Physicians Residency
Internal Medicine

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Goals
The Internal Medicine Residency at Physicians Medical Center Carraway (PMCC) is designed to train residents to become effective state-of-the-art general internists and provide them with skills necessary for primary care practice, hospitalist careers or fellowship training. The program is fully accredited by the Accreditation Council for Graduate Medical Education and offers six positions at each level of training.

The program provides a learning experience based on well-supervised patient care responsibility, exposure to academic medicine and clinical research, and an understanding of professional ethics and human behavior. Our affiliation with the University of Alabama School of Medicine in Birmingham provides our residents with the flexibility of taking some rotations at the university.

Internal medicine is changing. As health care evolves, health maintenance organizations and group practices will often define the role of internists. We feel that training in the setting of large private multispecialty group practices that are actively positioning themselves to effectively deal with the current changes in health care provides the resident with the best opportunity to develop the broad knowledge and skills necessary to succeed in this evolving environment.

The program encourages the acceptance of patient care responsibility while providing daily interaction with experienced, dedicated attending physicians, including general internists and specialists in virtually every subspecialty of internal medicine.

Since we are a relatively small program, one of our main strengths is the close working relationship and camaraderie between our attendings and residents. Our philosophy is to regard residents as colleagues, working together in a congenial and academic atmosphere, while providing our patients state of the art health care.

Inpatient Activities
The program is centered at the PMCC campus, which includes the Physicians Hospital, Norwood Clinic (NC), and other group practices physically adjacent to PMCC. General internists and subspecialists in the PMCC Department of Medicine serve as the principal teaching attendings for the program. All patients on the PMCC campus are available for teaching purposes. These patients are derived from the attending physicians' private practices, residents' continuity clinics, emergency department admissions and referrals from outside physicians. This results in exposure to a broad spectrum of clinical pathology from common general medical problems to critical care.

During the first postgraduate year, each resident spends six months on the general internal medicine teaching services, three months on internal medicine subspecialty rotations, one month each in Critical Care, Emergency Department, and a non-medicine elective rotation.

During the second and third postgraduate years, emphasis is placed on subspecialty rotations on the Physicians campus and the University of Alabama (UAB) Medical Center, while continuing to offer experience in general internal medicine as the supervising resident. Depending on their career goals, residents have the flexibility of concentrating on inpatient rotations or ambulatory rotations, including interdisciplinary non-medicine electives.

Electives include Dermatology, Adolescent Medicine, Psychiatry, GYN-Urology-STD, ENT-Ophthalmology-Allergy, Sports Medicine, Research and other fields of interest.

On each rotation, the resident works closely with other residents, medical students and the attending physician. A typical general medicine service consists of an attending, an upper-level resident, two or three first-year residents and possibly a third-year medical student. Each first-year resident is responsible for eight to 12 patients. A subspecialty service usually consists of one resident and one attending. Residents are expected to assume patient care responsibility appropriate for their level of training.

Residents actively participate in teaching medical students on general and subspecialty medicine rotations. Since PMCC does not have subspecialty fellows, residents have a greater opportunity to become proficient in a variety of procedures, including Swan-Ganz catheters, central venous lines, thoracenteses, arthrocenteses, etc.

Residents are allowed considerable flexibility in scheduling their own call, which averages every fifth night for first year residents and sixth and seventh night for upper level residents. While on call, first-year residents work closely with senior residents. At all times, general internists and medical subspecialists provide additional back-up. Morning report is held several times each week for residents and students on call.

Ambulatory Medicine
Residents at all levels of training attend the Internal Medicine Community Care Clinic each week. Each resident develops his/her own ambulatory practice and follows these patients until completion of training, having primary responsibility for their care. A clinic patient who requires hospitalization is admitted to the service to which his/her resident is assigned at the time. A full-time attending physician, based at the Community Care Clinic is present during each session to supervise and teach the residents.

In addition, residents take full-month block rotations at the Norwood Clinic, and other surrounding practice settings. These rotations are devoted to ambulatory general medicine and subspecialty care in cardiology, pulmonary medicine, and HIV. Ambulatory experiences are integrated into the Gastroenterology and Hematology-Oncology rotations. Patients with general medical and subspecialty problems are seen and managed by the resident under attending supervision. During these rotations residents have an opportunity to become proficient in ambulatory procedures such as GXTs, echocardiography, pulmonary function testing, flexible sigmoidoscopy, skin biopsies, and joint injections.

Conferences
Medical conferences are conducted daily. These include Morning Report, Medical Grand Rounds, Professor's Rounds, and Subspecialty conferences. Teaching Rounds are held at least three times a week. Journal clubs, morbidity and mortality, and research conferences are conducted monthly. All resident conferences focus on practical aspects of medical practice, professional development, quality assurance, and medical legal issues. Resident education is also enhanced by local and national meeting attendance, Medical Knowledge Self-Assessment Program subscriptions and opportunities for research. Residents have access to computers for medical database searches, research and graphic capabilities.

Evaluation
As recommended by the American Board of Internal Medicine, the clinical performance of each resident is evaluated throughout the program. Private conferences are held with each resident at six-month intervals to discuss progress and performance. The resident also evaluates his/her experiences in the program regularly.

Vacation
Each year, in addition to usual holidays, residents receive two weeks of vacation, one week off during the Christmas/New Year period, and up to five days of personal or professional leave.

Summary
The PMCC Internal Medicine residency provides ideal training in clinical and academic medicine by a faculty committed to maintaining high standards of educational quality. Graduates of our program have enjoyed highly successful professional careers in private and academic medicine.

Physicians Medical Center Carraway
Internal Medicine Residency Program
1600 Carraway Boulevard
Birmingham, Alabama 35234
(205) 502-6387
imres@pmcc.com