A message from the Program Director
I am honored to be the program director of the Nuvance Health Internal Medicine Residency Program where everything we do is driven by our focus on two things—excellence in education and phenomenal patient care.
Here at Nuvance Health, you have the best of both worlds. We are a young program whose inaugural class started in July 2019. Beginning in July 2021, we will have a full complement of residents. We have been able to build a residency culture from the beginning to meet the needs of modern-day medicine while incorporating techniques to improve resident wellness and work-life balance. We are imaginative and creative, and actively seek out feedback from our residents to help shape and continuously improve the program. However, we also understand that a strong and stable educational structure is essential to allow you to reach your full potential. To that end, from day one of our residency program, it felt like we had been a program for many years. We have incorporated the best of seasoned programs with the ingenuity and agility of the new, which has helped us adapt to challenges like the pandemic and come out stronger together.
Your education is our priority. We understand that there is a great deal to learn in these three years, and we want your time best spent on mastering your clinical and diagnostic skills, communicating with patients and learning about systems-based practice. Our curriculum, faculty, resources and diverse patient population provide an ideal environment for residency training. We are fortunate to have a dedicated, knowledgeable and easily accessible faculty and staff who are committed to your success. We have a wide range of medical pathology comparable to most busy academic medical centers but in a community hospital environment, which makes the residency experience appropriately challenging but also enjoyable. Residents have protected educational time each weekday with a fantastic noon conference series, morning report, subspecialty small-group sessions and ambulatory academic half-days.
We want our trainees to graduate with the preparation and confidence to pursue any of the diverse careers a residency in internal medicine allows, whether it is in primary care, subspecialty fellowship or hospitalist medicine. Our established advising program and mentorship begin early in the intern year to give you the support and resources you need to pursue your goals. We hope that you stay here and join our medical community, but we want you to reach your fullest potential wherever it may be, and are happy to support you to get there.
I hope you will apply to the Nuvance Health Internal Medicine Residency Program. You will gain the professional experience you need and the personal connections you want while enjoying the beauty of the Hudson Valley.
Susan Collins, MD
Nuvance Health Internal Medicine Residency Program
As an ACGME-accredited internal medicine residency program, our curriculum and clinical training experiences prepare graduates to be not only independent practitioners or candidates for fellowship training but also leaders in the field of medicine. By graduation, all residents will receive approximately the same exposure listed below in terms of weeks:
The 4+1 Schedule
The Nuvance Health Categorical Internal Medicine Residency Program structure is a three-year program in which our residents usually spend four weeks on a given assignment (e.g., medicine wards or ICU) and then one full week in the ambulatory setting which includes dedicated continuity clinic time to see an assigned patient panel. This 4+1 structure allows residents to focus on learning from their current rotation and gives protected time to the ambulatory experience to develop longitudinal relationships with patients.
In the example above, Dr. Adams begins his academic year with a four-week rotation on the inpatient medicine orange team. When the fourth week is over, Dr. Adams spends one week rotating in the continuity clinic and in various other internal medicine subspecialty clinics. Dr. Adams then changes to the next rotation, emergency medicine.
Note that as Dr. Adams is leaving the continuity clinic week, Dr. Berkley is coming into her continuity clinic week. The pattern continues with Dr. Catanese and Dr. Deighton. These four individuals together comprise the continuity clinic “firm.”
Firms are an additional benefit of our program’s structure. Each firm’s cohort of residents acts as practice partners for one another, mimicking the structure of most private group practices. This real-world experience reinforces the skills and competencies required to be fully prepared to successfully practice medicine by the end of training. The Academic Practice faculty are dedicated solely to the education of our residents and precepting their patients.
