Internal Medicine Residency Program at Norwalk Hospital

A message from the Program Director

Dear Residency Candidate,

Welcome to the Norwalk Hospital Internal Medicine Residency! We are dedicated to providing you with a world-class residency education in a setting that is friendly, warm and supportive. Affiliated with the Yale University School of Medicine, Norwalk Hospital has a long tradition of training excellent physicians who go on to achieve success and become leaders in a variety of careers within general internal medicine and its subspecialties. Let me share with you some of the unique aspects of Norwalk Hospital and our residency program.

Norwalk Hospital is ideally situated approximately one hour from New York City, in an area rich with cultural and recreational activities for adults and children of all ages. Our faculty is dedicated to the mission of teaching residents and medical students evidence-based, patient-centered care. We strongly believe that teaching the doctors of tomorrow is a special calling that must be approached with caring and dedication.

We provide all residents with individualized training and mentoring so that they can pursue their highest aspirations as physicians, whether in primary care, in hospital medicine, or through additional training in fellowship programs. As a result, over the last few years, our residents have been accepted to fellowships at Yale, Dartmouth, Mayo Clinic, Johns Hopkins, Brigham and Women’s and many other top university institutions. Our residents match in a variety of fellowships including highly competitive ones such as cardiology, gastroenterology, hematology-oncology, pulmonary/critical care, as well as many others. They have also been recruited to excellent positions in primary care and hospital medicine all over the country.

In addition to an extraordinary faculty, the Norwalk Hospital Internal Medicine Residency offers our residents outstanding educational experiences within each of the three major areas of residency training. Our Hospitalist Clinician Educator Program has been developed as an innovative model for integrating hospitalists and residents in a way that dramatically improves both inpatient care and residents’ educational outcomes. In our Critical Care units, residents work with an award-winning, nationally recognized team, are exposed to cutting-edge medicine, and participate in multiple clinically relevant quality improvement projects. Finally, our Ambulatory Care rotations take place primarily in a free-standing, community-based health center created as a site which integrates resident education with care for the medically underserved. Care for adult medicine patients at the health center is provided largely by resident physicians closely supervised by dedicated attending faculty.

These core rotations are supplemented by an extensive choice of elective opportunities both at Norwalk Hospital and Yale-New Haven Hospital as well at as other institutions throughout the country, including Sloan-Kettering. Novel educational opportunities also abound throughout the program. At the health center, residents participate in regular sessions on quality improvement, clinical examination skills and evidence-based medicine. At the hospital, training in simulation, a monthly interactive patient safety conference, and communication skills workshops enhance curricular learning.

Strong research opportunities supplement our residents’ educational experience. All trainees are encouraged to pursue scholarly activity, and faculty members involved in research are eager for resident participation. Residents and faculty at Norwalk Hospital regularly present at regional and national academic meetings. In addition, we have consistently been active in publishing articles and chapters in medical journals and textbooks. There are also numerous opportunities to become involved in research projects at the Yale University School of Medicine.

Finally, as a program, we feel strongly connected to the community we serve. Our residents reach out in many ways to serve beyond the walls of the hospital. They serve as leaders who provide “ask the doctor” counseling at health fairs, and community health education at talks throughout the city.

Thank you for taking the time to look at the Norwalk Hospital Internal Medicine Residency. We feel that we offer a superb training experience and hope that you will consider us as the way to foster your love, passion and excitement for internal medicine.

Sincerely,

Raman Gill-Meyer, Program Director

Internal Medicine Residency Program

Program Structure

Our 3-year categorical residency program has adopted the 4+2 curriculum model. Rotations are divided into 13 blocks consisting of 2 weeks each. Residents have separate blocks of inpatient and outpatient rotations, and alternate between 4- week rotations in the hospital and 2- week rotations in the outpatient continuity clinic or on elective. The benefits of the 4+2 model are enumerated below:

  • Balanced scheduled allowing focus in each aspect of medicine without being pulled for other commitments
  • Minimization of conflicts between inpatient and outpatient responsibilities
  • Improved transitions of care and preservation of inpatient team structure
  • Protected half-days during Ambulatory Blocks for administrative tasks/reading
  • Promotion of work-life balance

The chart below illustrates rotations by year of PGY training in weeks:

 

For residents interested in Global Health, a 6-week international elective is available during PGY-2 or PGY-3 year. Currently, the Global Health elective is on hold due to the pandemic however, we hope to reinitiate the elective once it is safe and appropriate per CDC guidelines.

