As an ACGME-accredited internal medicine residency program, our curriculum and clinical training experiences will 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 structure allows residents to develop a solid foundation in internal medicine with the flexibility to tailor your experiences as a second- and third-year resident to prepare you best for your future career choice.

PGY1

PGY2

PGY3

The Nuvance Health Categorical Internal Medicine Residency Program structure is a three-year program in which our residents usually spend 4 weeks on a given assignment (for example medicine wards or ICU), 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 the resident to focus on learning from the rotation they are on at the time and gives protected time to the ambulatory experience to develop longitudinal relationships with patients.

In the above example, 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; and the pattern continues with Dr. Catanese and Dr. Deighton. These four individuals together comprise the continuity clinic “firm.”

Firms are an additional benefit to 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 the subspecialties with which a well-rounded primary care physician should be familiar. We have asked our subspecialty faculty to make sure that during the rotations the residents become familiar with common medical conditions in their field but also learn to identify the “red flag” things that would trigger a consult to a specialist on either 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 ophthalmology, wound care, 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 of their choosing or at another primary care site. Also, they have protected time during their ambulatory weeks to design, develop and implement their required scholarly project.

Ambulatory Activities:

*PGY2s and PGY3s have one specialty session in an area of their choosing and 3 sessions for participation in scholarly activities in lieu of the 4 specialty clinic sessions when on ambulatory week.

Example Ambulatory Week Schedule:

Continuity Clinic

Poughkeepsie Primary Care, a Nuvance Health Medical Practice, serves as one of the continuity clinic sites for our residents and is conveniently located adjacent to Vassar Brothers Medical Center.  Starting in July 2021 we also have a continuity clinic site at the Castlepoint VA which is located 13 miles south of Vassar Brothers Medical Center. Residents are assigned to one site or the other for their primary care experience over the three years. Ultimately there will be 9 residents at the Poughkeepsie site (3 residents from each post-graduate year) and 6 residents at the Castlepoint VA site (2 residents from each post-graduate year). Both sites serve a diverse population of patients in terms of demographics, socioeconomic status, ethnicity, language, and payer mix.  Residents are encouraged to provide high value, high quality care and 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.  There is great emphasis placed on the importance of preventive medicine, patient education, communication skills, and patient and resident satisfaction.

Ambulatory Firms

Continuity is a key principle to successful patient care and, as such, we go to great lengths to ensure the patients are scheduled for their resident primary care providers for routine visits; however, residents are not always available to address their ambulatory patient’s 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 EMR to ensure their patients receive the best care no matter what rotation on which they are currently rotating.

Panel Management

Panel management is a proactive approach to healthcare delivery that aims to ensure that 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, at the Poughkeepsie site, 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 in order to provide better coordinated care, remain informed and engaged in their patients’ health, improve patients’ clinic outcomes while reducing healthcare costs, and increasing the promotion of preventive medicine by closing care gaps identified. At the Castlepoint VA, panel management is incorporated into each of the continuity clinic sessions. Patients and their resident primary care providers are encouraged to regularly communicate with each other via the EMR.   Residents will 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, which often inspires quality improvement projects.

Specialty Clinic

Residents participate in high-yield specialty experiences guided by expert attending specialist providers throughout the Nuvance Health network. First year residents based at the Castlepoint VA will also do subspecialty rotations there during their ambulatory week both in internal medicine and non-internal medicine-based specialties to develop the skillset of a well-rounded internist. Second- and third-year residents can 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.  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, in 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, engage in 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), discuss the 2020 American Diabetic Association guidelines for the pharmacologic treatment of type 2 diabetes guided by representative MKSAP questions, and complete the corresponding Yale Curriculum modules.

Inpatient Medicine Afternoon Report
Afternoon Report is a case-based conference which allows residents and faculty to 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 the resident is on medicine wards.

Subspecialty Teaching

On Tuesday and Thursday mornings during inpatient wards, the ward team meets in small groups of around 6 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 the residents have participated in these sessions. These sessions not only allow the residents to learn skills best taught in such an environment like interpretation of EKGs or understanding non-invasive ventilation options, but it also gives you unique access to subspecialty attendings which naturally fosters collegiality and mentorship which is 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 BIPAP machine being wheeled down the hall by the pulmonologist to have the residents learn how to set it up and what the mask feels like.

Noon Conference Series
Our General Internal Medicine Noon Conference Curriculum is the core of our academic and didactic series. Taught by board-certified internists and subspecialists, the curriculum is designed to provide residents to a wealth of topics and cases which 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 care 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 a variety of 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 on a monthly basis and are presented by residents with a faculty mentors’ guidance. Topics are decided 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 the opportunity to identify system errors. The faculty mentors facilitate the discussion based on the topic with a focus on approach to root cause analysis.

