Residency Program

Thomas Hospital Internal Medicine Residency

Ten PGY-1 residents are selected each year for the Thomas Hospital Internal Medicine Residency program. In addition to core Internal Medicine clinical training, the program emphasizes integration of new technology including bedside ultrasonography, simulation lab training, a telemedicine rotation and a rotation with the Associate Program Director, Dr. Darren Scroggie who is board-certified in medical informatics. All robust Epic functionalities will be taught and emphasized. Faculty will critique bedside examination and interview skills many of which were passed down from various Masters of the American College of Physicians. The Morbidity and Mortality Conference and Journal Club conferences will inculcate the use of evidence-based medicine and the development of critical thinking skills. Harrison‘s Textbook of Medicine is the premier internal medicine reference and was developed at the University of Alabama and the University of Utah under Dr. Tinsley Harrison and Dr. Maxwell Wintrobe where several of our faculty trained. This text will be utilized extensively in the didactic lecture series with broad coverage over an 18 month period. 

ROTATIONS 

Sixty percent of the resident’s time is devoted to two ward services as well as emergency medicine electives at Thomas Hospital and North Baldwin Infirmary with teaching divided between the 25 hospitalist staff members and the Core Faculty ward attending. The remaining time is devoted to the ambulatory care clinic experience at the Morphy Continuity Clinic under the direction of Dr. Bill Goetter and outpatient internal medicine rotations and sub-specialty electives at the Diagnostic Medical Center (75 physicians and sub-specialists). Additionally, there are state of the art new ambulatory clinics in Saraland (Northside Clinic), Hillcrest Clinic, and yet another 75,000 square-foot facility under construction in Baldwin County (Malbis). These facilities all have on-site comprehensive imaging capabilities as well as adjacent free-standing Urgent Care services.

Our residents rotate through these facilities for subspecialty and ambulatory care experience.

 

CONFERENCES

Grand Rounds are given every Thursday at 7 a.m.

The Morbidity and Mortality conference is given at noon every other Wednesday and includes interactive case discussions emphasizing the integration of multiple diagnoses, symptom and physical findings, history, laboratory and imaging results as well as literature input. Critical thinking is emphasized and there is a vigorous exchange of management approaches from core faculty members participating in these discussions.

Journal Club consists of one presentation weekly by OMS-3 students. Articles from the New England Journal of Medicine, the Annals of Internal Medicine and JAMA are usually reviewed. Evidence-based medicine is introduced in the inaugural Journal Club lecture reviewing the Cochrane report which stresses the important differentiation between peer-reviewed articles with statistical methodology versus internet “searches” which may support a specific agenda.

Morning Report is at noon on Mondays and reviews admissions and important updates from the previous weekend. 

Didactic Lectures are presented at noon on Tuesdays and Thursdays in a lunch and learn format, going over the table of contents from Harrison’s textbook of medicine (approximately 5 chapters/week and then resuming again in 18 months).

POCUS (Point of Care Ultrasound) Workshops and Pharmacy Fridays (led by a PharmD) are conducted on a biweekly basis on Fridays at noon. The pharmacology lecture includes an examination of drug-drug interactions, utilization of EPIC tools relating to medication reconciliation and dosing based on metabolic parameters, body weight, surface area, etc. Pharmacogenetics, drug fate and metabolism are reviewed, and there is an emphasis on antibiotic stewardship and newer biologic mediations.

Although interns are the primary doctors in the inpatient setting senior residents and faculty provide close supervision so that safety of care is constantly subject to supervisory interaction and feedback.

 

 

WARD TEACHING ROUNDS

Since involvement and respect for the multidisciplinary team members is such an important element of effective and safe patient care, the residents are instructed and encouraged to do a pre-conference huddle with the various team members during which the input from all team members is solicited so that on subsequent patient rounds the use of excessive medical jargon at the bedside can be minimized. A model for this activity is our 7 a.m. Safety Huddle which involves all members of the hospital team.

 

 

ACADEMIC TEACHING ROUNDS

Academic teaching rounds are Tuesday-Friday at noon and focus on new admissions.

WELL-BEING

Resident/physician burnout is an important concern to all training programs and is addressed in multiple ways. Advanced skills in the use of Epic hopefully will show ways to reduce the average daily click count from 7000 which has been reported in various internal medicine clinics to half that through focused attention and education by the informatics team. Scrutiny of resident notes will be part of this process to identify non-essential tasks and have them reassigned to paramedical staff (this activity is one of the core skills called “systems-based review” and can enlist residents and students in this discovery process). Subject matter mastery contributes to wellness (see Siddartha Mukherjee’s editorial in the NY Times), and this is one approach which our program has addressed through the emphasis of educational conferences, “one on one” teaching, feed-back drills and mentorship programs. A regularly scheduled Townhall meeting with residents and faculty as well as a resident’s retreat/picnic which are provided during the fall and spring provide an opportunity for more informal discussions of the program’s aims, goals and methods. Dr. Holly Pursley, who has experience in developing programs with good work-balance, will assign mentors to meet regularly with residents and will look to make programmatic changes so that this important goal is addressed.

 

Location

Thomas Hospital is located in Fairhope, Alabama, a small, charming town that carries the honor of being named one of Southern Living's best towns in the South. Fairhope is located on the eastern shore of Mobile Bay and is known for its walkable downtown, laid-back atmosphere and excellent public, private and parochial schools. Residents enjoy the superb location. In addition to the beautiful walking trails on the bluffs overlooking the Mobile Bay, the 11-mile commute to Mobile offers the advantages of a metropolitan city and the 45-minute drive to the sandy shores of the Gulf of Mexico make for a great weekend or evening adventure. Sailing, hunting and fishing are popular sports, but if you want to take it easy and relax, grab a chair and take in one of the spectacular sunsets Fairhope has to offer.

 

COVID-19

At Thomas Hospital, medical students are actively involved in COVID-19 patient treatment and drive-thru screenings. Physicians at Mobile Infirmary treat 80% of patients with COVID-19 in Mobile County and Thomas Hospital physicians treat more than 95% of patients with COVID-19 in Baldwin County, 50% of which are ICU stays.

For more information about the Internal Medicine Residency Program at Thomas Hospital, email imresidency@infirmaryhealth.org or call

Ana Peters
ana.peters@infirmaryhealth.org
251-279-1529

.