 

Detailed View of Program Structure:

Opportunity
The goal of the Categorical Internal Medicine Residency is to train superior internists able to care for inpatients and outpatients across a wide disease spectrum. By graduation, all of our residents have participated in leadership and scholarly activities. Our program is the right size to provide breadth and depth of experience with personalized mentoring and feedback. The three major areas of clinical exposure are Team Care, Critical Care and Ambulatory Medicine at the Norwalk Community Health Center. We have a high Internal Medicine Board passage rate, with our residents pursuing excellent fellowship and practice opportunities upon graduation from our program.

Team Care
Team Care (general medical floors) is vital to our residents’ education program and the delivery of quality healthcare at Norwalk Hospital. There are seven teams participating in Team Care as well as a night float system.

The Team Care Service has full-time hospitalist clinician-educator faculty members and one Chief Resident responsible for much of the ongoing teaching, in addition to that provided by other members of the Department of Medicine. Our hospitalists are stellar teachers and clinicians who have published their unique approach to inpatient care and teaching in prominent medical journals. On Team Care, you are responsible for all patients admitted under your care under attending supervision and enter all orders. Team Care is an invaluable close-to-the-patient learning experience and includes daily resident reports, walk rounds, daily teaching conferences and journal club.

Critical Care Facility
The Norwalk Hospital Critical Care Facility is nationally recognized for its work developing new technologies, including the use of computers in patient care. While on this rotation, our residents are closely involved with the care of patients in the Coronary Care Unit and Medical Intensive Care Unit. The house staff team has one PGY-3, two PGY-2s and four PGY-1s, as well as a critical care fellow and a full-time teaching attending.

Ambulatory Medicine
Ambulatory training in a variety of sites is critical to the development of outstanding clinicians. Our Ambulatory Medicine Program is composed of two major parts: continuity care and the ambulatory rotations offered in each of the three years.

Continuity Care
Participating in a unique academic practice model, residents follow their own group of patients in conjunction with a faculty member, at a state-of-the-art ambulatory care center located in Norwalk. Special emphasis is placed on the development of the patient-physician relationship, as well as establishing preventive medicine approaches to patient care. Teleconferencing equipment allows the residents to participate directly in conferences held at the hospital. Four dedicated faculty members and the Ambulatory Chief Resident work closely with the house staff in this setting, allowing for close one-on-one supervision and mentoring.

Ambulatory Rotations
There are Ambulatory block rotations in each of the three years of residency. The time is divided between a variety of patient care opportunities and a significant number of educational conferences. An extensive Ambulatory Curriculum includes exposure for medicine residents to nursing home care and multiple practice sites.

The patient care opportunities include continuity and acute medical visits (with particular emphasis on the approach to patients with undiagnosed symptom complexes), a general internal medicine private practice office experience, subspecialty office experiences, and geriatrics (including a four-week rotation at a teaching nursing home). The educational conferences include an ambulatory resident report, ambulatory care curriculum, evidence-based medicine, clinical skills curriculum and quality improvement.

Residents are provided a personal business card upon joining the program with the Norwalk Community Health Center phone number. Senior residents and faculty provide phone coverage 24 hours a day, seven days a week, so our patients have ready access to physician advice and residents have experience with telephone medicine.

Subspecialty Rotations
While at Norwalk Hospital, each resident is able to choose from many subspecialties electives including Hospitalist Medicine, Cardiology, Endocrinology, Gastroenterology and Nutrition, Hematology-Oncology, Neurology, Pulmonary Medicine, Nephrology, Wound Care, Allergy and Immunology, and Rheumatology. Residents also take electives at Yale where they draw upon the knowledge and skills of physicians doing pioneering work in the practice of medicine and in research. Residents who are highly interested in Hematology-Oncology will also be able to do a one-month rotation at MSKCC in New York City.

International Medicine/Global Health
In addition to exposure to general medicine as practiced in another setting, this 6-week elective offers a chance to experience another culture and broaden one’s perspective in a structured way through a partnership with the University Of Vermont School Of Medicine.

