Dr. Moran with resident and patient

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 atmosphere, we achieve this by:

  • Exposing trainees to a breadth and depth of clinical experiences across the spectrum of internal medicine and its subspecialties in both the 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, comradery, 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 the 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, accordingly.

Our residents also 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 CVICU as an upper level.

Interns will have approximately 7 months of inpatient rotations with 3-5 of those months being general medicine wards. The relative amount of time spent on inpatient rotations decreases in PGY-2 and PGY-3 years with increases in outpatient and consult/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 – ART
  • Malignant Hematology – ART
  • Stroke Neurology (interns only) – MUH
  • MICU – MUH
  • VA MICU– VAMC (upper-level residents only)
  • Night Float – All Sites

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. A typical week in the clinic includes 6-7 half-days of continuity clinic, 2-3 half-days of subspecialty clinic or ultrasound training, and one half-day of protected administrative time. Under normal circumstances, patients are seen in the University Internal Medicine (UIM) clinic at MUSC Rutledge Tower which is located on the downtown MUSC campus. In the current climate, we have increased our telehealth capabilities to include video and phone 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

Subspecialty consult rotations give interns and residents the opportunity to learn from experts in their respective fields. These rotations also provide faculty exposure for residents considering fellowship and are often where residents find subspecialty mentors. Consult rotations are typically half-month in duration to achieve exposure to a larger variety of medical specialties. However, residents with specific subspecialty career goals can participate in full-month subspecialty consult blocks according to their interests.

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

Our Geriatrics, Rheumatology, and Endocrinology rotations differ in that they include time in their respective outpatient clinics in addition to inpatient consults.

Clinical Electives

We also pride ourselves on working with residents for other unique elective opportunities including Global Health, Dermatology, Ophthalmology, Ambulatory Orthopedics, and inpatient General Medicine consults. They can be designed with faculty to suit your interests.

Research Elective

Residents with a mentor and specific project may request a month for dedicated research time. This frequently includes a presentation at academic half-day, grand rounds, or regional/national conferences and often leads to publication.

Emergency Medicine

Every resident spends a total of 1 month in the VA Medical Center emergency room.

Point-of-Care Ultrasound (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 (with a dedicated Butterfly ultrasound probe which connects to your MUSC issued iPhone), and during the ultrasound rotations incorporated into ambulatory blocks.

Night Coverage

We operate largely on a night float system. Upper-level night float residents cover Sunday through Thursday nights while the upper-level residents on the inpatient teams cover Friday and Saturday nights as part of 24+4 call shifts. In a typical month of inpatient wards, each resident will have a total of two 24+4 weekend call shifts. Residents on the night float rotation have weekends off. We have dedicated night float coverage for MUH General Medicine wards, VA General Medicine wards, ART Cardiology, and ART Hepatology / General Medicine / Malignant Hematology. Residents do not cover multiple hospitals at night. 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. For VA General Medicine wards, interns take 24+4 calls every 5-6 days, approximately.

Call Schedule

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” where 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 / Hepatology / Malignant Hematology. Day float is embedded in the Geriatrics and night float rotations. ART Day float shifts are Monday through Thursday with weekends off. VA day float serves as an inpatient rotation with shifts Monday through Friday and 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  UIM | Endocrine CS UIM UIM | VA ER
 October Stroke | Neuro CS Night Float  Gen Med ART | Inf Dis CS 
 November Gen Med ART Research Elective Gen Med VA
 December UIM | Endocrine CS Liver | UIM UIM
 January MICU Mal Heme  Ambulatory RT
 February Gen Med VA Rheum CS | Heme CS VA ER | Heme CS
 March Nephro CS | UIM UIM Cards CS | UIM
 April Gen Med VA Cardiology Geriatrics
 May Gen Med MUH VICU  Ambulatory VA
 June  Cardiology | UIM  UIM | Onc CS  UIM
 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