Clinical Curriculum

Introduction

Our program’s essential goal is to produce skilled, compassionate, and well-rounded internists who will excel in any career path. In the clinical realm, we achieve this by:

Exposing trainees to a breadth and depth of clinical experiences in general internal medicine and its subspecialties, in both inpatient and outpatient settings
Emphasizing the importance of patient-centered care with particular attention to social determinants of health and cultural influences
Fostering a positive learning environment that promotes graduated autonomy, camaraderie, diversity, and interdisciplinary collaboration
Tailoring training experiences to specific career interests and educational goals

Structure and Schedule

In your search for a residency program, you have likely come across many different scheduling strategies aimed at balancing inpatient and outpatient education. We consider our approach to be one of our greatest strengths. Every third month—for either a half-month or full-month—categorical residents rotate through our continuity clinic. Combined Med-Peds and Med-Psych residents have slightly different continuity clinic arrangements (see respective websites). The remainder of clinical scheduling includes a mixture of inpatient wards, electives, outpatient rotations, and subspecialty consults. Our unique structure ensures that residents and interns spend no more than two consecutive months on inpatient services while still providing flexibility for scheduling changes when needed. Lastly, this allows for weekends off on all outpatient, inpatient consult, elective, and night float rotations!

Inpatient Rotations

Inpatient rotations occur at three hospitals which are all located in the downtown Charleston Medical District: MUSC Main University Hospital (MUH), MUSC Ashley River Tower (ART), and the Ralph H. Johnson VA Medical Center (VAMC). A short walk will take you from the resident parking garage to each of these sites.

General medicine wards and cardiology inpatient teams are comprised of one upper-level resident and two interns. The inpatient hepatology and malignant hematology services are comprised of one upper-level resident and one intern; these teams have lower maximum patient caps and help from a subspecialty fellow as well.

Our residents receive excellent ICU training. Interns spend one month in the MICU, PGY-2 residents spend one month in MICU and one month in VA ICU, and PGY-3 residents typically spend one month in either MICU or VA ICU. Both of our ICUs operate as closed units. You can also elect to complete a rotation in the Cardiovascular ICU as an upper level.

Interns will have approximately 7 months of inpatient rotations with 3-5 of those months being general medicine wards. During the PGY-2 and PGY-3 years, residents have less time scheduled in inpatient rotations and more outpatient, consult, and elective time.

List of all inpatient services:

General Medicine Wards – 4 Teams at MUH, 1 Team at ART, and 3 Teams at VAMC
Cardiology – 2 Teams at ART
Hepatology – MUH
Malignant Hematology – ART
Stroke Neurology (interns only) – MUH
MICU – MUH
VA MICU– VAMC (upper-level residents only)
Night Float – All Sites

Outpatient Medical Clinics (OMC)

Residents rotate in through outpatient clinics (both continuity clinic and subspecialty clinics) every three months, for either a half-month or full month. A typical week in the clinic includes 6-7 half-days of University Internal Medicine (UIM) continuity clinic, 2-3 half-days of subspecialty clinic or ultrasound training, and one half-day of protected administrative time.

For continuity clinic, each incoming intern assumes a panel of primary care patients handed down from a recently-graduated resident. Patients are typically seen every 3 or 6 months for their routine health care. For any necessary outpatient visits that occur outside of your scheduled clinic blocks, one of your co-residents on your assigned “Color Team” will see the patient, and vice versa. The shared patient pools provide an added level of continuity. Patients are seen in the University Internal Medicine (UIM) clinic at MUSC Rutledge Tower which is located on the downtown MUSC campus. Residents also gain experience in telehealth with video visits. We have a stellar group of primary care faculty who help hone your skills in ambulatory care!

Examples of possible subspecialty outpatient clinics:
Benign Hematology, Cardiology, Dermatology, Endocrinology, ENT, Gastroenterology, Geriatrics, Infectious Diseases, Nephrology, Neurology, Oncology, Pain Management, Pulmonology, Rheumatology, Sleep medicine

Subspecialty Inpatient Consult Rotations:

Examples of subspecialty inpatient consult rotations:
Benign Hematology, Cardiology, Endocrinology, Gastroenterology, Geriatrics, Hepatology, Infectious Diseases, Nephrology, Neurology, Oncology Solid Tumor, Palliative Care, Pulmonology, Rheumatology.

Clinical Electives:

We also pride ourselves on working with residents to build unique elective opportunities in Global Health, Dermatology, Ophthalmology, Radiology, and Ambulatory Orthopedics, for example.These rotations can be designed with faculty to suit your interests.