Academic Didactic Schedule

Didactic sessions are held daily and are designed to complement teaching rounds. Lectures are given during inpatient and outpatient blocks to provide a broad range of knowledge for future practice as competent physicians.

A comprehensive description of didactic sessions can be found below:

Grand Rounds

Grand Rounds occur every Thursday morning and are led by outside speakers or multidisciplinary team members. The sessions serve as a platform for topic review, clinical pathology review, ethics discussion, discussion of new developments and competency-based topic review.

 

Noon Conference

Noon conference is held daily for all residents in both inpatient and ambulatory rotations. Lectures are provided by our Norwalk faculty and also by renowned Yale University speakers to provide comprehensive knowledge in a wide breath of internal medicine topics. Additionally, noon conferences encompass lectures regarding billing and coding, job market and job search, internal systems education, teaching skills, patient perspectives, and Patient Safety and Quality Improvement lectures led by PGY-3 residents.

 

Patient Safety and Quality Improvement Conference

Patient Safety and Quality Improvement conferences are held once or twice each month to discuss a patient case wherein a safety event occurred or was narrowly missed requiring closer systems evaluation. PGY-3 residents prepare the presentation under the guidance of faculty and the inpatient Patient Safety team. This conference is intended to promote quality improvement by performing a root cause analysis and encouraging multidisciplinary discussions for each case.

 

Resident Report- Inpatient

Resident Report is held 4 days per week for PGY-2’s and PGY-3’s. Intern Report is held once weekly. Led by the Chief Resident, residents hold thought-provoking discussions regarding journal updates and participate in patient case presentations. A Journal Club is held each block during which time a recent journal article is dissected and reviewed for validity and application to our patient population. Internal Medicine Board Preparation occurs during Resident Report each block.

 

Morning Report- Ambulatory

Morning Report is held daily in the continuity clinic and is hosted by the Ambulatory Chief Resident and attendings. Residents hold vibrant discussion about journal articles and topics related to primary care to ensure practice of evidenced based medicine in the outpatient setting.

 

Clinical Skills

Clinical Skills lectures occur during the outpatient blocks. One half day is reserved for lectures by our senior-most ambulatory faculty. Lectures consist of physical exam maneuvers and review of topics based on each system spanning from ENT to the nervous system.

 

Academic Half Day

Academic Half Days occur during the outpatient blocks. One half day is dedicated to didactics. Residents learns about medications such as inhalers and insulin devices. Additionally, patient participate in lectures led by the Chief Resident and complete Ambulatory Medicine multiple choice questions through the Physician Education and Assessment Center.

 

Simulation Sessions

Our state-of-the-art Simulation Lab is available to all house staff. Sim sessions for Mock Code Training and rapid response scenarios occur twice a week. Also, provided for our residents is Vascular Access Training, which is run by the Pulmonary Fellows. They hold regular sessions in the Simulation Center for procedural training, including peripheral IV line placement, central line placement, arterial line placement, paracentesis, thoracentesis and lumbar puncture.

Scholarship & Research Opportunities

The Internal Medicine Residency Program requires all residents to participate in scholarly activity. Through the Nuvance Innovation and Research Department, residents are provided lectures regarding the approach to evidence-based medical research. Residents can enjoy our network-wide implemented Research Curriculum with includes a series of lectures on how to initiate, develop and complete a research project. This lecture series is complemented by educational research modules that are also available to all the residents. The internal office of Patient Safety can provide residents with quality improvement projects in the inpatient setting. Residents are also encouraged to initiate quality improvement projects in the resident clinic, a Federally Qualified Health Center.

The Program Director and Associate Program Directors meet with each resident each semester to review their participation in scholarly activity and assess their progress. Residents are provided a mentor on arrival to Norwalk Hospital and are otherwise encouraged to seek out mentors in their field of interest. Faculty are extremely approachable and have assisted residents by introducing them to consultants in their desired fields. Currently, several projects are underway in the Pulmonary department, Gastroenterology department, Infectious Disease Department, and Cardiology Department. Several quality improvement projects are being conducted in the outpatient clinic with the help of faculty and ancillary clinic staff. Clinic faculty have experience with Institutional Review Board (IRB) approval and comprehensive research project development.

