Categorical Medicine

The Categorical Internal Medicine Track comprises 40 interns per year. Around 80% of these residents complete the traditional three years of residency and 20% enter subspecialty fellowship after two years (“short-tracking”). Of the graduating categorical residents each year, approximately 80% go on to complete subspecialty training, with the others focusing on Hospital Medicine, General Internal Medicine, Health Policy or other careers.

The Categorical Track experiences are divided between inpatient care, outpatient care and a variety of clinical, research and other electives, during which residents can choose to enter one of the focused residency pathways.

Inpatient Rotations

Housestaff rotate through several inpatient services including General Medicine, Cardiology, Oncology, ICU and CCU at the main teaching hospital. Other inpatient rotations include General Medicine and ICU care at Faulkner, and General Medicine, Cardiology and ICU at the West Roxbury VA. Each rotation lasts for two weeks, though ITU and some of the off-site rotations are four weeks.

There is a comprehensive curriculum that covers the spectrum of internal medicine topics, cost-effective and quality care, communication and humanism in medicine. Core medicine conferences include (but are not limited to): Morning Report, Intern Workshops, Procedural Simulation Curriculum, Noon Conference Series (Summer-Emergency topics; Fall to Spring-Core topics), Morbidity and Mortality, Clinicopathological Case Discussions (which appear in NEJM), Master Physical Examination Series and Journal Club.

Outpatient Rotations

Each member of the medical housestaff has a weekly outpatient session either at Brigham and Women’s Hospital or at one of the several practice sites throughout the Boston area. The single largest training site is The Phyllis Jen Center for Primary Care Clinic, which is at Brigham. Sites also include several bilingual Spanish-English community health centers, such as Southern Jamaica Plain Health Center as well as other affiliated sites. The housestaff serve as the primary care providers for their patients, working as members of ambulatory care teams along with staff internists, nurse practitioners and secretarial staff. Residents are assigned a preceptor at the beginning of intern year and remain with them for all 3 years to foster mentorship.

In addition to the weekly continuity clinic, residents have five 2-week blocks of outpatient medicine rotation during both their first and second years. During these blocks, the residents participate in an ambulatory didactic curriculum planned over the course of two years to include important ambulatory internal medicine topics. Residents also have additional continuity clinics, see patients in urgent care and rotate through several core sub-specialty rotations and also rotations of their choice. Sub-specialty rotations provide an intensive outpatient clinical experience in core areas such as pulmonology, rheumatology, cardiology, infectious disease, allergy, addiction medicine, etc.

The BWH is proud to feature two primary care training programs for residents with dedicated interest in ambulatory and general medicine, advocacy, epidemiology and health policy.

Rotation Overviews

Residents spend around 2 months per year on the General Medicine, with time split between the Integrated Teaching Unit (ITU) and the General Medicine Service (GMS). Both services care for a diverse range of patients including underserved patients from the Boston area and patients transferred from around New England for tertiary or quaternary care. The services make use of a twilight system, in which a resident-intern pair come to the hospital in evening to help take over patient care responsibilities from the day team.

Brigham medicine services also have regionalized care, with at least 80% of each team’s patients all on the same unit. The benefit is that this allows residents, nurses and the rest of the interdisciplinary team to work together closely to provide optimal care for our patients. The services both place a large emphasis on teaching and have dedicated time each afternoon for didactics.

Integrated Teaching Unit (ITU)

The Integrated Teaching Unit (formerly Intensive Teaching Unit) is a core general medicine rotation for all housestaff that was the result of an innovative research project in medical education. The service is uniquely designed to provide more time for teaching by creating a team structure that allows for more clinicians to care for each patient. The team is comprised of two attendings (one generalist and one specialist), two residents, three interns and two medical students; the teams have the same cap as the GMS teams, which results in fewer patients for each intern and more time to be present on rounds. The team is led by one the residents, with the other resident focusing on the more mundane tasks enabling the interns to focus more on their presentations and learning from the attendings and teaching resident; the resident alternate roles each day.