Newly designed electives for residents include Ultrasound Elective, Hospitalist Elective, and Cardiovascular ICU Elective.

Research Elective:

Residents with a mentor and specific project may request a dedicated research block. This frequently results in a presentation at MUSC’s research day, grand rounds, or regional/national conferences and often leads to publication.

POCUS Curriculum:

We integrate POCUS training into multiple areas of our residency program. In addition to didactic ultrasound lectures during Academic half day, residents also get hands-on ultrasound experience in the ICUs, on pulmonary consults, on the general medicine wards, and during the ultrasound rotations incorporated into ambulatory blocks. We have dedicated Butterfly ultrasound probes which can connect to your MUSC issued iPhone for on-the-go ultrasound use.

As mentioned above, we have also created an Ultrasound Elective. At the VA Medical Center simulation lab, residents can learn from two state-of-the-art CAE Vimedix ultrasound simulators.

Night Coverage:

We operate largely on a night float system. We have dedicated night float coverage for MUH General Medicine wards, VA General Medicine wards, ART Cardiology, and ART General Medicine & Malignant Hematology, and MUH Hepatology. Residents do not cover multiple hospitals at night. Upper-level night float residents cover Sunday through Friday nights. Upper-level residents on the inpatient teams cover Saturday nights as part of 24+4 hour call shifts. In a typical month of inpatient wards, each upper-level resident will have a total of one to two 24+4 hour call shifts. Residents in the ICUs rotate through night coverage of their respective ICUs for 5-6 nights at a time.

Interns also have a night float structure while on MUH General Medicine wards and in the MICU. 24+4 hour call for interns is limited to VA General Medicine wards.

Call Schedule:

On General Medicine wards at MUH and VA, call shifts typically occur every 3 to 4 days and end at 8 pm. On-call residents are responsible for distributing and assisting with admissions, leading rapid responses, and “cross-cover” from 5-8 pm. Each of our inpatient teams admits patients daily, also known as a “drip system”, so new patients are distributed evenly between teams. We also have day float residents who help with afternoon admissions to Cardiology, VA General Medicine wards, and ART General Medicine & Malignant Hematology. Day Float schedule is Monday through Friday with weekends off.

Sample Schedules

	PGY-1	PGY-2	PGY-3
July	Gen Med MUH	MICU	Gen Med VA
August	Mal Heme \| Card CS	Gen Med VA	MICU
September	OMC \| Endocrine CS	OMC	OMC \| VA ER
October	Stroke \| Neuro CS	Night Float	Gen Med ART \| Inf Dis CS
November	Gen Med ART	Research Elective	Gen Med VA
December	OMC \| Endocrine CS	Liver \|OMC	OMC
January	MICU	Mal Heme	Ambulatory RT
February	Gen Med VA	Rheum CS \| Heme CS	VA ER \| Heme CS
March	Nephro CS \|OMC	OMC	Cards CS \| OMC
April	Gen Med VA	Cardiology	Geriatrics
May	Gen Med MUH	VICU	Ambulatory VA
June	Cardiology \| OMC	OMC \| Onc CS	OMC
Totals	7.5 Inpatient Months 2.5 CS / Elective Months 2 Outpatient Months	6.5 Inpatient Months 2.5 CS / Elective Months 3 Outpatient Months	3.5 Inpatient Months 2.5 CS / Elective Months 5 Outpatient Months 1 Emergency Medicine Month
Legend	The vertical line indicates split month; ART - Ashley River Tower; CS - Consult Service; ER - Emergency Room; MUH - Main University Hospital; RT - Rutledge Tower; UIM - University Internal Medicine Continuity Clinic; VA - Veterans Affairs Medical Center

Division Curriculum

Below is a preview of the division curriculum.

Cardiology Consultation Service
Cardiovascular Intensive Care Unit (CVICU)
Continuity Clinic
Coronary Care Unit
Critical Care Medicine
Elective in Neurology
Emergency Department
Ambulatory Endocrinology, Diabetes & Metabolic Diseases
Gastroenterology Luminal Inpatient Service
Gastroenterology Liver Service
General Internal Medicine Consult Service
Geriatric Evaluation and Management
GI Consults in MUSC
Hematology & Oncology Inpatient Service
Hematology & Oncology Consult Service
Hospitalist Service
Infectious Disease Consult Service
MUSC & VA Night Float
MUSC Gen Med Wards
Nephrology General Consultation Service
Palliative Care Inpatient Consult
Pulmonary Consult Rotation
Rheumatology Service
VA Cardiology Consult Service
VA GM Wards
VA Intensive Care Unit
VA Primary Care and Urgent Care
VA Subspecialty Ambulatory