Electives
Interns in our program have elective weeks scattered throughout the year; they may choose a traditional hospital-based elective or they can choose a special "mentorship" week. A mentorship week pairs an intern with a faculty member in the intern's field of interest; the intern attends clinics, meetings, lab time, and sees inpatients with the faculty member.
Junior and Senior Residents have 1-3 week electives evenly spaced throughout the year in our ACES schedule. Elective options include traditional medicine specialties, clinical rotations outside of internal medicine. Almost half of each year is spent in a combination of ambulatory time, ambulatory electives, research time, and traditional electives. We have an extensive list of electives; we highlight some of the most unique possible "elective" rotations separately below.
Area of Concentration
Area of Concentration, or AOC time, is available to junior and senior residents interested in pursuing an independent project in basic science or clinical research, medical education, health policy, quality improvement, or hospitalist or primary care medicine. Interested residents apply for AOC time in the preceding academic year and can request up to 9 weeks of dedicated time for their project. During an AOC experience, residents continue to see patients in their continuity clinics but time is otherwise dedicated to their AOC project. International Health experiences can also be pursued during AOC time (link the International Health section). Residents typically work closely with a mentor from Beth Israel Deaconess Medical Center, the Dana Farber Cancer Institute, the Harvard Clinical Research Institute, or the Boston VA Healthcare System, depending on their area of interest. In the past, residents have had great success transitioning their AOC work into subsequent publications. At the end of the year, all residents participating in AOC present their work at a resident research night, which is open to all Beth Israel Deaconess housestaff and faculty. A list of titles of resident research projects for the 2007-2008 academic year can be found here.
Each year a group of junior and senior residents travel to the beautiful Maine coastline for a 1-week basic science immersion experience in comparative physiology. The goals of the course are to increase appreciation for physiology and enhance residents' routine incorporation of pathophysiology into their teaching and clinical roles on the general medical ward and ICU rotations. The course, held at Mount Desert Island Biologic Laboratories, is comprised of multiple modules (for example, water metabolism, NaCl excretion, hematology/coagulation, cardiovascular physiology), each with basic science experiments utilizing aquatic species, and accompanied by clinical correlation discussions. After each module, residents present their findings to one another, with specific aims for subsequent groups to investigate. Beyond the laboratory experience, residents are encouraged to enjoy all the Maine coastline has to offer including, hiking, kayaking, rock climbing, and fishing. Although exact numbers are not collected, reports suggest that copious lobsters and microbrews are consumed during off hours thanks to our gracious internal medicine training program.
Medical/Geriatrics Consult
- The goal of this rotation is to introduce internal medicine residents to key concepts in medical consultation on specialty services, preoperative management, and inpatient geriatrics. During this 3-week rotation, 2nd and 3rd year residents spend time seeing consults with both a hospitalist and a geriatrician.
- Frequent medical consults include providing pre-operative medical clearance for surgical patients, providing medical clearance prior to ECT for psychiatric patients, providing guidance for specific medical issues for patients on another service, as well as serving as the triage point for non-medical services requesting a transfer to the internal medicine service.
- Residents also spend time in weekly didactics and teaching rounds which cover topics such as 1) cardiac preoperative clearance; 2) Pulmonary preoperative clearance; 3) clearance for ECT; 4) VTE prophylaxis; 5) role of beta blockers; 6) prevention of iatrogenic complications in the elderly; 7) pain management in the elderly; 8) evaluation and management of delirium.
- Once per week residents rotate through the anesthesia pre-operative clinic.
- The hours are generally 7:30 am until 5:00 pm, Monday through Friday with weekends and holidays off.
- The medical consult service is covered by the MERIT resident during off-hours and weekends.
Palliative Care
The palliative care rotation is a unique opportunity to learn how to care for patients and families facing end-of-life decisions in a multidisciplinary setting. You work closely on this inpatient consult service with 3 palliative care attendings, each with a unique clinical focus and expertise. Dr.Mary Buss is dually boarded in oncology and palliative care with a particular interest in the management of delirium. Dr Cindy Lien is both a hospitalist and a palliative care physician who has put forth effort in educating housestaff on pain management and other end-of-life topics. Dr.Lachlan Forrow is a nationally recognized ethicist, who additionally runs the Albert Schweitzer fellowship program. You also observe and work closely with Julie Knopp, a nurse practitioner with years of hospice experience and Annie Banks, a social worker with extensive experience in bereavement care. Beyond working in the hospital-based consult service, you spend time at the Hospice of the Good Shepherd in Newton making home visits. Residents traditionally love this rotation and find it to be personally and professionally enriching.