One of the incredible strengths of the ITU is the ability to learn from multiple senior clinicians discuss patient care approaches, and teach about physical exam findings, cost-effective medicine and clinical reasoning on many patients. Additionally, having a specialist on the services allows for a unique insight into that specialty’s approach to patients and consults. Finally, the Chief Residents also rotate as attendings on this service.

GMS

The General Medicine Service is the more traditional medicine service with one attending, one resident and two interns per team. Similar to ITU, the interns present all the patients and are responsible for all patient care orders and consults. The resident functions as the leader and teacher of the team both on rounds and at the afternoon sessions, with the attending functioning to help teach and provide clinical insight. A typical census for the team is around 16-18 patients (8-9 per intern) with the average length of stay of 3 days.

Residents spend around 2 months a year on the cardiology services, which are comprised of General Cardiology, Congestive Heart Failure and the Cardiac Intensive Care Unit. Brigham has a strong tradition of cardiology with exceptional teachers and a vast diversity of inpatient cardiology problems including Acute Coronary Syndromes, end-stage heart failure including mechanical circulatory support and heart transplant, severe valvular disease, congenital heart disease, pulmonary vascular disease and electrophysiology. Patients are referred from around the country for specialized procedures and are cared for by our housestaff. Structured didactics exist on both general cardiology, congestive heart failure and the cardiac intensive care unit.

General Cardiology

The General Cardiology service is made up of three teams, each with one attending, two residents (one day, one night) and three interns (only there during the day); one of the services is also joined by a cardiology fellow each day. As with all rotations, the interns are the primary care giver for their patients and the resident and attending focus on leading the team and teaching. As cardiology has many procedures and imaging studies, the census has intentionally been kept low to allow interns the opportunity to explore the primary data with their attendings and residents. These procedures include coronary angiograms, TAVR, TMVR and advanced electrophysiology procedures. In addition to General Cardiology, patients on these teams may also be cared for BACH (Boston Adult Congenital Heart Disease) or PVD (Pulmonary Vascular Disease) attendings, though still primarily cared for by the housestaff. These patients present opportunities to learn about and care for patients with rare congenital heart diseases and pulmonary hypertension.

Congestive Heart Failure

The Congestive Heart Failure team is the fourth cardiology floor team and led by a heart failure attending, heart failure fellow along with two residents (one day, one night) and three interns. The Congestive Heart Failure team specializes in caring for patients with end-stage heart failure who may be candidates for advanced therapies including LVADs and transplant, along with those who have already received these therapies. The structure of the service allows for patients to remain on the floor with Pulmonary Artery Catheters while on a variety of inotropes and vasoactive drips. Caring for patients post-transplant helps familiarize housestaff with principles of transplant immunosuppression and allograft vasculopathy and rejection.

Cardiac Intensive Care Unit (Named the LCU after Dr. Samuel A. Levine)

The Cardiac Intensive Care Unit is comprised of three junior residents, four interns as well as one fellow and critical care cardiologist. The junior residents rotate on q3 twenty-four-hour call, truly running the unit and all Codes in the cardiology building during those shifts. The interns rotate through on a corkscrew system, getting the chance to experience the unit throughout the day and night. The LCU is a highly educational rotation, caring for the sickest patients in the cardiology building and learning from incredible leaders in cardiology. It provides exposure to mechanical circulatory support (Peripheral VADs, Impellas, ECMO, IABPs), post-cardiac arrest care and malignant arrhythmias.
Residents spend approximately two months each year split between the five housestaff oncology teams, which provide all inpatient care for the Dana-Farber Cancer Institute (DFCI) patients. All of the oncology teams are led by DFCI attendings and some have DFCI fellows as well. As a world leader in cancer treatment and research, DFCI cares for everything from extremely rare to more common cancers as well as using traditional and innovative treatments.