Our goal is to give our residents exposure to all of the subspecialties that a well-rounded primary care physician should be familiar with since they are often the first physician a patient presents to. We have asked our subspecialty faculty to make sure that during the rotations, residents become familiar with common medical conditions in their field but also learn to identify the “red flag” things that would trigger a consult with a specialist on a routine or urgent basis. In addition to seeing their own panel of patients in the Academic Practice, our interns spend time during the ambulatory week rotating through dermatology, ophthalmology, wound care, gynecology and ENT/allergy/immunology practices. Our second- and third-year residents continue to manage their own panel of patients and establish an additional outpatient continuity clinic site either in a medicine subspecialty practice or at another primary care site. In addition, residents have protected time during their ambulatory weeks to design, develop and implement their required scholarly project.
Continuity Clinic Week Schedule
*PGY2s and PGY3s have one specialty session in an area of their choosing and three sessions for participation in scholarly activities in lieu of the four specialty clinic sessions when on ambulatory week.
Example Ambulatory Week Schedule
P.C. Poughkeepsie Primary Care, a Nuvance Health Medical Practice, serves as the continuity clinic site for all of our residents and is conveniently located adjacent to Vassar Brothers Medical Center. It is a fully academic primary care practice that serves a diverse population of patients in terms of demographics, socioeconomic status, ethnicity, language and payer mix. At this office, every patient is scheduled to see a resident, great lengths are taken to ensure continuity in patient care when scheduling appointments, and the wait time for appointments is very short. Residents are encouraged to provide high-value, high quality care; residents routinely perform appropriate ambulatory procedures for their panel of patients, such as pelvic and breast exams, as well as urgent procedures, such as incisions and drainages, injections and more. The importance of preventive medicine, patient education, communication skills and patient and resident satisfaction is emphasized.
Continuity is a key principle of successful patient care, and thus, we go to great lengths to ensure patients are scheduled for their resident primary care providers for routine visits. However, residents are not always available to address their ambulatory patients’ needs. To ensure continuity in coverage, each resident is assigned to a firm of residents who provide coverage for unexpected patient issues that arise between regularly scheduled visits, such as tasks and urgent appointments. Residents regularly communicate with members of their firm in-person and via our electronic medical record (EMR) to ensure their patients receive the best care no matter what their current rotation.
Panel management is a proactive approach to healthcare delivery that aims to ensure all patients of a given care team receive the necessary preventive services and chronic disease management they deserve, not just those who present for office visits. During the ambulatory week, each resident is given one session (during which they are not scheduled for patient visits) to review their panel of patients, conduct necessary outreach and plan for in-reach at upcoming visits; This session allows residents to provide better coordinated care, remain informed and engaged in their patients’ health, improve patients’ clinical outcomes while reducing healthcare costs and increase the promotion of preventive medicine by closing identified care gaps. Patients and their resident primary care providers are encouraged to communicate regularly with each other via the patient portal. Residents also regularly receive data on the health of their panel of patients as well as their personal performance on key markers of quality patient care, such as the percentage of their patients who are compliant with certain age-appropriate screenings (i.e., breast cancer screening in women age 50-75) and the percentage of their patients who are meeting certain disease-specific goals (i.e., A1c<9 in diabetics). Residents meet with the associate program director for ambulatory education to review this data twice a year to develop action plans to improve the quality of care they provide and often inspire quality improvement projects.
Residents participate in high-yield specialty experiences guided by expert attending specialist providers throughout the Nuvance Health network. While these experiences are assigned to interns, residents have the opportunity to choose their area of specialty to provide additional, focused training congruent with their future career goals.
Ambulatory Academic Half Day
Every Wednesday morning, residents on ambulatory week gather to participate in the Ambulatory Academic Half Day, which includes dedicated workshops, simulations, didactics and case reviews.
Inpatient Medicine Morning Report
Morning Report is a case-based conference during which residents and faculty discuss patient care in an organized and efficient manner. Residents present cases to their peers and faculty with a faculty member as the facilitator. The facilitator uses the information in the resident’s presentation as a springboard for robust conversation and discussion to develop medical knowledge and critical thinking skills with a focus on evidence-based practice and high-value care. Interns and residents have separate morning report conferences to focus on level-appropriate aspects of diagnosis and management. Resident Report is Monday and Wednesday, and Intern Report is every Friday while residents are on medicine wards.
