 year): 0 – 1 module
  • Palliative Medicine: 0-1module
  • Psychiatry: 0 – 1 module
  • Vacation: 1 module, includes a float week 
Second Year

Second-year residents act as supervising residents for three or four modules, including one module on a General Medicine Service and one module as a Night Float. Second-year residents rotate on subspecialty and general medicine consult services, gaining expertise in consultative medicine. Junior residents work one module in either the Coronary or Medical Intensive Care Unit, under the supervision of a senior resident, subspecialty fellows, and a full-time intensivist. Second-year Hospital Medicine Track residents may have Palliative Medicine ward service and/or General Internal Medicine consult service if not performed during their PGY-1 year. Second-year Hospital Medicine Track residents have a dedicated block of 2 consecutive modules during which includes introduction to the system-based concepts of Hospital Medicine.  Approximately one-half of the block will be spent working one on one with a Hospitalist at the community hospital, and the other portions will be spent in other educational activities or seminars as described above.

Typical PGY-2 Schedule (13 modules)

  • Supervisor Subspecialty and/or General Medicine Services (3-4 modules)
  • Coronary Intensive Care Unit (0-1 module)
  • Medical Intensive Care Unit (0-1 module)
  • Consult Services (3-4 modules)
  • Neurology (or as a PGY-1) (0-1 module)
  • Outpatient Clinic or Research Elective (1 module)
  • Night Float (NFT) (0-1 module)
  • Longitudinal Care Clinic (1/2 day per week)
  • Vacation (1 module)
  • Hospital Medicine Track Block (2 modules)
  • GIM Consults and Palliative Medicine (0-2 modules)
Third Year

Third-year residents act as supervising residents for five modules, including two to three modules on General Medicine Services and one module as a Night Float. Senior residents act as supervisors for one module in the Medical Intensive Care Unit. Third-year residents work one module in the Emergency Department. Third-year Hospital Medicine Track residents will spend 2 modules in the Hospital Medicine  Block which expands on systems-based concepts of Hospital Medicine learned during the second year, and builds on leadership, business practice, and medical-legal experiences from the second year.   About one third of this time is spent in the clinical setting at the community hospitals or in perioperative medicine settings.

Typical PGY-3 Schedule (13 modules)

  • Supervisor General Medicines Services (2-3 modules)
  • Supervise Green Team (0-1 module)
  • Supervise Medical Intensive Care Unit (1-2 modules)
  • Clinics, Consults, Electives or Research (3 modules)
  • Night Float (0-1 module)
  • Longitudinal Care Clinic (1/2 day per week)
  • Attendance at CCF I.M. Board Review Course in June (1 week)
  • Vacation (1 module)
  • ED (1 module)
  • Hospital Medicine Block (2 modules)
  • GIM Consults (0-1)

Longitudinal Continuity Clinic

All residents in the Hospitalist Track are responsible for ambulatory outpatient clinic half a day per week throughout the three years of training. Residents have clinic either at the Cleveland Clinic main campus or at a Cleveland Clinic Family Health and Surgical Center. These Family Health and Surgical Centers are located throughout the greater Cleveland area and make up the Division of Regional Medical Practice. These Family Health and Surgical Centers provide an excellent setting in which to experience the delivery of primary care to the community.

Lakshmi Khatri, MD

Lakshmi Khatri, MD
Director, Primary Care Track
Associate Program Director
Email: khatril@ccf.org

Internal Medicine Residency Program Primary Care Track

In addition to the Cleveland Clinic’s three-year Internal Medicine Categorical Residency Training Program, we also offer a three-year Primary Care Track Program.

Learn more about this program.

Each year consists of 13 modules, each 4 weeks long.

The primary care track is designed for physicians who wish to prepare themselves for the practice of general internal medicine, in both the inpatient and outpatient settings.

The primary care track curriculum includes the following:

  • Additional outpatient medicine rotations, particularly in Geriatrics, Palliative Medicine, and primary care.
  • Additional experience in the traditional non-Internal Medicine areas of Psychiatry, Dermatology, Otolaryngology, Gynecology, and Orthopedics.
  • One module in the office of a practicing physician outside the Cleveland Clinic to gain experience in office management and community based practice.
  • Longitudinal care practices one to two half-days per week supervised by members of the Department of Internal Medicine.
  • Primary Care Block rotation which includes extended time in the Longitudinal Care Clinic, seminars on topics and procedures relevant to primary care, and the opportunity to care for patients in underserved areas.
  • Residents spend 60% of their time on inpatient services and 40% in outpatient clinics.
First Year

First-year residents typically work as part of a health care team which includes a supervising second or third-year resident, an attending physician, and medical students. First-year residents spend the majority of the year providing primary care for Internal Medicine patients admitted to one of the geographic medical units. Residents gain critical care experience in the Coronary or Medical Intensive Care Unit, ambulatory care experience in block outpatient rotations, and experience in the Emergency Department. Primary Care Track residents also have one module dedicated as a Primary Care Block in the first year.