Solid Oncology

There are two solid oncology teams, each with one attending, one resident and either one and two interns. The interns are the primary caregivers, while the resident focuses on teaching and leading the team. The attendings teach about the intricacies of malignancy management as well as the chemotherapeutics being used. In addition to oncologic care, the patients also have a variety of general medicine and cardiac issues that are care for by the resident and intern with the help of the attending and consulting services.

Liquid Oncology

There are two liquid oncology teams with a similar structure to the solid oncology teams. These teams primarily care for patients with AML, ALL and lymphoma while they are undergoing induction or consolidation therapy or when admitted due to complications from those treatments.

Bone Marrow Transplant

One of the unique services at Brigham is the Bone Marrow Transplant service, which has a similar structure to the other oncology services. The service provides an excellent opportunity for residents and interns to learn about immunology, transplant immunology, transplant infections and many post-transplant complications including Graft vs Host Disease. Due to the complexity of these patients, there is always a DFCI fellow on the service, who helps the residents and interns understand the physiology and deal with complications that arise.

During each year, residents spend approximately 1 month in the one of the two BWH Medical ICUs (MICU). Each MICU has a capacity of 10 patients and the MICU teams are made up of one critical care trained attending, one critical care fellow, three residents (two day, one night) and four interns (two day, two night). The day residents and interns alternate between long and short days. On all days, the interns are responsible for presenting all the patients in the MICU to the long-call resident and proposing their plan of care for the day. The long call resident weighs in on the plan and teaches about evidence based critical care with help from the fellow and attending. Throughout the rest of the day, the care of all the patients is split between the interns, who are responsible for entering orders, discussing with consultants and holding family meetings with the help of the residents. All procedures are performed by the interns with supervision from residents and fellows as needed. There are formal didactics each morning led by the critical care fellows and attendings.

Brigham and Women’s Faulkner Hospital

The Brigham and Women’s Faulkner Hospital (also referred to as Faulkner) is the community hospital associated with Brigham and Women’s. All residents rotate at Faulkner and spend approximately 1 month there each year, either on the general medicine services (FGMS) or in the intensive care unit (FICU). Faulkner offers the opportunity to provide care in a community hospital setting with somewhat limited resources (though always able to transfer to Brigham if needed). Due to the team structure and the generally slower pace, there is more time for teaching and there are multiple didactic sessions each day.

Faulkner GMS

The FGMS teams are smaller than Brigham GMS with one attending, one resident and a single intern on each team; teams usually also have a medical student. The smaller team and the one-on-one nature allow for more teaching from the resident and more time to talk about patient care decisions. As a community hospital, patients typically have more common general medicine problems and have a shorter length of stay.

Faulkner ICU

The FICU, similarly to FGMS, is a smaller intensive care unit with a maximum of 6 patients and is run by a single senior resident and a single intern. Despite its smaller size, the FICU sees a wide array of patients from those with severe alcohol withdrawal to those with septic shock and severe hypoxemic respiratory failure.

VA West Roxbury

Each resident spends approximately one month at the VA each year on either cardiology, general medicine or the intensive care unit (VA-MICU). The VA is jointly staffed by residents from Boston Medical Center (BMC), Beth Israel Deaconess (BI) and Brigham. Rotating at the VA exposes residents to different practice styles and diagnostic approaches, along with teaching and conferences from all three residencies. The structure of the services is very similar to those services at Brigham, though all are staffed by VA attendings.

In addition to the core rotations listed, there are a variety of other rotations to help train well-round clinicians. Some are mandatory rotations for all residents and some are elective.

Geriatrics

All junior residents spend two weeks on the Geriatrics service. Those two weeks include didactic sessions, working on the inpatient consult service, shadowing outpatient palliative care nursing and following geriatricians in clinic.

Emergency Medicine

All residents spend at least four weeks working in the BWH Emergency Department spread across the three years of residency. The rotation gives residents the experience to be the first physician to triage and evaluate a new patient, decide which diagnostics to pursue and care for multiple patients at once.