Procedure Service 
The Medical Procedure Service rotation is a unique educational feature of the BIDMC training experience. The rotation was the first of its kind in medical residency training and has been featured in several medical education articles. While on this rotation, the resident's sole focus is on performing common therapeutic and diagnostic procedures such as central venous catheterizations, paracenteses, thoracenteses, lumbar punctures, and arthrocenteses. Similar to calling a consult, the general medical ward teams page the procedure resident requesting one of these procedures. The procedure resident is then responsible for obtaining informed consent from the patient and reviewing the indications, contraindications, risks, benefits, and alternatives to the procedure. Members of the Department of Medicine's Hospitalist group or members of the Division of Interventional Pulmonology provide education and supervision for all procedures. In addition, the procedure resident has the opportunity to assist with elective cardioversions and right heart catheterizations with the Division of Cardiology. While the Procedure Service is extremely valuable in helping to offload the busy schedules of the medical ward teams, the greatest benefit is having the procedure resident perform a large number of procedures under the guidance of an expert faculty member who provides the education, supervision and feedback needed to safely and effectively perform these procedures.
In addition to the Procedure Service, other opportunities for procedural training are available in our Simulation Center. Here, interns and residents are able to practice placing central lines on mannequins, and also practice mock "CODE" situations in a controlled environment. These sessions are videotaped to allow housestaff to later watch their performance and obtain feedback from participating faculty. Prior to their first ICU rotation, every intern participates in a formal central line simulation training session in the Simulation Center.
Senior Teacher
Resident-as-Teacher Rotation: Senior residents choose to do a one to three-week rotation which involves a mix of outpatient and inpatient teaching. They have a syllabus of readings and are evaluated after direct observation of their teaching skills in multiple settings. Their teaching responsibilities include:
- Providing didactic sessions for 3rd and 4th year medical students rotating on the inpatient services.
- Leading weekly bedside physical diagnosis rounds for all medical students.
- Observing and providing feedback of clinical skills examinations for subinterns.
- Leading one intern report, under the supervision and mentorship of the Chief Residents.
- Precepting interns in continuity clinic, under the supervision and mentorship of the Program Director and other faculty.
Stoneman Quality Improvement Elective
Residents rotate through the Stoneman Quality Improvement elective during one of their ambulatory blocks; this rotation is required of all graduating BIDMC housestaff. The elective allows residents to participate in ongoing quality improvement activities within BIDMC. Residents work with a preceptor as well as Patient Safety Core Faculty members to learn basics of quality improvement and how quality improvement is achieved in our own hospital.
Over the three-week elective, residents complete a didactic series on adverse event investigation, performance improvement, and an introduction to quality at BIDMC. There are opportunities to attend meetings regarding patient safety and quality throughout the hospital. The residents work together on a project aimed at quality improvement; recent projects have addressed Emergency Department to Medicine sign out and correct application of previously accepted criteria for admission of patients to the Orthopedics service. Residents work with a Patient Safety Core Faculty member to learn the basics of patient safety and the process of quality improvement at our medical center.
VA Primary Care Chief
As BIDMC is one of three affiliates of the West Roxbury VA, each year four Senior Residents have the opportunity to act as the VA Primary Care Chief Medical Resident.
This 6 week elective provides a unique opportunity to concentrate on teaching outpatient medicine. Residents lead ambulatory conferences for a mix of housestaff from BIDMC, Brigham & Women's Hospital, and Boston Medical Center.
Teaching responsibilities include leading morning report, and teaching sessions for interns and medical students, along with facilitating the Morbidity and Mortality and Medical Forum conferences. Given the minimal administrative responsibilities, as compared to the traditional Chief Resident role, this rotation provides a unique opportunity to act as a peer and mentor for interns and junior residents rotating at the VA.
Best of all, the Chief Resident acts as the “Grillmaster” for the weekly BBQ during the summer months!
Subspecialties
Subspecialties
Subspecialties
In addition to the electives above, residents and interns at BIDMC have the opportunity to join the inpatient consult services for the following subspecialities:
Medical Specialties (mixed inpatient/outpatient):
- Allergy (combined with ENT)
- Cardiology
- Endocrinology
- Electrophysiology
- Hematology & Oncology
- Gastroenterology
- Geriatrics
- Infectious Disease
- Hepatology
- Neurology
- Palliative Care
- Pulmonology
- Nephrology
- Rheumatology (combined with orthopedics)
- Sleep
Primary Care Electives:
- Adolescent Medicine
- Behavioral Medicine
- Dermatology
- General Medicine Consults
- Healthcare for the Homeless
- Occupational Medicine
- Ophthalmology
- Planned Parenthood
- Private Practice
- Rural Medicine
- Urology
- Women's Health
