Case Western Reserve University (CWRU) School of Medicine, Department of Medicine

University Hospitals


Are international experiences available?
Case Western Reserve has a long tradition of involvement in International Health research, education and clinical training. Many of our residents pursue overseas experiences during training. This year a group of five will spend one month in Hyderabad, India, working on an HIV prevention project. Other sites visited by our residents include Vientiane, Laos (where the Department of Medicine is engaged in an education project) and Kampala, Uganda (where we have a long-standing, multifaceted research collaboration).

Are there housestaff social events?
Our residents organize housestaff social events on an ad hoc basis during the year with financial support from the residency. The Department of Medicine organizes a Holiday Party in December, and a graduation dinner in the spring. Families and friends are invited to the graduation dinner, which also features awards and a skit spoofing the hospitals and faculty (primarily the program directors…………). Chief Residents and Program Directors also organize ad hoc social events; including a series focused on the arts, which includes book clubs and a ‘night at the art museum.’

Are there required Neurology and Geriatric services?
Yes, interns spend two weeks on Neurology consults and PGY2 residents have a two-week outpatient Geriatric experience.

Are there research electives?
Residents can use some or all of their elective time throughout their training to pursue research projects. As above, we also participate in the ABIM research pathway. We have a monthly evening seminar series (called the Agre Society, named for a graduate of our program who received the Nobel Prize for discovering the aquaporin channel) on research careers and mentorship.

Are your rotations based on months or blocks?
We use a block schedule- a block is 4 weeks. The interns schedule is based upon 13 blocks. A block schedule makes the switch days standard and facilitates days off and weekend coverage.

Do you have hospitalist services?
At UHCMC our academic hospitalist attend on our general medicine teams, and we have non-teaching hospitalist services. In 2009 we have established one of the first non-teaching hospitalist service at any academic VA Hospital, which expanded this year.

Do you have non-housestaff covered services?
We have continually expanded our non-teaching services in order to decrease the housestaff work load and keep the focus on education on the housestaff team. At UHCMC we have non-teaching services in cardiology, oncology and general medicine, and we have expanded our general medicine non–teaching service at the CVAH, allowing us to cap interns at 8 patients.

Do you have residency retreats?
We have three major retreats- at the end of the year we meet off site with all the categorical interns to talk about the skill set needed to be a successful resident and teacher. We have an offsite retreat for the rising PGY3s, with the focus on system issues and the leadership role of a PGY3. Mid-year we have an evening retreat for current interns to discuss how the year is going and get their feedback on the training program.

Do you have short call?
Our subspecialty wards do not have short call. There is no short call on clinic days. Our General Medicine wards have one short call per four-day admitting cycle, which is limited to nightfloats and ICU transfers (no new admissions).

How are the ancillary services at the VA?
The ancillary services have improved significantly over the years. There are phlebotomy “rounds” 8 times daily to ensure that pt’s can get their lab draws throughout the day, and IV therapists also available during the day to place IV lines. After midnight, the IV therapist is also available to do blood draws (blood cultures, etc.) Nurses in the ICU and telemetry floor do all admission ECGs, and all nurses will do ECGs for acute clinical changes in patients (i.e., chest pain).

How do days off work?
Typically, on inpatient rotations housestaff get one Saturday, one Sunday and one “Golden Weekend” per 4-week block. Non-ward rotations have additional weekend days off.

How do I find a research mentor?
There are a large number of faculty supported by NIH grants and other external funding who provide mentorship. Interns meet with the Chair of the Department early in the intern year to discuss career counseling, and meet with one of the programs directors twice a year. We hold interactive sessions with the subspecialty divisions so housestaff can gain awareness of the faculty’s research interests. Interactions during these meetings, as well as less formal interactions with Chief Residents and peers provide guidance for selecting research mentors.

How do you educates housestaff about patient safety and quality?
Both of our teaching hospitals have committed significant resources to patient safety and quality. CVAH is a center for patient safety and quality scholarship and education, and offers a fellowship in this area. UHCMC ranks third in the 90 member university hospital consortium in quality measures, and has a large quality center that is involved in many initiatives, including education our residents. In 2009 we established a specific rotation for PGY3 residents- the Patient Safety and Quality Externship- which is a ‘first of its kind1 rotation where our residents participate in our hospitals’ quality initiatives. We expect our residents to be leaders in patient safety and quality initiatives at the next step in their career. We also include Patient Safety and Quality modules in the Clinical Skills block for Interns, and involve PGY2 residents in quality committees.

How do your residents do in obtaining fellowships?
In the past decade our residents have done extremely well in matching to competitive fellowships, with greater than 95% getting one of their top choices. Our web site and application materials list the fellowship choices of our residents over the past decade. We have data on where our residents have gone for the past eleven years on our web site, and include this information on the interview day.

How does continuity clinic work?
All housestaff on average have a ½ day continuity clinic per week. There is no clinic on the on call and post call days for interns and residents on inpatient rotations. Clinic is held on the same day each week to ensure continuity with the preceptor. Housestaff have clinic at UHCMC and CVAH and have the option of choosing one of several community sites. The faculty to resident ratio is 1:3 or 1:4.

How have you done in the NRMP IM match?
We have done consistently well, with outstanding matches the past few years. Our match lists are on our web site, and will be include in material in the interview day.

How many admissions can I get when I am on call?
Interns are allowed to get three patients on call, including nightfloat admissions and ICU transfers. Interns are not allowed to follow more than 10 patients at UH and 8 at the VA, and will get fewer admissions if they are at their cap. Interns do not take overnight call and take no new admissions after 7 pm on their call day. This year we modified out nightfloat system to ensure that interns can signout at 9 pm when on call. Like all programs, we reorganized the way interns take call as of 7/1/11 to be compliant with the new duty hours. We piloted these changes during the 2010-2011 academic year; made additional changes on the basis of these pilots, and feel our system of intern call is working very well.

