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Residency Program
Applicant Information
House Staff Resources
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Educational
Resources
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Rotations (Intern | Junior | Senior)
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Intern Year |
The intern year is designed to foster the clinical skills, professional development, and personal growth of new doctors. Interns participate in structured rotations in inpatient wards, intensive care units, and ambulatory clinic, which by the end of the year provide them with the training to diagnose and treat a broad range of illnesses in many settings. Unstructured elective time is also provided so that interns may explore an area of interest.
There are 36 categorical track, 4 primary care track, 4 research track and 8 preliminary track interns. Each intern spends approximately eight months at Columbia University Medical Center (252 medical beds), and three months at the Allen Pavilion (105 medical beds). There are minor differences in the schedule between the tracks, but in general all interns are well integrated with each other.
Each medical service is generally staffed by two Interns, two Junior or Senior Residents and two Attending Physicians with some variation. The daily census per intern averages 8 to 10 patients. |
In-Patient Medicine
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Ward services include a General Medicine team, a General Medicine/Liver team, which sees a combination of general and hepatology patients, an ID (largely AIDS-related illnesses and tuberculosis) team, as well as Cardiology and Hematology-Oncology teams. All teams have a 1:1 resident to intern ratio, and each team has two attendings, a unique feature of this medical center and one we feel allows for a unique combination of perspectives in teaching rounds. Many teams will also carry Columbia third-year clerks and sub-interns.
Interns will typically spend five or six 4-week rotations on in-patient services where they will take call. During this time, the intern will be primarily responsible for interfacing with different services and (with direction from his or her resident and attendings) for navigating diagnostic and treatment decisions. Usually one or two of these rotations will be in general medicine in Milstein Pavilion [the 750-bed hospital that is the central clinical facility for Columbia University] and one in the Allen Pavilion [a 100-bed hospital in the Inwood region of Northern Manhattan staffed with Columbia attendings]. Two to three rotations will be in the subspecialty services at the Milstein Pavilion.
Interns take overnight call every fourth night, and each team has one “golden weekend” each month. On call days, resident supervision is divided between day and night residents. All team members stay through the post-call teaching rounds, after which (at 11 a.m.) the post-call intern and the night resident go home.
Interns get additional inpatient experience during two “team intern” rotations. Each ward service is assigned an intern whose job it is to relieve the post-call intern after their duties end at 11AM. As opposed to a ‘day float, who attends to busy work on unfamiliar patients, the team intern role was designed such that they would be tied to a single team, getting to know the patients on the service. This arrangement, as well as exposure to the same conferences as primary ward interns, maintains a high quality educational experience for the team intern. |
Intensive Care Units
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Interns will spend two to three months of their year in the ICU setting. Columbia house staff runs three different ICUs. Milstein has medical and cardiac ICUs staffed by four interns and four junior residents each. In the units, both interns and residents take overnight call on a “Q4” schedule, with one day off each week.
Interns also rotate through the Allen ICU. While the residents have the primary decision-making responsibility in the Milstein units, the smaller size and lower level of acuity of illness in the Allen ICU makes it possible for interns to “hold the board” while on call, dictating management decisions. Two attendings and a senior resident provide supervision and teaching during the day, and a Hospitalist/Intensivist supervises at night. This experience is consistently identified as one of the high points of the year for interns. |
Ambulatory Care
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During the ambulatory care rotation, interns sharpen their outpatient skills and are also exposed to a structured curriculum exploring key aspects of outpatient management and the critical reading of medical literature. The block also allows interns to attend subspecialty clinics (e.g. nephrology, cardiology) as well as clinics in disciplines that treat diseases we often care for as primary care physicians (e.g. ophthalmology, orthopedics).
Interns also spend one month focusing on the multidisciplinary care of the geriatric patient. The experiences during this month are varied, including in-patient geriatrics consultation, outpatient geriatrics clinics, assessment of healthy geriatric community-dwellers, experience with subacute and chronic nursing facilities, and participation in a palliative care curriculum. |
Additional Experiences
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Interns will also spend one month of the year on an Elective of their choice, most often either serving on a clinical consultation service or beginning clinical or basic science research. Two 2-week vacations will round out the rest of the intern year.
