Junior and Senior Years
Residency solidifies clinical and teaching skills by having juniors and
seniors lead medical teams. Junior residents supervise interns and students
on general medical services and in the medical and cardiac intensive care
units, which continues with increasing autonomy in the senior year. Our
culture espouses the resident as the primary leader and teacher of the
medical team, and autonomy is one of the frequently cited positive
attributes of our program.
The junior and senior years also provide more elective time to sample
subspecialty training in areas of interest. The elective opportunities are
diverse, ranging from traditional specialty rotations to primary care in
Provincetown to Healthcare for the Homeless. Tracks (e.g., global health,
clinician educator) are of course other chances to gain specific training
and experiences, and the curricula for these tracks are more intensive
during the junior and senior years.
The year is structured in a 3+3 “Alternating Call and Electives” (ACES)
model, with general medicine, specialty wards, and critical care rotations
alternating with elective, ambulatory, and nighfloat weeks.
Other rotations available in the junior and senior years are:
- Stoneman Quality Improvement elective: one of the first resident QI
rotations in the nation to teach residents QI skills, while having them
participate in meaningful projects at the hospital
- Hospital medicine elective: an experiential rotation covering the
administrative, financial, and academic aspects of hospital medicine
- Medical Consult: providing medical and pre-operative consultation on
non-medical inpatient services
- Procedures rotation: an intensive clinical exposure performing procedures
on multiple services under supervision
- Area of Concentration: protected time to work on research (basic science,
clinical, QI, or education) or other scholarly project
Teaching as a Resident
Teaching is an important privilege and responsibility of all residents; as
such, they are viewed as some of the core teachers within the Department of
Medicine. At the same time, observation of resident teaching by Firm
Chiefs, clinical attendings, and Chief Residents is a routine aspect of the
way we train residents to be better teachers. Teaching is an important
privilege and responsibility of all residents; as such, they are viewed as
some of the core teachers within the Department of Medicine. At the same
time, observation of resident teaching by Firm Chiefs, clinical attendings,
and Chief Residents is a routine aspect of the way we train residents to be
Leading inpatient medicine rounds: Residents run ward rounds, with the
attending hospitalist providing support as necessary. Medical students and
interns look to the resident as the primary decision-maker for the patients
on their service.
Leading teaching attending rounds: During every rotation on the medical
wards, each resident will lead at least one teaching session.
Small group presentations: During ambulatory weeks, residents will lead a
majority of the pre-clinic conferences, typically presenting either a
challenging ambulatory case or ambulatory-based topic. Once during
residency, each junior resident will also present an article at ambulatory
journal club to a small group of their peers.
“Senior” Teacher Rotation: Residents may choose to do the 1-2 week senior
teacher elective as junior or senior residents.
Teaching activities include:
- Weekly lectures to the 3rd year medical students rotating on the
inpatient medicine wards
- Weekly lectures to the 4th year medical students rotating on the
- Running one intern report under the mentorship of the Chief Residents
- Precepting interns in continuity clinic, under the supervision and
mentorship of the primary care faculty.
- Working with the Director of Simulation in simulation-based teaching for
students and fellow residents.
Foundations of Medical Education Course
This novel week-long medical education course is designed for residents who
want even more opportunities to become an exceptional medical educator. The
Foundations of Medical Education Course utilizes a "flipped classroom"
model to stimulate group discussions and learning on common topics such as
adult learning theory, cognitive learning theory, feedback, small group
teaching, bedside teaching, and ambulatory teaching. In addition, during
this course, residents have ample opportunity to practice these skills and
receive feedback from education leaders. Senior Talks/ Lecture: Each senior
resident presents a required 20-30 minute talk to all housestaff on a
clinical or basic science topic. A mentor helps the resident develop the
talk to a sufficient academic rigor that it could be disseminated as a
conference presentation or publication. Program leadership observes and
Preceptors in Practice of Medicine:
This is the course for pre-clinical Harvard medical students, which lays
the foundation for clinical medicine. Each year a number of our residents
participate either longitudinally or during some weeks.
Tutorial Leaders for Pathophysiology:
Residents can lead problem-based tutorials in the pathophysiology course at
HMS for first year students.
West Roxbury VA Chief Resident:
Some of our senior residents are selected each year to serve as a Primary
Care Chief Resident at the West Roxbury VA Medical Center. Duties include
administrative work, numerous teaching conferences including resident
reports, and bedside teaching. They also help precept ambulatory care
visits at the West Roxbury outpatient clinics.