Clinical Curriculum for Internal Medicine

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, and elective rotations.

Inpatient rotations occur at three hospitals which are all located in the downtown Charleston Medical District: MUSC Main University Hospital (MUH), 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 2, two-week rotations 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 Cardiac 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
• Day Float

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 half-days of University Internal Medicine (UIM) continuity clinic, two to three half-days of subspecialty clinic, and two half-days 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, Psychiatry (Behavioral Medicine), Shifa clinic

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

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, Cardiac ICU Elective, Quality Improvement Elective, Health Disparities 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.

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 elective. 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.

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 plus 4-hour call shifts. In a typical month of inpatient wards, each upper-level resident will have a total of one to two 24 plus 4-hour call shifts. Residents in the ICUs rotate through night coverage of their respective ICUs for five to six nights at a time.

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

On General Medicine wards at MUH and VA, call shifts typically occur every three to four days and end at 8 p.m. On-call residents are responsible for distributing and assisting with admissions, leading rapid responses, and “cross-cover” from 5 to 8 p.m. 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.

Inpatient:

• General Medicine wards
• ART General Medicine wards
• General Cardiology/
• Heart Failure/VB
• Malignant Hematology wards
• GI Hepatology wards
• Stroke
• MICU
• VA MICU
• Night Float
• MUSC Day Float
• VA Wards Day Float

Consults/Electives:

• Palliative Care
• Neurology CS
• Cardiology CS
• Infectious Diseases CS
• Oncology CS
• Gastroenterology CS
• Pulmonology CS
• Nephrology CS
• Hematology CS
• VA Cardiology CS
• VA Gastroenterology CS
• Liver CS
• Research Elective
• Clinical Elective
• Hospitalist Elective
• Allergy & Immunology Elective
• Health Disparities 
• CICU
• MSICU
• Quality Improvement Elective
• POCUS Elective
• Global Health Elective

Outpatient Medical Clinics (OMC):

• OMC
• Rheumatology
• VA Subspecialty Clinic
• RT Ambulatory Clinic
• Geriatrics