Program Basics

Inpatient rotations take place in a wide variety of hospitals:

• University Hospital (UH)
• Ross Heart Hospital (RHH)
• East Hospital
• The James Cancer Hospital and Solove Research Institute (OSUCCC)

UH, RHH and OSUCCC are all located on the campus of The Ohio State University.  East Hospital is located approximately six miles away in downtown Columbus. These four hospitals provide a terrific spectrum of patient acuity and pathology. At the end of three years, our residents are proficient in caring for inpatients and ICU patients in both community and tertiary settings.

Senior residents are the team leaders and have a significant amount of autonomy in the daily evaluation and management of patients. The initial patient assessment and management plan be developed by the house officer. The attending physicians participate with residents, interns and medical students on daily teaching rounds and have been repeatedly recognized for their support and dedication.

At OSU, the Internal Medicine residents on inpatient services also form the "Code Blue team," which respond and lead code blues across the hospitals. The team leader is almost always an Internal Medicine senior resident. 

Our MICU rotation is one of the most popular rotations. In this busy environment, the residents care for critically ill patients under the guidance of fellow and faculty physicians who consistently win teaching awards. Teams become proficient at acute management of acute hypoxic and hypercarbic respiratory failure, septic shock, hemorrhagic shock, and more. All residents are coached in proper procedural techniques and get extensive experience performing central venous and arterial line placement, hemodialysis line placement, ventilator management, and ACLS.

We intentionally provide various team structures to expose residents to different workloads and responsibilities. For example, we have nine different inpatient general medicine teams with structures varying from 1 intern/1 resident/10 patients, to 2 interns/1 resident/16 patients, to 2 residents/16 patients. Some structures encourage optimizing efficiency while others provide more time and individual attention to hone in on intern development.

We offer an inpatient Hepatology service staffed by an attending hepatologist that handles complex decompensated cirrhotic complications as well as patients with liver transplants. Transplant Medicine cares for recipients of Kidney and Kidney Pancreas Transplants.

In our James Cancer Hospital and Solove Research Institute, we have three teaching services that our interns and residents staff. There is an inpatient hematology service, an inpatient oncology service, and a unique undifferentiated cancer service. In the latter service, patients with a new finding concerning for undiagnosed malignancy are admitted for expedited diagnostic evaluation and treatment. We also offer additional inpatient electives on the bone marrow transplant service, acute leukemia service, and benign hematology service.

There are three cardiology teaching services: An Acute Coronary Service staffed by interventional cardiologists, a General Cardiology service, and an Advanced Heart Failure service. The Ross has a unique structure in that each patient room can be converted from Med/Surg level to ICU, and our nurses are ICU-trained. This means if a patient were to develop cardiogenic shock, the patient would remain on the same service under the same resident’s care rather than being transferred to an ICU or CCU.

• Acute Coronary Service
• Congestive Heart Failure
• General Cardiology
• Hematology
• Oncology
• Undifferentiated Cancer Service
• General Medicine
• Hepatology
• Medical Intensive Care Unit
• Transplant Medicine
• Night Team

At Ohio State, we felt the traditional model of inpatient long-call (ie “q4” night shifts) generates unnecessary fatigue and sacrifices both learning potential and quality of patient care. We instead created a night team responsible for the care of patients on our teaching services over night. The team collaborates with the day team to share management duties. Those on inpatient services have 6am sign-in and 5pm sign-out. For interns, the night team month is known for development in admitting patients and dealing with overnight urgent and emergent clinical scenarios. For residents, the night team month is known for building leadership and care management skills. Just as important, the camaraderie that forms between the team members over the course of the month lasts for years to follow.

Acute Leukemia Service Addiction Medicine Airway Management Benign Hematology Bone Morrow Transplant Cardiology Consults - UH and East Diabetes Consults Electrophysiology Endocrinology Consults Gastroenterology Consults

General Medicine Consults Hematology/Oncology Consults Hepatobiliary Consults Hospital Medicine ID consults - UH and East Nephrology Consults Neurology Consults Pain/Palliative Consults Pulmonary Consults - UH and East

Addiction Medicine  Advanced Pulmonary Advanced GI Allergy Cardiology Dermatology Endocrinology Gastroenterology General Medicine

Geriatrics Hematology Medical Oncology Infectious Disease Independent Research Integrative Medicine Medical Education Nephrology

Primary Care/Surgical Subspecialty Pulmonary/Sleep Medicine Quality Improvement Rheumatology Sports Medicine Women's Health Wound Clinic

We require all interns to complete a one month elective called Career Development Block in which they pursue a research or academic project with a mentor in their desired specialty (whether hospitalist, primary care, or subspecialty). During PGY2 and PGY3, our residents may take up to a total of 2.5 months of elective time dedicated to scholarly work and research. This can include an Extended Research Block in which the resident can focus entirely on research without clinical responsibilities. Providing this protected time for research, our residents publish in high impact peer-reviewed journals and travel all over the country and world presenting their findings. Residents who are interested in a more robust research experience are invited to apply to the Enhanced Research Pathway, see more information below.