First-year residents
Typical PGY-1 Schedule
  • Emergency Department: 1 module
  • General Medicine Services: 3 modules
  • Medical Intensive Care Unit or Critical Intensive Care Unit: 1 module
  • Outpatient Clinic: 2 modules
  • Primary Care Block: 1 module
  • Subspecialty Services: 4 modules
    • Cardiology Inpatient
    • GI/Hepatology (Green)
    • Hematology/Oncology Inpatient
    • Nephrology
    • Neurology
  • Vacation: 1 module, includes a float week
Second Year

Second-year residents act as supervising residents for four modules, including one module on a General Medicine Service and one module as a Night Float. Second-year residents rotate on subspecialty and general medicine consult services, gaining expertise in consultative medicine. Junior residents work one module in either the Coronary or Medical Intensive Care Unit, under the supervision of a senior resident, subspecialty fellows, and a full-time intensivist. Second-year Primary Care Track residents have three consecutive modules as a dedicated Primary Care Block. The primary care block includes additional geriatric lectures and experiences. Lectures include falls, urinary incontinence, advance care planning, management of glycemic control in the frail elder, and others. During the 3-month primary care block, the residents spends one half-day at Fairfax Nursing Home, an inner-city nursing home within walking distance of the Cleveland Clinic. Residents evaluate patients receiving rehabilitation, assess ability to return to the home, evaluate disease management, participate in a Quality Improvement project, and provide an “in-service” to the nursing staff on a clinic topic.

Typical PGY-2 Schedule
Second-year residents
  • Consult Services: 3-4 modules
    • General Medicine and Subspecialty
  • Medical Intensive Care Unit or Critical Intensive Care Unit: 1 module
  • Night Float Supervisor: 1 module
  • Outpatient Clinic: 1 module
  • Primary Care Block : 3 modules
  • Supervisor: 2-3 modules
    • General Medicine Service
    • Cardiology
    • Hematology/Oncology
  • Vacation: 1 module, includes a float week
Third Year
Third-year residents

Third-year residents act as supervising residents for five modules, including two to three modules on General Medicine Services and one module as a Night Float. Senior residents act as supervisors for one module in the Medical Intensive Care Unit. Third-year residents work one module in the Emergency Department. Senior residents have a three-month block dedicated as a Primary Care Block.

Typical PGY-3 Schedule
Typical PGY-3 Schedule
  • Electives: 1 module
  • Emergency Department: 1 module
  • Medical Intensive Care Unit: 1 module
  • Night Float Supervisor: 1 module
  • Primary Care Block : 3 modules
  • Psychiatry Consult/Liaison: 1 module
  • Supervisor: 3-4 modules
    • 3 General Medicine Services
    • 1 Subspecialty Service
  • Vacation: 1 module, includes a float week
Longitudinal Continuity Clinic
longitudinal clinic

Longitudinal Continuity Clinic

“During their intern year, categorical and primary care track residents engage a in a weekly half-day longitudinal clinic. In their second and third-years, residents transition to a group practice clinic model and participate in dedicated two week blocks of ambulatory clinic every three months. Clinic sites include our main campus, Stephanie Tubbs Jones Health Center or our family health centers, which are located around Greater Cleveland. All are ideal settings to experience the delivery of primary care within community.”

Preliminary residents

The year consists of 13 modules, each 4 weeks long.

Preliminary residents typically work as part of a health care team which includes a supervising second or third-year resident, an attending physician, and medical students. Preliminary residents spend the majority of the year providing primary care for Internal Medicine patients admitted to one of the geographic medical units. Preliminary residents have elective time to do non-Internal Medicine rotations such as Radiology or Pathology. Preliminary residents also rotate through the Emergency Department.


Preliminary Year 2

Typical Schedule

  • General Medicine Services: 3 modules
  • Subspecialty Services: 4 modules
    • Cardiology Inpatient
    • GI/Hepatology (Green)
    • Hematology/Oncology Inpatient
    • Nephrology
    • Neurology
  • Electives: 2 – 3 modules
  • Emergency Department: 1 module
  • Vacation: 1 module, includes a float week

Center of Excellence Track

Hosted by the VA Transforming Outpatient Care (TOPC) Program

The Louis Stokes Cleveland VA Medical Center
Center of Excellence in Primary Care Education

As a Categorical Resident, you have the option to participate in the Center of Excellence Track. 