On Tuesday and Thursday mornings during inpatient wards, the ward team meets in small groups of around six residents with a subspecialist attending who does a small group “chalk talk.” This is a revolving curriculum so that by the end of residency all residents have participated in these sessions. In these sessions, residents learn skills best taught in this environment, such as interpretation of EKGs or understanding noninvasive ventilation options. Residents are also given unique access to subspecialty attendings, which naturally fosters collegiality and mentorship, essential for collaboration in the future on scholarly activity or possibly fellowship pursuit. Current subspecialty teaching sessions include GI, cardiology, pulmonary, ID and rapid response team training. It is a wonderful opportunity; It is not unusual to see a pulmonologist wheeling a BiPAP machine down the hall so residents can learn how to set it up and what the mask feels like.
Noon Conference Series
Our General Internal Medicine Curriculum is the core of our academic and didactic series. Taught by board-certified internists and subspecialists, the curriculum is designed to expose residents to a wealth of topics and cases that span the care continuum. There is an initial core curriculum series to make sure that all of the residents learn the typical medical conditions. Other regular conferences include high-value care, health disparities, the business of medicine, career development, clinicopathologic conference, resident as teacher and wellness.
Internal Medicine Grand Rounds
Grand Rounds conference is a platform for faculty and invited speakers to present on various topics, including case-based presentations, research or current relevant topics in the field of internal medicine.
Quality & Process Improvement
Quality & Process Improvement (Q&PI) Conferences, formerly Mortality and Morbidity (M&M), occur monthly and are presented by residents under the guidance of a faculty mentor. Topics are chosen by residents and faculty based on actual patient care cases where a significant system error occurred. Q&PI provides a forum for resident interaction and discussion with attending physicians regarding care that could have been improved, and provides the opportunity to identify system errors. Faculty mentors facilitate the discussion based on the topic with a focus on root-cause analysis.
Residents’ Journal Club
As the first step in learning how to effectively practice evidence-based medicine, interns and residents participate in a weekly Journal Club to appraise a recent study published in the medical literature. Each intern presents at least once at Journal Club. They partner with a subspecialist or internist to develop the topic review and with our associate program director, Dr. Valerie Cluzet, to critically appraise the study. The intern then presents the appraisal to their peers and faculty during Noon Conference.
The purpose of the Nuvance Health Tumor Board is to educate multidisciplinary physicians and ancillary staff who treat or manage patients with cancer. Cancer conferences improve the care of patients with cancer by contributing to the patient management process and outcomes, and by providing education to the physicians in attendance. Residents review and discuss diagnostic studies and learn the best evidence-based processes for implementing treatment plans, which will:
- Optimize outcomes
- Differentiate between diagnosis and follow-up modalities for various cancer types
- Assess available clinical trials
- Review new procedure guidelines, technology and treatment for patients with cancer
MKSAP Board Review
Residents are provided with access to MKSAP. In addition, they have a generous stipend for reimbursement of board review materials of their choosing. Topic-based quizzes are assigned throughout the year to emphasize and practice board-type questions. Board review electives are offered for graduating residents, and residents may choose to attend board review conferences offered nationally.
Nuvance Health Residency Joint Program Lecture Series
The Joint Program Lecture Series occurs quarterly in conjunction with the general surgery and internal medicine residency programs. The lecture series covers GME-wide topics, such as resident fatigue, burnout, resident wellness and other issues. Sessions are hosted by the GME office, and invited speakers present. Topics include, but are not limited to:
- Stress and depression
- Substance abuse
- Disruptive behavior
- Boundary violations
- Instructive feedback.
ABIM In-Service Training Exam
Residents’ medical knowledge and clinical reasoning are benchmarked to measure longitudinal growth through the results of the annual American Board of Internal Medicine In-Service Training Examination. All internal medicine residents complete the exam annually. Results are reviewed individually with the program director to inform discussions and individualization of curriculum and clinical training (e.g., reading material, board prep and electives). Struggling learners have the opportunity to work closely with program leadership to improve study habits and test-taking skills so that their confidence improves over the three years well before the actual board exam.