Designed for residents interested in exploring the option of a career as a clinician educator, the medical education elective exposes residents to the variety of educational activities common to medical educators in academic centers. Residents choosing a medical education elective can learn curriculum development, participate in peer review of teaching for faculty and residents, develop skills in web based education and initiate an educational scholarship project. Residents can also participate in small group teaching of students in physical diagnosis, clinical problem solving, procedural skills and diagnostic test interpretation.

The Medical Teaching and Leadership (MeTaL) Pathway is aimed to develop medical educators through cultivation of teaching and leadership skills. In this year-long program, selected second-year residents are provided additional training in teaching and leadership theory as well as opportunities to develop and practice these skills. Our first class was developed in 2020.

We have residents who participate in educationally rich international electives. We work with residents to provide the opportunity to take the trip that best suits their interests.

The OSUWMC Global Health Interest Group is dedicated to improving the global health experience of faculty, residents, and fellows across all specialties throughout the medical center. Their goals are to enhance global health knowledge, coordinate sustainable and productive medical trips abroad, and set up knowledgeable speakers on relevant global health issues. They have quarterly meetings to discuss cross-cutting global health topics and host an annual symposium for faculty and trainees to present their work and share ideas.

The Global Health Scholars Program provides structured training and mentorship across multiple participating residency programs.

Our quality improvement (QI) curriculum is led by Dr. Allison Heacock and is comprised of a full day QI bootcamp in the fall of intern year, interactive didactic sessions, and a longitudinal class QI project which is aligned with medical center quality and safety goals, and is designed to take interns through the complete QI cycle. Residents will be prepared to pursue an individual or small group projects during a QI elective, and they may present their results at the department’s annual research day and other regional, national and international venues.

The Fundamentals of Medicine is a highly popular lecture series presented July through August and targeted towards our new interns. These lectures focus on core topics that our interns are sure to manage throughout residency. Topics include acute respiratory failure, acute coronary syndromes, oncologic emergencies, GI bleed, and heart failure to name a few. This lecture series gets all of our interns up to speed so they can be confident when being the primary doctor managing these conditions for the first time.

Three hours of educational activity are held in a block on Tuesday afternoons following a housestaff lunch. Residents on elective and clinic months are free of clinical duties on Tuesday afternoons to attend this conference. Separate Senior and Intern sessions add protection for attendance by those on Inpatient Services.

The content of the conference varies from session to session. Incorporated lectures include core topics in general and subspecialty medicine and:

Tuesday School Flipped Classroom
At Tuesday School, our interns and residents complete brief pre-reading on the designated topic. Senior residents lead small-group sessions in which groups work through case-based discussions. All groups then reconvene to review key teaching points with a specialist within the field.

Morbidity and Mortality
The traditional conference has been replaced with a resident peer review conference where residents use the tools of medical error root cause analysis and quality improvement to identify and correct problems that led to suboptimal outcomes for our patients. An emphasis is placed on systematic problem solving and prevention.

Ultrasound curriculum
Pulmonary and Critical Care attending Dr. Vincent Esguerra has designed and leads a comprehensive point-of-care ultrasound (POCUS) curriculum that runs longitudinally across the year. Residents are trained in both performance and interpretation of common POCUS testing, including cardiac exam, pulmonary effusion evaluation, FAST exam, and abdominal examination.

Journal clubs/evidence-based medicine
Journal clubs take several formats. One intent of this journal club is to teach skills of critical appraisal. We have a “rapid” fire journal club in our outpatient clinic that reviews a select group of recent journals and how they will impact on our practice of medicine.

This weekly conference highlights recent advances in internal medicine and draws accomplished speakers and investigators from within the university, as well as around the world. Topics range from comprehensive updates on common clinical problems to pioneering research in internal medicine. Faculty, trainees, medical students and community physicians attend.

One case from an inpatient service is presented at each of these popular conferences. A program director or other attending physician and the chief resident facilitate an in-depth discussion about the presentation, physical exam, differential diagnosis, diagnosis and patient management of a particular disease process. The application of evidence-based medicine is role modeled. This highly educational conference remains a favorite among housestaff, and is part of protected learning time for our residents.

The residency program believes that a great physician is someone who has excellent patient care skills and exemplary leadership skills. In order to help residents develop all of the skills necessary to be a great physician, we have created the Leadership Development Program.

Development of the program is based on four guiding principles:

• All physicians are leaders
• Strong leadership skills make us better doctors and improve patient care
• Leadership skills can and should be taught
• Creating a culture that embraces leadership training is a critical step towards preparing physicians to lead complex, multidisciplinary teams

The Leadership Development Program will provide educational programming that is meaningful and applicable to residents' everyday practice. Through this programming, residents will be able to:

• Describe how effective leadership is important in their practice and how their personal leadership skills impact patient care
• Recognize their personal leadership skills and leadership preferences so that they can use them most effectively in different situations
• Utilize new leadership skills in different settings so that they can more effectively cope with leadership challenges

OSU is committed to leading the way in advancing the quality and effectiveness of residency education. As one of the few programs in the country to provide an integrated leadership training curriculum within the residency program, we will continue to provide residents with unique experiences and opportunities that will allow them to become excellent physicians.