Residents’ Journal Club
As a 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. He/she partners with a subspecialist/internist for development of the topic review and with our Associate Program Director, Dr. Valerie Cluzet, to critically appraise the study, and then presents the appraisal to his/her peers and faculty during noon conference.

Clinicopathologic Conference (CPC)

Each month we have a CPC conference where a resident presents a case to the rest of the residents as well as to a panel of experts including subspecialists and pathologist. We have explored fascinating clinical cases and extracted salient teaching points.

Tumor Board
The purpose of the Health Quest Tumor Board is to educate multidisciplinary physicians and ancillary staff who treat or manage cancer patients. Cancer conferences improve the care of cancer patients by contributing to the patient management process and outcomes, and by providing education to physicians in attendance.

Board Review
Board review is incorporated into noon conference at least weekly as well as into weekly medical knowledge “Jeopardy” games. Additionally, residents are provided with access to Rosh Review and also have a generous stipend to reimburse 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 some residents may choose to attend board review conferences offered nationally.

Nuvance Health Residency Joint Program Lecture Series
The Joint Program Lecture Series will occur on a quarterly basis 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 will be hosted by the GME office and invited speakers will present. Topics include, but are not limited to:

• Fatigue
• Stress and depression
• Substance abuse
• Disruptive behavior
• Burnout
• Boundary violations
• Impairment
• Instructive feedback

ABIM In-Service Training Exam
Residents’ medical knowledge and clinical reasoning is benchmarked for measuring 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 can work closely with program leadership to improve study habits and test taking skills so that their confidence improves over the three years well in advance of 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.

Point-of-Care Ultrasound (POCUS)

In response to overwhelmingly positive feedback from our residents about the POCUS elective, we have added it as a standing 3-week rotation for all our third-year residents. POCUS education is also supplemented by monthly didactics in our noon conference series and through practical application during patient care.

The goal of the internal medicine scholarly activity curriculum is to advance each resident’s knowledge of the basic principles of epidemiology and clinical research, including how it is conducted, evaluated, explained to patients, and applied to patient care. Understanding and appraisal of the medical literature is critical to providing evidence-based care. All residents in the Nuvance Health Internal Medicine Residency Program are provided opportunity for, and are fully supported in scholarly activity, including research, quality improvement (QI) and medical education pursuits. Two of the Associate Program Directors, Dr. Valerie Cluzet and Dr. Becky Mazurkiewicz, mentor all residents in the development and conduct of scholarly activity projects that reflect each resident’s interests and career goals. Dedicated time for scholarly activity is provided during continuity clinic weeks for second- and third-year residents with additional elective time available. Rotation-specific curriculum is provided to residents with goals and objectives, requirements, and expectations for the rotation.

We require each resident to complete a minimum amount of scholarly activity which may include research publications, case reports or case abstracts, internal quality improvement projects, teaching presentations, etc. Additional participation by residents above the minimum requirements are highly encouraged. During their residency, the class of 2022 completed 5 research projects published in peer-reviewed journals, 29 research abstracts accepted for presentation, 12 case reports accepted for publication in peer reviewed journals and 145 case report abstracts accepted for presentation at international, national, and local conferences. As of Fall 2022, the class of 2023 has had 8 research abstracts accepted for presentation, 13 case reports accepted for publication in peer-reviewed journals, 128 case abstracts accepted for presentation at local, national, and international conferences, 8 quality improvement projects completed, and 55 teaching presentations created and delivered.

The Nuvance Health Internal Medicine Residency Program at Vassar Brothers Medical Center (ACGME 1403500932, NRMP# 2183140C0) thanks you for your interest in applying to our program. We are an ACGME accredited internal medicine residency who was given full continued accreditation status in January 2021 and is valid for a period of 10 years. We accept all applications through the ERAS only and participate annually in the NRMP Match Program. We hope you choose to join us.

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.

Requirements: The following items are required for consideration of interview. All items must be received through ERAS application portal:

• Personal Statement
• Current CV
• 3 Letters of Recommendation
• USMLE Step 1 Pass or COMLEX Level 1 Score
• USMLE Step 2 CS or COMLEX Level 2 PE Score (we understand that due to COVID-19 and USMLE changes some people may not have been able to take CS or PE)
• USMLE Step 2 CK or COMLEX Level 2 CE Score
• MSPE (Dean’s) Letter

Timeline: We will interview candidates during select dates in October, November, and December. Exact dates will be provided to the invited residency applicants via email notification.

We will have two live virtual overview sessions to provide you with program information and answer any questions you may have early in the application process.

You are invited to a Zoom meeting.

