There are no private patients and no private attendings at Mayo Clinic. Hospitalized patients are assigned to an individual intern or resident physician who is responsible for that patient's care in the hospital and, when appropriate, for follow-up care in the resident's outpatient clinic.
While on a hospital team, all trainees receive appropriate supervision and daily teaching from a single faculty member assigned to the team. The faculty member acts as both the attending physician of record and the teaching attending for the service. Selection of faculty for teaching assignments is based in large part on resident teaching evaluations.
Second- and third-year residents are responsible for teaching, leadership and supervision of intern teams. All residents receive formal instruction in these three key resident roles.
Performance in the six Accreditation Council for Graduate Medical Education competencies — medical knowledge, patient care, professionalism, interpersonal communication, practice-based learning and systems-based practice — is monitored carefully throughout the Internal Medicine Residency to ensure that residents acquire adequate knowledge and develop appropriate technical skills.
Supervising faculty members and resident peers provide feedback and formally evaluate residents after each clinical rotation. Each resident has an electronic portfolio that can be freely accessed to review evaluations. This portfolio is also a repository for evidence of ongoing learning from presentations, projects and publications.
Each resident is assigned a personal faculty adviser to provide regular feedback and guidance. During regular review sessions with the program director or an associate program director, the resident's progress is reviewed. In addition, residents regularly evaluate the faculty, each rotation and the program to ensure that the educational needs of the resident are being met.
Approximately half of the three-year program is spent in outpatient assignments. Experience includes general medicine continuity clinics and subspecialty consultation clinics. Residents learn to practice high-quality, cost-effective outpatient medicine during their ambulatory care experiences. Residents uniformly cite these ambulatory clinic experiences as an invaluable part of their training.
Residents follow their own patients each week in the ambulatory care center as part of a continuity clinic "firm." To enhance both experiences, continuity clinics are during outpatient training months, not during inpatient months.
Mayo Clinic's primary care clinics have these unique characteristics:
- The clinic "panel" includes new ambulatory patients as well as post-hospital visits.
- Residents are responsible for the initial evaluation and all follow-up care for the patients in their panel.
- Residents gain experience with a broad spectrum of outpatient problems, which enhances their primary care skills.
- Residents work in the same firm of 24 residents with a group of eight supervising physicians for three years.
- A resident procedure clinic provides a learning experience for a variety of ambulatory procedures.
- Patient appointments, test scheduling, chart availability, and secretarial and nursing support are all provided in a modern ambulatory care center where residents dictate their notes.
- During continuity clinics, supervising faculty are free from other responsibilities in order to focus on the learning needs of residents.
Ample training and experience are provided to gain expertise in procedures such as paracentesis, central line insertions, arthrocentesis, lumbar punctures and tracheal intubation. All residents complete a half-day procedure skills workshop before starting residency, and additional basic procedural skills workshops are scheduled during the residency to refine these skills.
In addition, a new internal medicine hospital procedure service was developed that all of our residents will rotate on early in training. Residents can also elect to rotate on the pleural procedure team and in the ambulatory procedure clinic.
Residents may access Mayo's web-based procedure skills curriculum on the Mayo intranet for just-in-time review prior to performing a procedure at the bedside. The program maintains a computerized database of procedural competence for each resident. Residents also have scheduled learning experiences in the Multidisciplinary Simulation Center.
Highly skilled allied health staff performs nearly all ancillary procedures, such as venipunctures, electrocardiograms, starting intravenous fluids, drawing blood gases and inserting urinary catheters. This allows residents to spend more time at their patients' bedsides and in self-directed learning.
Interns work no more than 16 hours each duty period during inpatient rotations. Second- and third-year residents take call every fourth night during call rotations.
In addition, admission caps, service census caps, backup systems and a sophisticated electronic medical record help balance resident education and service responsibilities.
Limiting workload and limiting hours worked are educationally and medically sound approaches to residency training in the increasingly intense environment of the academic medical center. In accordance with the latest ACGME requirements, interns are not allowed to be on duty for more than 16 consecutive hours. PGY-2 and PGY-3 residents are not allowed to be on duty for more than 28 hours. No resident is allowed to work more than 320 hours a month. Each resident has at least one day off each week, on average.
We have implemented several strategies to control workload, total and consecutive duty hours and days worked. All services have service size caps, admission caps and duty-hour limitations. We have systems to handle overflow, overcap and floats for services that warrant them. Duty hours are closely monitored to ensure compliance.
As ACGME duty-hour limits change, we are well-positioned with innovative scheduling models to ensure adequate education while meeting all duty-hour requirements.
Students from Mayo Medical School as well as a large number of medical students visiting from other institutions rotate on many of our services. Because many Mayo residents plan an academic career, the students provide opportunities to develop teaching, mentoring and supervisory skills.
Rochester has one of the most diverse immigrant populations in the nation with large concentrations of people from Southeast Asia, Africa and Eastern Europe. While Mayo Clinic has a reputation for successfully managing the most obscure and difficult medical problems for people from around the world, common medical concerns are actually the norm. This mix of "bread-and-butter" general medicine patients and a robust referral practice allows residents to see and treat patients with an exceptional variety of illnesses.
Opportunities are available for residents to gain experience in a number of administrative capacities. Internal medicine residents participate in the administration of the educational programs and the clinical practice at Mayo Clinic through these committee experiences.