“Phys”

The Phys (short for physician) is a time-honored tradition at Brigham that all senior residents rotate through. While the position serves multiple roles, the primary responsibilities are to act as the senior medicine consult for other services in the hospital, to be the MICU triage resident for the medicine services and to assist at all Codes in the hospital. The Phys rotation is designed to help teach about preoperative medicine along with working on triaging and code skills.

Elective

All junior and senior residents have time for elective rotations. There is much flexibility in how this time is spent, but includes rotating on specialty consult services, working on research or a scholarly project, or participating in some of the other medicine tracks (such as the Management Leadership Track). Senior residents can also act as an off-site chief resident during their elective time at either the Faulkner or VA sites.

Primary Care

Brigham and Women’s Hospital launched the first internal medicine primary care residency training program in the country in 1970, beginning a longstanding tradition of excellence in generalist training that thrives to this day.

The institution’s commitment to primary care training is evidenced by the fact that the Department of Medicine proudly offers two distinct training programs for applicants interested in primary care careers: one affiliated with the Division of General Medicine (DGM), and one affiliated with Atrius Health and Harvard Medical School’s Department of Population Medicine Harvard Medical School’s Department of Population Medicine (AH/DPM). Both programs share a common goal: to train leaders in general internal medicine.

Our vision of primary care is broad and encompasses the many interests and talents of our faculty and residents, including clinical practice, education, health services, research, community service, health care policy and administration. We invite you to read more about our primary care programs at the links above.

Current Residents

PGY-3

Alicia Corwin

Medical School: Sidney Kimmel Medical College at Thomas Jefferson University

Cheikh Njie

Medical School: University of California, San Francisco School of Medicine

Curtis Ginder

Medical School: University of Chicago The Pritzker School of Medicine

Ericka Howard

Medical School: McGovern Medical School at the University of Texas Health Science Center at Houston

Hannah Chen

Medical School: University of North Carolina School of Medicine

Kush Patel

Medical School: University of Virginia School of Medicine

Olivia Hulme

Medical School: Michigan State University College of Human Medicine – Grand Rapids

Orly Leiva

Medical School: Boston University School of Medicine

Parth Patel

Medical School: Perelman School of Medicine at the University of Pennsylvania

Ronuk Modi

Medical School: Sidney Kimmel Medical College at Thomas Jefferson University

Sophia Hayes

Medical School: Oregon Health & Science University School of Medicine

Victor Kovac

Medical School: Washington University in St. Louis School of Medicine

Walker Redd

Medical School: University of Virginia School of Medicine

PGY-2

Amin Nassar

Medical School: American University of Beirut Faculty of Medicine

Bobby Endo

Medical School: University of Washington School of Medicine

Eleanor Taranto

Medical School: University of Chicago Division of the Biological Sciences The Pritzker School of Medicine

Hari Raman

Medical School: Washington University in St. Louis School of Medicine

Jonathan Kotzin

Medical School: Perelman School of Medicine at the University of Pennsylvania

Joseph Kim

Medical School: Case Western Reserve University School of Medicine

Kelly Skrable

Medical School: The Warren Alpert Medical School of Brown University

Rose Olson

Medical School: University of Minnesota Medical School

PGY-1

Anna Borton

Medical School: Case Western Reserve University School of Medicine

Charlotte Story

Medical School: University of North Carolina at Chapel Hill School of Medicine

Hanna Vollbrecht

Medical School: University of Chicago Division of the Biological Sciences The Pritzker School of Medicine

Mark Chee

Medical School: University of Chicago Division of the Biological Sciences The Pritzker School of Medicine

Meera Sury

Medical School: University of Minnesota Medical School

Ramon Rodriguez

Medical School: Columbia University Vagelos College of Physicians and Surgeons

Ryan Denu

Medical School: University of Wisconsin School of Medicine and Public Health

Sonya Davey

Medical School: Perelman School of Medicine at the University of Pennsylvania

Wesley (Alex) Spacht

Medical School: University of Chicago Division of the Biological Sciences The Pritzker School of Medicine