When: 9/29/22 5:00 PM Eastern Time (US and Canada)

Register in advance for this meeting:

https://nuvancehealth.zoom.us/j/99794386571?pwd=WkdON3ppVGtyNDlRaWdOUWM5dUNvdz09 

When: 10/19/22 5:00 PM Eastern Time (US and Canada)

Register in advance for this meeting:

https://nuvancehealth.zoom.us/j/99110420362?pwd=dDhYZmxnaVF0ckhObjFlNitueElBUT09

After registering, you will receive a confirmation email containing information about joining the meeting.

After reviewing applications in ERAS we will send out invites via e-mail with available dates for interviewing. All interviews will be done virtually for the 2022 interview season.

What to expect for the interview day? We do our interviews via Thalamus. You will meet in small groups with the Program Director, and you will have two interviews with other faculty members. You will also speak with the residents in breakout sessions.

In addition to your interviews and breakout sessions, we run a parallel Zoom for you to join when you are not in an interview which provides a lot of information on the area, the program, and the opportunities here.

Post-interview communication: We are available for any questions that may arise after your interview day. Please free to reach out to the program managers, Nancy Hebrank, Alexandra Belmonte or Kecia Edwards at VBMCIMRecruitment@nuvancehealth.org and to the chief residents at VBMCInternalMedicineChiefs@nuvancehealth.org if you have any lingering questions during this often chaotic time. Please do not feel obligated in any way to provide a thank you note to any of our faculty. Our policy is to not provide any communication to you regarding ranking or fit or preference.

We have our own internal medicine residency wellness committee which has a dedicated budget to support wellness activities. Previously our residents have participated in team building activities such as, mini-golfing, bowling, painting night, Lego building competitions and so much more. We have an annual resident wellness retreat. We incorporate wellness into many of our daily activities including guided meditation and gratitude sessions. We have monthly noon conferences dedicated to wellness and organized by the wellness committee leadership.

We also ensure that our residents average weekly duty hours are well under 80 hours by creating a schedule and admitting cap to allow residents adequate time off to focus on developing a work-life balance.

Academic Hospitalist and Core Faculty at Northeast Georgia Medical Center, GA

Chief Resident, Nuvance Health, Vassar Brothers Medical Center, Poughkeepsie, NY

Core Faculty in ambulatory medicine at WellStar Internal Medicine Residency Program, Atlanta, GA

Endocrinology Diabetes & Metabolism Fellowship at UMass Baystate, Springfield, MA

Hospitalist at Garnet Health Medical Center, Middletown NY

Hospitalist at Guthrie Robert Packer Hospital, PA

Hospitalist at Long Island Jewish Forest Hills, Long Island, NY

Hospitalist at Medstar Georgetown University Hospital in Washington, DC

Hospitalist at Nuvance Health, Vassar Brothers Medical Center, Poughkeepsie, NY (2)

Hospitalist at NYU Long Island Community Hospital, NY

Hospitalist at St. Luke’s University Hospital, Bethlehem, PA

Hospitalist at Washington University School of Medicine, St. Louis, MO

Infectious Disease Fellowship at Dartmouth-Hitchcock Medical Center, NH

Infectious Disease Fellowship at Rutgers New Jersey Medical School, Newark, NJ

Medical Genetics Fellowship at University of California San Diego, CA

Medical Oncology Fellowship at East Tennessee State University, TN

Nephrology Fellowship at George Washington University Hospital in Washington, DC (2)

Nephrology Fellowship at MedStar Georgetown University Hospital in Washington, DC

Primary Care, Swedish Health, WA

Pulmonary and Critical Care Fellowship, Albany Medical Center, Albany, NY

Pulmonary and Critical Care Medicine Fellowship at Louisiana State University School of Medicine, New Orleans, LA

Rheumatology Fellowship at Albany Medical Center, Albany, NY

Rheumatology Fellowship at Houston Methodist, Houston, TX

Our overall two main drivers are to provide phenomenal patient care and to pursue excellence in education. As a program our aim is to build better health for our community by training leaders in the delivery of high quality, compassionate healthcare for a community rich in cultural, economic, gender, racial and physical diversity.

PROGRAM HIGHLIGHTS

• A “4+1” training model that allows residents to spend one week fully dedicated to continuity of care for their primary care patients in between four-week blocks assigned to a given rotation
• Team-based training with direct patient care and progressive responsibility as residents advance through the program
• Diverse training program with specialty experiences in neurology, critical care, cardiology, endocrinology, pulmonary medicine, geriatrics, rheumatology, point-of-care ultrasound, palliative care and more.
• Daily didactic training exploring topics such as basic sciences, clinical practice, medical ethics and research methods
• Committed, passionate, diverse faculty
• A mentorship program to facilitate professional and personal growth and provide support throughout training
• All residents participate in scholarly activity and/or quality improvement projects
• Emphasis on resident well being

During the first year of training interns care for patients in the emergency department, ICU and medical floors at Vassar Brothers Medical Center, a large tertiary care facility with high patient acuity. They will also be introduced to the Academic Practice where they will provide care for their own panel of patients with their precepting attending faculty. They will work directly with a co-intern, a senior resident and attending physician. Each intern will present at journal club.

