On the general medicine—or GenMed—
ward services, residents care for patients
with conditions spanning the entire
scope of internal medicine. On GenMed 2,
residents also round with the liver failure
and transplantation team and manage
patients on their service. There are four
resident teams, each consisting of either
a senior or junior resident paired with
an intern in a one-to-one resident-to intern
ratio. The teams admit on a four day
cycle. Each morning, two resident
teams round with two attending
physicians, usually one hospitalist and
one specialist. The specialist physicians
come from a wide variety of disciplines,
including pulmonology, rheumatology,
nephrology, gastroenterology, and
endocrinology. Residents occasionally
assume responsibility for medically

complex patients under the care of
private specialist physicians; however,
a majority of the patients are under
the direct care of the ward attendings
(and, in the case of GenMed 2, the liver
transplant attendings).

On the solid oncology service, junior
residents care for patients with solid-organ
tumors who present with complications,
including neutropenic fever, spinal cord
compression, malignant e’usions, and
many more. There are two resident teams
that work with one attending oncologist
and one oncology fellow.
On the malignant hematology service,
junior residents care for patients with
hematologic malignancies, including
leukemias, lymphomas, multiple myeloma
and myeloproliferative disorders. Patients
who have received bone marrow
transplants are managed in the new
BMT Unit. Residents become proficient
in the management of neutropenic fever,
tumor lysis syndrome, hypercalcemic
crisis, and blast crisis.

Only a few programs in a handful of
cities have enough clinical volume to run
a dedicated infectious disease service,
caring for patients with HIV/AIDS,
tuberculosis, and other complex
infections. At Columbia, our residents
gain exposure to patients with these
problems on a regular basis when they
rotate through the infectious disease
service during both their PGY-1 and
PGY-2 years. Patients with advanced
AIDS are regularly admitted to the
service, and residents become
experienced with complications such
as pneumocystis pneumonia, cryptococcosis,
toxoplasmosis, CNS lymphoma,
cryptosporidiosis, Mycobacterium avium
infection, and much more. The service
consists of two attendings, three
residents, and three interns working
as a single team and admitting on a
three-day cycle.

The medical ICU is a twelve-bed unit
that cares for the most critically ill and
complex patients in the entire hospital.
Four junior residents and four interns work
together under the supervision of a critical
care attending and fellow. Rounds include
nurses, pharmacists, respiratory therapists,
and other key members of the care team.
Residents and interns admit on a four-day
cycle; the long-call day is a 24-hour shift
which a’ords the unique opportunity to
admit patients and participate in their
entire initial course. Interns perform
invasive procedures, such as insertion
of central venous catheters and arterial
lines, under the supervision of the junior
residents. Housesta’ become proficient
with the management of shock and
respiratory failure, managing pressordependent and mechanically ventilated patients with acute respiratory distress syndrome (ARDS), septic shock, massive gastrointestinal bleeding, acute renal failure, fulminant hepatic failure, and a host of other challenging conditions.

Junior residents spend two weeks on
the neurology inpatient service, one week
on the dedicated stroke service and one
week on the general ward service, refining
their management of conditions such as
stroke, neuromuscular disease, movement
disorders, and seizure disorders.

On the cardiology ward service,
residents care for patients with a
wide range of cardiovascular diseases,
including heart failure, valvular disorders,
acute myocardial infarction, and
dysrhythmias. There are four resident
teams, each consisting of a senior
resident and intern. The teams admit
on a four-day cycle. Each morning,
two resident teams round with two
attending physicians, who include
general cardiologists, interventional
cardiologists, electrophysiologists, heart
failure specialists, and cardiac imaging
specialists. The residents also round with
attendings and fellows from the heart
failure and transplantation program—
the largest and most active in the
United States—and manage patients
on their service.

In the CCU, four junior residents and
four interns work together under the
supervision of two attending physicians
and a cardiology fellow. Rounds include
nurses, pharmacists, respiratory therapists,
and other key members of the care team.
The admitting cycle is the same as in the
medical ICU. Interns become proficient
in the insertion of central venous and
arterial catheters, while junior residents
can participate in the insertion and
management of pulmonary artery
catheters, intra-aortic balloon pumps,
and transvenous pacemakers. Residents
and interns both learn how to manage
patients requiring mechanical ventilation,
continuous venovenous hemofiltration
(CVVH), extracorporeal membrane
oxygenation (ECMO), ventricular-assist
devices (VADs), and other advanced
life-support measures. The on-call CCU
resident is also known as the “code
resident” and is responsible for directing
the management of all cardiac arrests
that occur on the entire hospital campus.

On this service, senior residents function
as hospitalists, caring for a wide range
of patients and learning how to manage
an e¢cient, high-volume inpatient service.
Patients often present with more common
diagnoses than on other services, allowing
residents to become familiar with pathway

driven care that delivers comprehensive, evidence-based therapies while also minimizing length of stay. Four residents work with sub-interns, admitting on a four-day call cycle.

The elective block provides residents at
all levels with several weeks to pursue a
clinical or research opportunity not o’ered
through the regular curriculum. Residents
use this time to write research articles,
rotate through subspecialty or nonmedical
services, pursue education
projects, and much more.