Scholarly activities and quality improvement initiatives at Nuvance Health are designed to help residents advance their knowledge in the principles of research and become competent in evidence-based medicine through self-directed assessment and learning. Residents are encouraged to present their work at local, state and national conferences. Many of our residents participate in the annual ACP state conference and have gone on to compete at the next level as well as nationally. They also participate in the annual Belsky Research Day. Residents also submit cases and abstracts to national conferences and many have been selected to present. An educational stipend is provided for travel expenses to remote conferences where a resident has been asked to present.

Resident / Fellow Resources

Board Preparation:

At Norwalk Hospital we are very proud of our residents and their accomplishments. These accomplishments include our consistently exceptional board passage rate. Board review is incorporated into resident report weekly and often takes the form of “Medical Jeopardy” making the learning experience extra fun and enjoyable. Additionally, interns and residents are provided with their own individual subscriptions to MKSAP digital as well as NEJM Knowledge Plus to further enhance their learning and medical knowledge.

Mentoring Program:

Each of our interns is assigned a faculty advisor and the first meeting occurs during the Intern Mentorship Luncheon. This luncheon occurs 2-3 times a year, but faculty advisors are interns are encouraged to continue to meet periodically throughout the course of internship year. The first meeting usually involves discussions regarding how the interns are transitioning from medical student to house staff. It is also an opportunity to explore what fears, struggles and ultimately what goals the intern may have. The faculty advisor uses this occasion to provide insight and support to the intern to help make this a smooth transition. Throughout the rest of the academic year, these meetings focus on the personal and professional development of the interns and their achievement of professional as well as personal milestones. The faculty advisor will also help the intern choose an appropriate subspecialty mentor if needed. During the second and third years, the faculty advisor along with the subspecialty mentor if selected, will continue to guide and mentor the resident to help them achieve his or her specific goals.

Research Opportunities:

Our residency program provides all residents with opportunities to learn about the research process and develop skills in the areas of quality improvement, evidence-based medicine, and research. Abundant opportunities for elective rotations are available at Norwalk Hospital and its affiliated hospitals such as Yale and Sloan-Kettering for residents interested in research. Many of our residents present their work at national or regional professional meetings. We also offer a formal research curriculum which includes research seminars that are conducted throughout the year and review fundamental principles of the research process. This is complemented by educational research modules that are available to all trainees. The residents also have access to the research department that provides them guidance for their projects and also with statistical analysis support.

Simulation & OSCES:

Norwalk Hospital’s brand new Advanced Learning Center, is a large, bright and airy space and popular resident hang-out that houses the library, learning spaces geared towards group and individual study, and our state-of-the-art Simulation Lab. The Simulation lab is used at least weekly to provide our interns and residents with a fun, interactive and educational experience both in regards to practicing their skills with running and participating in mock codes, but also with practicing management of rapid response scenarios that are encountered on the medical floors. Our program offers a carefully crafted simulation curriculum with the goal of mastery and graduated difficulty to keep learners engaged and growing in their skills. Other important elements such as team work, closed-loop communication, ABG and CXR interpretation are also a focus of attention during simulation education. Residents also participate in OSCES annually, often with the focus on communication skills as they relate to patients, patient families and how to initiate and navigate difficult or sensitive conversations.

Vascular Access Curriculum: 

We provide a formal vascular access curriculum for the residents that is led by the pulmonary fellows. The house staff are scheduled with an instructor for sessions in the Simulation Lab where they are instructed on the procedures, policies and then hands-on placement of central lines, arterial lines and peripheral IVs. These sessions are held 2-3 times per week early in the academic year with the frequency decreasing as the house staff become more comfortable in their skills.

POCUS:

Norwalk Hospital was one of the first in the network to develop and implement a point-of-care ultrasound (POCUS) program specifically for the internal medicine residency program. This program was designed to provide internal medicine residents with a thorough understanding and hands-on skills in bedside ultrasonography. A POCUS elective with a dedicated curriculum divided by organ systems is also available to residents and tends to be one of our most popular electives! Residents are also taught POCUS protocols such as RUSH, Blue Protocol, and DVT protocol. Articles regarding these evidence-based protocols are also reviewed and discussed during didactic sessions. Residents start their mornings while on the POCUS elective in the Sim- lab, learning fundamental skills, identifying structures and learning probe movements on the POCUS-simulator. Then the experience moves to the bedside of actual hospitalized patients, on the general medical floors and the ICU.