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 Junior Year
As junior residents, house officers take on significantly greater autonomy and responsibility. Junior residents lead teams in the units and on the ward in General Medicine, Oncology, and Infectious Diseases.
Junior residents will spend about 3 months leading ward teams divided between general medicine and subspecialty services, five weeks spent in both the MICU and the CCU, and a two 2 1/2 week rotations as night resident. Seven weeks are spent in the outpatient department. Five weeks are dedicated to elective time and 2 weeks for an in-depth exposure to clinical research sponsored by the Irving Center for Clinical Research (ICCR). Two and one half additional weeks are spent working in our Emergency Department alongside residents training in emergency medicine.
Call on the wards as a junior resident is taken on a Q4 basis, but unlike the intern year, call ends at 10 p.m., at which time the junior signs out to the team’s night resident who continues to advance care on the team. MICU and CCU call remains overnight, with the resident going home after rounds post-call.
Unique Junior Resident Rotations:
ICCR
This is a 2 1/2 week rotation, spent in the Irving Center for Clinical Research, dedicated to exposing residents to clinical research. During this block, house staff will meet with a variety of the clinical investigators in Columbia’s Department of Medicine. Each resident will design an IRB proposal for a clinical project in conjunction with biostatisticians experienced in guiding clinical research, and will present their proposal at the conclusion of the rotation. Many residents have subsequently gone on to perform the research piloted in this setting, and many others have been paired up with research mentors with whom they have gone on to collaborate during residency. Residents present their proposals at the end of the rotation to ICCR staff, medical attendings, and other residents. A full list of junior resident ICCR presentations for the past 9 years is available.
Night Resident
Columbia has moved away from interns serving as day ‘floats’, opting instead to design a rotation in which interns fully participate in the rounding and educational opportunities on their assigned teams. Similarly, we have moved away from residents serving as night ‘floats’. Instead of admitting patients to every team in the hospital, residents working at night are more fully integrated into a given team, participating in the morning attending rounds and having a greater investment in the care of the service. This change improved the night rotation considerably from an educational standpoint.
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The senior year of the residency is designed to allow residents to take on more leadership, educational, and supervisory duties, work more with other disciplines within the hospital, and to consolidate their experience before moving on to fellowship or other practice.
Most senior residents spend about four months on the wards with two months supervising a General Medicine team, one on Cardiology, and a fourth on “Senior Medicine,” a Hospitalist rotation described below. Other rotations include two blocks of outpatient medicine, two blocks of flexible elective time, and two half-blocks of vacation. The additional 3 blocks are typically divided among rotations in Medical Consultation, Rheumatology consultation, and supervising interns in the Allen ICU.
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Unique Senior Resident rotations:
Senior Medicine
The unique team structure is a streamlined unit, where a senior resident works closely with a hospitalist attending, social workers and a care coordinator. There are no interns or third-year medical student clerks on the service, allowing the focus of teaching to remain at the senior resident level. Given the team structure and the nature of the hospitalists’ role in the hospital, residents are afforded the opportunity to interact more closely with their supervising attendings than in traditional general medicine rotations. Without an intern, residents manage their patients more as a private attending would manage patients in an off-service setting. There is also an integrated curriculum for this rotation focusing on evidence-based inpatient medicine, culminating in an evidence-based medicine project, which is incorporated into a resident-run web site, available to our house staff.
Teaching Senior
This rotation involves a curriculum aimed at teaching residents how to teach. Didactic sessions are designed to address various aspects of the resident’s role as a teacher. Residents get an opportunity to practice these skills in various forums. Each resident presents at noon conference in a “Senior Talk” which ranges from a traditional clinical topic to a presentation of their research. These residents also lead a morning report in an evidence-base case discussion.
Medical Consultation
The medical consult service allows for intensive exposure to two broad areas of medical practice: risk assessment and management of the peri-operative patient, and management of commonly encountered medical problems in surgical, neurological, or obstetrical patients. The diversity of patients on the consult service is greater than that of any other rotation. Residents manage some diseases with which they are completely familiar—diabetes, congestive heart failure, pulmonary embolism—and others, which they may not have seen since medical school, such as HEELP syndrome in a pregnant woman. In addition, the resident will have the opportunity to interact with housestaff and attendings from a variety of services.
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