Senior residents spend two weeks on
the medicine consult service, performing
inpatient consultations and preoperative
evaluations for the hospital’s
many non-medicine services. Residents
become the hospital’s medicine experts,
guiding other physicians through the
management of some of their most
complicated patients. Residents spend
the other two weeks as the ICU triage
resident, responsible for evaluating all
patients potentially requiring admission
to the medical ICU. In this capacity,
residents regularly see the hospital’s
sickest patients, perform rapid evaluations,
provide initial recommendations, and
determine whether transfer to one of
the hospital’s MICU beds is warranted.
Two senior residents alternate day and
night shifts, working closely with a
critical care specialist.

Interns and senior residents care for
patients on the general medicine service of
the Allen Hospital, a 196-bed community
hospital located at the northern tip of
Manhattan. The hospital cares for patients
from the underserved populations of
Northern Manhattan, the Bronx, Westchester,
and Northern New Jersey. Two
teams—each consisting of two attending
physicians, one senior resident, and two
interns—round together, admitting new
patients on a four-day call cycle.

Junior and senior residents spend
two weeks working regular shifts in the
Emergency Room, caring for patients
with a full range of medical and surgical
conditions. The adult ER currently
encompasses 25,000 square feet and
accommodates over 200 patients per
day. The rotation o’ers an opportunity
to participate in the management of
surgical, orthopedic, and gynecologic
emergencies. Residents perform twelve hour
shifts under the direct supervision of an ER attending.

This 10-bed ICU is sta’ed by four interns
who are supervised by two senior
residents and an attending physician.
Each day, one of the interns is the “board
resident,” admitting new patients and
deciding the plan of care for those
patients already in the ICU. Each week,
one of the four interns works nights,
admitting patients under the supervision
of an overnight attending. The Allen ICU
o’ers interns an unprecedented level
of responsibility caring for critically ill
patients. The senior residents on service
serve in a fellow-like role, moderating
discussions on rounds and advising the
interns on management decisions. As a
whole, we believe the Allen ICU experience
is one of the most unique educational
opportunities in our program.

Each resident has a continuity clinic with
a panel of patients that they care for over
the three years of residency. Our goal is to
ensure residents develop the knowledge

and skills required to manage acute and
chronic outpatient illnesses, as well as an
enthusiasm for the practice and teaching
of high-quality and high-value health care.
Residents independently perform initial
H&Ps, and then present the cases to
attending preceptors. Preceptors review
the history and physical exam findings,
then help guide the generation of a
diagnostic and therapeutic plan. Residents
can choose to work in one of two primary
care clinics. The multi-subspecialty
Associates in Internal Medicine (AIM)
clinic, our program’s main teaching clinic,
is on campus and houses the practices
of ~120 residents and over 20 attendings.
The Washington Heights Family Health
Center, a community-based clinic on 181st
Street, o’ers the experience of a tight-knit
primary care group practice. Both clinics
are accredited Patient Centered Medical
Homes. During dedicated ambulatory blocks,
interns and residents spend full days in
clinic and have the opportunity to attend
subspecialty clinics including dermatology,
rheumatology, and endocrinology. Daily
didactic sessions review a wide range of
primary care topics, and also cover clinical
epidemiology, quality improvement, note
writing, and physician billing.

The night team is responsible for new
admissions and for cross-coverage of
patients under the care of the day teams.
The night intern receives sign-out from all
of the day interns on a specific service
(i.e. cardiology) and, under the direct
supervision of the junior resident, is
responsible for addressing all acute
issues overnight. The intern therefore
gains experience with the workup and
management of common clinical scenarios,
such as shortness of breath, hypotension,
delirium, and more. The night intern also
admits new patients from the emergency
room under the supervision of the night
resident. The night resident supervises
the intern and performs additional
admissions on his or her own. The
overnight ICU triage resident and service
attendings provide supervision as needed;
however, residents generally find that the
autonomy a’orded during this rotation
helps them rapidly mature into more
sophisticated and confident clinicians.
All new admissions are presented by night
interns and residents on attending rounds
so that residents receive feedback on
overnight management.

This four-week rotation at the Allen
Hospital provides interns with a
comprehensive review of geriatric
medicine, as well as the opportunity to
see patients at home, at nursing homes,
and in the inpatient and home hospice
setting. Interns work directly with Dr.
Evelyn Granieri, Chief of the Division
of Geriatric Medicine and Aging. Interns
deliver formal presentations to their
colleagues about topics and recent
articles in geriatric medicine. They also
visit a recreational center for seniors and
lead a basic discussion about a medical
issue of their choice.

The code team consists of both the
intern and resident on call from the
general medicine (1 & 2) and cardiology
teams. During the call day, they respond
to all arrests called in Milstein Hospital,
the neighboring clinics, and the procedure
suites. At night, all residents respond to
every arrest. The code team is lead by
the junior resident on call in the CCU with
the assistance of the senior resident on
ICU triage.

From Our Residents

Residency at Columbia has given me the opportunity to be part of a system that welcomes diversity and quickly makes you feel at home. It has certainly been a privilege to work in a setting that fosters underserved communities and mediates exposure to treat a wide array of disease in a challenging learning environment driven towards growth as well-rounded physicians while providing high quality patient care.

- Dennis De León, MD 


  University of Puerto Rico 

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