Residents have access to online POCUS modules, in addition to simulators in the form of POCUS-enabled mannequins, as well as actual patients both on the general medical floors and the ICU.

Additional Academic Resources for Residents Include:

  1. Weekly Noon Conference dedicated to EKG interpretation led by our in-house electrophysiologist
  2. Weekly Grand Rounds
  3. Global Health Elective
  4. Generous Annual Educational Stipend
  5. Abundant elective choices available to residents at Norwalk Hospital and the program affiliates, Yale and also Memorial Sloan-Kettering Cancer Center

How to Apply

We accept all Applications through the ERAS only and participate annually in the NRMP Match Program.

Program Requirements

All applications to the Norwalk Hospital Internal Medicine Residency Program, which is fully ACGME accredited, will only be accepted through the Electronic Residency Application Services (ERAS). The ERAS website can be located at http://www.aamc.org/students and we participate annually in the NRMP Match Program. We thank you for your interest in applying to our program!

For the 2022 ERAS® cycle, our program will be participating in the supplemental ERAS application offered through the AAMC’s ERAS program. Applicants will be required to complete the MyERAS application, and participation in the supplemental ERAS application is optional but encouraged. The purpose of the supplemental application is to provide a more balanced and whole view of applicants as it helps further highlight your experiences through your educational journey.

Requirements for Application: The following items must all be submitted through the ERAS application website:

  • Current Curriculum Vitae
  • Dean’s Letter/MSPE
  • 3 Letters of Recommendation
  • Personal Statement
  • Medical School Transcripts
  • USMLE Step 1 CK or COMLEX Level 1 Score
  • USMLE Step 2 CK or COMLEX Level 2 CE Score

Additional Requirements for International Medical Graduates:

  • All of the above requirements
  • US. citizen or permanent residency preferred
  • J-1 Visa’s and H1-B Visa’s will be considered
  • ECFMG Certificate
  • Recent US clinical experience is preferred

Important Dates

All applications must be submitted and completed by November 15, 2021 in order to be considered for review. Early applications are strongly encouraged.

Candidates selected to interview will be notified by email invitation only. Interviews will take place during select dates in October, November, and December, and potentially January.

A variety of interview dates to choose among will be provided to the candidates who were selected to interview.

All interviews will be conducted virtually this year.

FAQs

Our frequently asked questions page is the place to find the answers to your common questions regarding the Norwalk Hospital Internal Medicine Residency and Fellowship Programs affiliated with the Yale University School of Medicine.

What are the special aspects of the Norwalk Hospital Internal Medicine Residency?

How do you prepare residents for the Internal Medicine Boards?

Does Norwalk Hospital have a night float system?

Vacation!!! Vacation!!! Vacation!!! How much?

What is the conference schedule like for the medical residents?

How often am I on-call overnight?

Do I have to work every day during certain rotations?

Where have your recent graduates gone? Can I get a prestigious fellowship after completing this residency?

What is the role of residents in residency program decision-making?

Is there special attention to transitions from one year to the next?

When do residents rotate to Yale?

Is it possible to do outside electives at any other location than Yale?

What kind of research opportunities are available at Norwalk Hospital?

Q: What are the special aspects of the Norwalk Hospital Internal Medicine Residency?

A: Our faculty and residents have:

  • All the benefits of an individualized and personalized educational experience that comes from being in a community hospital setting, and the world-class opportunities that come from our affiliation with Yale.
  • Participated in the creation of the Norwalk Community Health Center, a Federally Qualified Health Center committed to medical education
  • Monthly resident-faculty meetings which facilitate increased resident participation in residency program development
  • Created and sustained multiple research projects on topics such as hypertension, diabetes, pulmonary embolism, syncope, viral hepatitis and anesthesia use for gastrointestinal procedures
  • Won awards for presentations at the regional and national American College of Physicians Annual Meeting as well as at other regional and national specialty meetings
  • Career mentoring including a structured mentorship program
  • An annual Leadership Skills Retreat for rising PGY-2 residents
  • Implemented multidisciplinary rounds on the medical inpatient service to facilitate medical care and residents’ systems-based learning
  • Involvement in community activities and health fairs to promote health education and wellness

Q: How to you prepare residents for the Internal Medicine Boards?