Academic Half Day
Every Wednesday morning, residents on ambulatory week gather to participate in the Ambulatory Academic Half Day, which includes dedicated workshops, simulations, didactics and case reviews. The designation of this time to educational endeavors ensures our residents get the highest-quality education without the burden of conflicting responsibilities, such as patient care and task completion. The weekly sessions include a workshop or simulation exercise, a didactic discussion and participation in a case-based discussion of high-yield topics in ambulatory medicine as outlined in the Yale Curriculum under a central theme. For example, during the Men’s Health Academic Half Day, residents participate in a simulation exercise regarding the correct performance of external male genital and rectal exams using our life-size full manikin simulator and a case-based discussion of common men’s health issues (such as erectile dysfunction, low testosterone and benign prostatic, hypertrophy) and complete the corresponding Yale Curriculum modules. During the Diabetes Ambulatory Academic Half Day, residents participate in a workshop designed to teach them how to perform finger stick glucose measurements and administer insulin (using actual glucometers, insulin pens and other supplies); residents also discuss the 2020 American Diabetes Association guidelines for the pharmacologic treatment of type 2 diabetes, guided by representative MKSAP questions, and complete the corresponding Yale Curriculum modules.
Research and Quality Improvement Opportunities
The goal of the internal medicine scholarly activity curriculum is to advance each resident’s knowledge of the basic principles of research, including how it is conducted, evaluated, explained to patients and applied to patient care. All residents in the Nuvance Health Internal Medicine Residency Program are provided the opportunity for, and are fully supported in, research and quality improvement (QI) pursuits. Additional research and QI participation by residents above the minimum requirements are highly encouraged. Two of the associate program directors, Dr. Valerie Cluzet and Dr. Becky Mazurkiewicz, mentor all residents in developing and conducting a scholarly activity project, which can be a research or QI project. They guide the residents in research question development, feasibility assessment, background research, study design, Institutional Review Board (IRB) approval, implementation in interventions, data collection and analysis. Residents are also paired with a faculty content mentor for all scholarly activity projects. Dedicated time for scholarly activity is provided during continuity clinic weeks for second- and third-year residents with additional research elective time available. Rotation-specific curriculum is provided to residents with goals and objectives, requirements and expectations for the rotation.
Residents present all research either within the department, locally, regionally or nationally. Each year, the Nuvance Health Graduate Medical Education Department sponsors a Resident Research Day during which residents can present posters and oral presentations on ongoing or completed research topics. Additionally, third-year residents are expected to present a Grand Rounds on their scholarly activity project as part of the Noon Conference Series.
How to Apply
The Nuvance Health Internal Medicine Residency Program thanks you for your interest in applying to our program. We accept all applications through the ERAS only and participate annually in the NRMP Match Program. We hope you choose to join us.
The following items are required for consideration for an interview. All items must be received through the ERAS application portal:
- Personal statement
- Current CV
- Three (3) letters of recommendation
- USMLE Step 1 CK score
- USMLE Step 2 CS score (we understand that due to COVID-19 some people may not have been able to take CS)
- USMLE Step 2 CK score
- MSPE (Dean’s) letter
- COMLEX Level 1
- COMLEX Level 2 CE
- COMLEX Level 2 PE (We understand that due to COVID-19 some people may not have been able to take PE)
We interview candidates on select dates in November, December and January. Exact dates are provided to the invited residency applicants via email notification. The annual schedule generally is as follows:
- September 1: Applicants may begin submitting applications to residency programs.
- October 21: Residency programs may begin reviewing applications, and MSPE (Dean’s) letters released.
- November-December: Interview invitations emailed out.
- November-January: Interviews
- February 1: Ranking opens
- March 3: Rank order list deadline
- March 15-19: Match week
- March 19: MATCH DAY CELEBRATION