During the second year of training, residents will gain experience leading the medical team under the close supervision of their attending physician as they have progressively more independence. Rotations in geriatrics, neurology and outpatient hematology/oncology as well as ample elective time give residents the opportunity to grow their breadth and depth of knowledge tailored towards their future career goals. Residents will design, develop and start to implement their scholarly project.

During the third year of training, residents will gain progressive independence and will solidify their clinical knowledge in more challenging roles with triage and consults developing leadership skills and increased patient care responsibilities. Third-year residents take the lead on cases, and will act as clinicians, leaders and teachers. Third-year residents will also have several elective opportunities to guide their own training path and prepare for the next stage of their career.

Why should I come to the Hudson Valley for residency?

It’s beautiful here! It is lovely to enjoy four seasons with apple-picking and hiking with brilliant, colorful foliage in the fall; skiing, sledding, snowboarding and ice skating in the winter; more kayaking and biking in the spring, and enjoying swimming, outdoor concerts, drive-in movie theaters, water parks and more in the summer. We have fantastic restaurants with the Culinary Institute of America 10 minutes away from the hospital and we benefit from a lot of their graduates settling locally. We have multiple local colleges and universities which provide an array of cultural opportunities – the initial Hamilton was workshopped at our very own Vassar College by Lin Manuel Miranda and is known as the Hamilton Mixtape! There is something for everyone here. Within a 30 minute drive you can explore the cities of Poughkeepsie, Beacon, New Paltz, Rhinebeck and Kingston; you can head to  the surrounding suburbs to shop at the malls or local stores and enjoy activities like the hot air balloon festival, the Great Jack-O-Lantern Blaze or sunflower festival. You can participate in local farm shares or go horseback riding. For the ultimate city experience, we are only a 1.5 hour train ride along the picturesque Hudson River to get to New York City. It is nice to train in a place where you can see people as much or as little as you like during your time off.

How are you preparing your third-year residents for independent practice/applying for fellowship?

We want all of our graduates to have the freedom to pursue the career of their choosing. We meet with our residents who are interested in applying to fellowships and discuss the nuts and bolts of the process including a separate session on how to write a CV and another on how to ask for letters of recommendation and suggestions for interview days. We also provide our residents the opportunity to do a mock 1:1 interview with a faculty member. We also allow residents to do elective rotations elsewhere to explore programs which may be of interest to them in their fellowship pursuit. We have a curriculum for our residents on the business of medicine including coding and billing, evaluating opportunities in primary care and hospital medicine, navigating the recruiting process and what to look for in a contract.

Will I be able to work with medical students?

Yes! We have rotating MS3 and MS4 from Touro School of Osteopathic Medicine in Middletown rotating on many of the medicine rotation. There are also PA students from Marist College as well as MS4s who rotate from other medical schools.

What has been the impact of COVID-19 on the residents?

We have been fortunate that we have been able to quickly adapt to the pandemic. In the spring of 2020, we only had our inaugural intern class here and for the first wave we protected the residents from exposure to the virus given how little was known about it at the time and out of concern for PPE. Fortunately, we never were in a situation where we did not have the appropriate PPE and for the second wave, residents worked alongside the attendings to care for our patients with COVID-19 both on the medical floors and the COVID-19 dedicated ICU we needed to open up. At our peak we have had around 100 patients with COVID-19 in Vassar Brothers Medical Center. Our conferences have very rarely been interrupted though we have had to use a virtual platform to continue the conference series when the numbers are high out of concern for spread of infection. We also have been able to institute telemedicine to provide some of the outpatient care virtually.

Do you have any rotations with 24-hour call?

No. We have a night float system both during medicine wards and ICU so that you never work a 24-hour shift.

What are the rules around vacation?

Residents have 4 weeks of vacation per year. In general, these weeks are broken down into 2 two-week blocks but on occasion can be taken as a 4-week block.

How do you prepare us for the Boards?

We have purchased Rosh Review for all our residents to use for board preparation. In addition, each resident has a generous annual stipend to use for board materials of their choosing. Also, we have board review as part of noon conference series led by faculty and chief residents which helps not only with topic review, but the approach to test questions and developing good test taking skills.