Contact:

Jared Moore, MD
OSU Division of General Internal Medicine
Martha Morehouse Pavilion, Suite 2335
2050 Kenny Rd.
Columbus, OH 43221
Jared.Moore@osumc.edu

We are fortunate to have access to a state-of-the-art, high fidelity, simulation areas and expert staff. These special Tuesday afternoon sessions allow further coaching of clinical and procedural skills using simulation tools, models and standardized patients/clinicians. Critical Care and Ambulatory Procedural Training sessions are facilitated by faculty and specialty fellows. “Mega-Sims” give small groups of interns and residents the opportunity to respond to mock “emergency response team” calls.

Residents gather between outpatient clinics or continuity clinics Monday, Wednesday and Friday. They are introduced to a variety of outpatient care topics, such as hypertension management, diabetes care, anticoagulation, contraception, vaccination schedules, ADD/ADHD, depression and anxiety, the evaluation of headache, etc. Using a variety of resources, including the Yale curriculum, some topics are presented by residents under faculty supervision.. Ambulatory Journal Club is a highlight each month, led by Dr. Chris Chiu from the Curbsiders podcast.

Our quality improvement (QI) curriculum is led by faculty experts in quality improvement and patient safety. Our curriculum is comprised of a full day QI boot camp in the fall of intern year, interactive didactic sessions, and a longitudinal QI project which is aligned with medical center quality and safety goals. Prior resident projects have been presented at the department’s annual QI symposium as well as other regional, national and international conferences.

The Enhanced Research Pathway (ERP) is a formalized augmentation to resident participation in scholarship. It includes research-related didactics and workshops on topics including IRB development, biostatistics, grant writing, and more. Residents selected for the ERP will be paired with a dedicated faculty mentor to provide guidance throughout their research endeavors. Residents will present at conferences and prior projects within the ERP have resulted in first authorships and national presentations.

The Medical Teaching and Leadership (MeTaL) curriculum is a pathway within the Internal Medicine Residency Program aimed to develop medical educators though cultivation of teaching and leadership skills. The MeTaL pathway allows interested residents the opportunity to further develop skills in education and leadership, better preparing them for their future careers. In this year-long program, selected second-year residents are provided additional training in teaching and leadership theory as well as opportunities to develop and practice these skills.

The Enhanced Hospital Medicine Pathway is a pathway within the Internal Medicine Residency during the PGY2 and PGY3 years that aims to provide targeted and specific content to residents who are interested in the field of Hospital Medicine (HM). Residents will participate in a structured curriculum covering pertinent, high yield HM topics and receive mentorship from HM faculty. The curriculum will include expanded hospitalist relevant clinical experiences, QI and scholarly work opportunities, and personal and career-oriented mentorship.

The University Hospital, known as Doan and Rhodes Hall to the residents, is the home to a majority of the inpatient care activities and services. UH serves as a secondary care hospital to the central Ohio community and a tertiary care hospital to patients from as far away as Pennsylvania, West Virginia, Kentucky and Michigan. Resident inpatient services include four general medicine services, one hepatology service and a solid organ transplant service. In addition, residents rotate through many consult elective months at the University Hospital.

A new University Hospital is under construction and is scheduled to open by 2026.

The James Cancer Hospital and Solove Research Institute opened in December 2014 and includes integrated spaces for research, education and patient care. "The James" as it is known to the residents, is the clinical home of the vast majority of patients with an established diagnosis of cancer as well as those patients with benign hematologic conditions such as sickle cell anemia, TTP, ITP and other diseases. Three of the department's hematology/oncology services are staffed by the medicine housestaff. Hematology 1 cares for patients with lymphoma, myeloma, chronic leukemias and benign hematologic disorders. Hematology 5 cares for undifferentiated cancers. Oncology 1 cares for patients with solid tumors requiring inpatient care. Elective rotations in benign hematology, bone marrow transplantation and acute leukemia are available for interested residents. The James is also home to the Critical Care Center and is where the residents rotate for the MICU service.

The Ross Heart Hospital opened in 2004. Each patient care room has the capability of changing into an intensive care room whenever needed by the patient. Residents provide care on a general cardiology service, an acute coronary syndrome service and a congestive heart failure service. Experience with electrocardiology services are also available during elective consultative rotations.

Located approximately six miles away from the main campus, East Hospital is a community hospital in the heart of inner city Columbus. The two general medicine ward services have one intern and one resident. Residents may also spend time on elective consult rotations in pulmonary, infectious disease, nephrology and cardiology. There is no overnight call at this site; nocturnal care of patients is provided by hospitalists. The spectrum of patients at this hospital is different than at OSU Main/University Hospital. Residents care for more patients with isolated problems, such as asthma or congestive heart failure.