A: Our educational and clinical experience prepares residents well for the Internal Medicine Boards. The core conference schedule focuses each month on specific organ systems delivered by full-time faculty and speakers from Yale. The annual in-service exams are reviewed with the Program Director to aid studying. There are weekly board review sessions provided by attending physicians and chief residents.

Q: Does Norwalk Hospital have a night float system?

A: Yes. Norwalk Hospital’s Internal Medicine Residency has night float systems in place for the general inpatient service and in the ICU for interns. For Team Care (general medical floor), there is a night float intern handling cross coverage seven days a week for all teams from 7:30 p.m. to 7:30 a.m. Each intern has 1-2, two-week blocks on this rotation. A senior medical admitting resident night float has been in place for many years with the on-call Team Care resident returning home to sleep every night.

Q: Vacation!!! Vacation!!! Vacation!!! How much?

A: House staff get four weeks of vacation per year. Maternity and paternity leave are also available.

Q: What is the conference schedule like for the medical residents?

A: There are many different conferences each week for the residents to attend. Core conferences are attended on all rotations, and there are specific additional teaching conferences during Team Care and Ambulatory rotations. There are weekly Grand Rounds and four lunchtime resident-oriented conferences per week. Core conferences are teleconferenced between the hospital and NCHC with participation of residents and faculty at both sites at lunchtime with food provided. There are also subspecialty conferences.

On Team Care, resident report is an integral part of inpatient medical education. The first-year residents on Team Care attend a special intern report once a week. Second- and third-year residents attend resident report four times a week. Furthermore, on Team Care, there are daily Attending Rounds, except for Thursdays. In the Critical Care Facility, there are daily ICU and CCU rounds with the Team, which consists of four first-year residents, two second-year residents, one third-year resident, a Pulmonary/Critical Care fellow and an attending from Pulmonary/Critical Care Medicine or Cardiology.

Ambulatory conferences, as well as special courses on physical diagnosis skills, patient interviewing, quality improvement and evidence-based medicine are provided during the ambulatory block rotation.

Q: How often are you on-call overnight? 

A: On-call varies by residency year and the service that you are on. Our on-call schedule varies by rotation.

  • First Year: No overnight call on the general medical service. On average, interns do four weeks of night float on the general medical wards. While in the ICU, interns do 2-4 weeks of nights over the course of intern year.
  • Second Year: No overnight call on the general medical service. While in the ICU, overnight call is every third night.
  • Third Year: No overnight call on the general medical service. While in the ICU, overnight call is every third night.

Q: Do I have to work every day during certain rotations?

A: No. Even during the busiest rotations, you will get on average of at least one day off every week.

Q: Where have your recent graduates gone? Can we get a prestigious fellowship after completing this residency?

A: For the past several years, many of our graduates have entered fellowship programs, with other graduates entering practice or research positions at major institutions. Our track record for fellowship placement is outstanding.

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Q: What is the role of residents in residency program decision-making?

A: There is a longstanding monthly interactive Resident-Faculty Meeting, which provides a forum for input and review of changes planned for the residency.

Q: Is there special attention to transitions from one year to the next?

A: The Department of Medicine faculty and staff are devoted to the promotion and well-being of our residents. Besides mentoring, we have formalized a retreat for interns becoming PGY-2 residents and meetings for residents in each year to enhance leadership and cohesiveness.

Q: When do residents rotate to Yale?

A: PGY-2s and PGY-3s rotate to Yale for electives. Usually this includes a month at the PGY-2 level and up to three months at the PGY-3 level.

Q: Is it possible to do outside electives at any other location than Yale?

A: Sometimes PGY-2 or PGY-3 residents make special arrangements to do electives in a different part of the country where they are planning to move for fellowship or private practice. In addition, residents who are interested in hematology-oncology may apply to do a month long rotation on the leukemia service at MSKCC in New York City.

Q: What kinds of research opportunities are available at Norwalk Hospital?

A: As outlined in the previous section, Norwalk Hospital has a strong commitment to scholarly activity. Residents are currently active in studying the diagnosis and treatment of hypertension, diabetes, anemia evaluation, pneumonia, syncope and others. Many opportunities exist to join projects underway; however, there is more than enough help here at Norwalk to start your own!

For those interested in “bench” research, there are also numerous opportunities at Yale to work with cutting-edge physicians nationally known for their subspecialty work. Special research blocks are given to interested residents who wish to pursue these opportunities.