This track is designed for physicians with an interest in health care systems, quality improvement, patient safety, and interprofessional collaboration.

During your residency, your schedule will include four outpatient blocks.  During the outpatient blocks, you will see patients in a primary care setting at the Cleveland Louis-Stokes Veterans Administration.  You will be paired with one other Center of Excellence resident, and together you will share a panel of patients.  This unique opportunity provides a great deal of autonomy and unrivaled continuity.  Skills and training obtained as a participant in this track will be applicable to all physicians, whether planning further specialty training or a career in primary care.

The Center of Excellence curriculum includes the following:

  • Creation and implementation of Quality Improvement and Patient Safety Projects
  • Yellow belt certification in Lean Six Sigma process improvement training
  • Subspecialty rotations in geriatrics, outpatient procedures, urgent care, and women’s health
  • Subspecialty blocks in the area of your choice at the VA or Cleveland Clinic.
  • Bioethics and health care humanities

 First Year: One Block 
 Second Year: Two Blocks
 Third Year: One Block

Background: In January 2011, the Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC) received a five million dollar federal grant to offer physician learners a novel and visionary approach to healthcare in the 21st century. In collaboration with the Cleveland Clinic Internal Medicine Residency Program, the Frances Payne Bolton School of Nursing, and supported by the VA Office of Academic Affiliations, the Center of Excellence will prepares caregivers to work in new models of care that demand teamwork and patient centered care. Participants will be offered novel educational opportunities to build on current strengths in the curriculum as well as acquire new skill sets.

Setting

The VA Primary Care Clinics: The outpatient clinical experience at the Cleveland VA medical center serves a diverse patient population of varying age and medical complexity with oversight by dedicated faculty who are selected on academic merit and proven commitment to clinical education. In this environment, participants manage patients in collaboration with pharmacists, psychologists, and registered nurses. Emphasis on chronic disease management is provided via traditional office visits, shared medical appointments, tele-health communication, and through utilization of locally-developed diabetes, chronic kidney disease and heart failure disease registries. The Cleveland VAMC has fully implemented the “PACT” (Patient-Aligned Care Team) model (synonymous with patient centered medical home), which provides dedicated interdisciplinary team members to enhance patient care and provider and patient satisfaction.

Curricular Components:

Training in Six Sigma and other Performance Improvement Tools: The Center of Excellence partners with faculty from the Case Weatherhead School of Management to provide the skills and tools necessary to implement quality improvement into the everyday care of patients. Residents receive training in management skills and receive yellow belt certification in Lean Six Sigma process improvement training.

Leadership in Quality Care Improvement: Residents will become competent in leading and incorporating quality measures and performance improvement into the delivery of healthcare. You will have access to chronic disease registries and will be provided various opportunities to learn how to use these tools effectively for panel and population management, and improve safety and quality at the system level.

Interdisciplinary team based care: Residents will engage in a team-based model for healthcare delivery. To facilitate this model, the VA has partnered with CCF and the Frances Payne Bolton School of Nursing to support the integration of the education of medical residents and nurse practitioner students. As members of a PACT team, residents and nurse practitioners will work collaboratively with RNs, LPNs, social workers, pharm-Ds, health psychologists, as well as dedicated administrative support for a specified panel of patients. The goal of this model is to provide comprehensive patient care while enhancing provider and nursing staff satisfaction.

Proactive Care: Residents will learn motivational interviewing via collaboration with our behavioral health specialists.  The will also be teaching patients self-management skills (via collaboration with the Frances Payne Bolton School of Nursing’s NIH funded Self-Management Advancement through Research and Translation Center).

Real time real patient feedback: Residents will be provided unique opportunities to obtain real-time feedback from selected patients to understand the patient experience along the entire continuum of healthcare as patients experience it. Also, video of patient encounters will be reviewed and critiqued by select staff, in order to improve upon patient care skills.

Humanities in Healthcare: Residents will engage in a Narrative Healthcare Course, which includes pre-designated reading assignments of relevant popular press and movies. Discussion of these selections will occur at regular meetings led by members of the Department of Bioethics and Case Western Reserve University. Additionally, the VA has partnered with the Cleveland Museum of Art to develop an Art in Healthcare curriculum as well as with the Allen Memorial Art Library to provide a historical perspective to the practice of Medicine and Nursing.  Residents participate in live session at theh Cleveland Museum of Art as a portion of their training in humanities in health care.