How many clinical training sites are there?
Two, University Hospital Case Medical Center (UHCMC), which is a large tertiary academic hospital located on the medical school campus on the east side of Cleveland and is the primary teaching affiliate for Case Western Reserve University, and the Cleveland Veterans Administration Hospital (CVAH), which is located one mile across University Circle [] from UHCMC. University Hospital Case Medical Center has an attractive, updated physical plant, and the Cleveland VA is one of the most modern and well laid out VA hospitals.

How many people are on a team?
Most of our teams are one resident and two interns- and for the first 4 blocks we put two residents on these teams to help with the additional supervision needed for new interns, acting interns, etc. Two of our subspecialty teams (renal and cardiology) are 2 resident, 4 intern teams.

How many PGY1 positions are available?
We have 26 Categorical positions, 4 Med-Peds, 4 Prelim, 2 IM-Genetics, 2 Research Pathway and 2 Patient Safety.

How much time do housestaff spend at the two sites?
Housestaff spend approximately 2/3 of their time at UHCMC and 1/3 at CVAH.

How will I eat?
Lunch is served at noon conferences. At UHCMC residents have swipe cards for on call meals, and at CVAH food is provided for on call residents.

Is there a “scholarly requirement”?
All Senior residents are required to give a scholarly seminar as part of noon conference. The majority or residents do research, many presenting at national meetings. Resident research is not a requirement, but the overwhelming majority of our residents are involved in research projects.

Is there a mentoring program?
All housestaff are assigned to one of the four program directors to being the mentoring process, and then obtain mentors based upon career choice.

Is there a nightfloat system?
We have a nightfloat system at both UHCMC and CVAH. Under the new duty hours, all interns are now part of the nightfloat team, supervised by upper level resident. We emphasize teamwork and mentoring of nightfloat interns by upper level residents who are part of the nightfloat team. Interns on the nightfloat team cover the teams not on call, and may admit 1-2 patients. Most admissions are done by the residents, or by the non-teaching services.

Is there a required Ambulatory rotation?
Starting in the 2011-2012, all residents will have three ambulatory blocks per year. During this rotation there is no overnight call inpatient responsibility. There is a conference every day at 8 am, subspecialty clinics in the morning and ambulatory electives in the afternoon. One morning a week is devoted to an Evidenced Based Medicine curriculum, and one afternoon a week to a Quality Improvement curriculum and project. Residents interested in primary care can do additional ambulatory blocks and can tailor their experience based upon their career goals.

Is there a research pathway?
Yes, we participate in the ABIM research pathway and support a year of research for residents who want to pursue this option. There are a large number of well-funded, research-intensive faculty in the Department of Medicine. The Department of Medicine at Case ranks 11th out of 126 in NIH funding among academic departments of medicine.

On the inpatient service, do you have subspecialty teams?
We have a mixture of general medicine and subspecialty teams. At CVAH there are four general medicine teams, a Cardiology team and a MICU team. At UHCMC there are two general medicine teams, and five subspecialty teams (hematology/oncology, GI, renal, cardiac and infectious diseases). There are also separate CICU and MICU teams.

What are the unique aspects of the Internal Medicine Residency at Case?
When asked this question, we usually cite our clinical and academic breadth and depth combined with a collegial, supportive atmosphere. When we ask our residents, they say housestaff camaraderie – in the setting of a large academic program. We are proud of our diverse and close-knit housestaff, and collegiality among the housestaff and between the housestaff and faculty. Our residents receive outstanding clinical training and opportunities for career development. We also have innovative programs in Patient Safety and Quality, Population Health, and International Health.

What changes have you made to support duty hour reform?
We have limited the total number of patients interns can care for and the number of admissions, and have continually expanded the number of non-teaching services. We have changed the structure of several of our teams, adding members and eliminating all Q3 overnight call. We have added nightfloats at both UHCMC and CVAH, and have created robust non-teaching services at both UH and the VA.

What criteria are used to select housestaff?
We look for applicants with a commitment to learning and professionalism, who value teamwork, and who have academic potential. We hope to recruit residents who will become excellent teachers, and help make our program better.

What do most of the residents do after residency?
A large portion of our residents go on to subspecialty fellowships (and are successful in obtaining spots at competitive fellowships), but we support and encourage diverse career paths.

What is the approach to work hour reform at the Case IM residency?
Our experience has taught us that only by decreasing the workload can we achieve duty hour compliance, and we have limited the number of admission and number of patients an intern can follow. We have tried to use a team approach that minimizes the amount of handoffs. Interns do not take overnight call, nor do residents on the wards. Resident on the ICU take overnight call, with protected time for napping.

What is the Clinical Skills Block?
All categorical interns spend two weeks on the Clinical Skills block, which focuses on developing procedural competency, proficiency at resuscitation, and honing physician exam skills. The block also include modules on cultural competence, patient safety, humanism in medical and conflict resolution.

What is the conference curriculum?
We have a resident conference every day at noon with food at both UHCMC and CVAH. One noon each week we have a Morbidity and Mortality Conference (done separately at the VA). The M and M Conferences include discussion of challenging clinical issues and patient safety and system issues. Once a week there is Grand Rounds, which is ‘live’ at UHCMC and is broadcast to the VA. Three days a week there are resident noon conferences, which include an annual curriculum and focuses on case-based, interactive teaching. In the beginning of the year some of the noon conferences are “Intern Boot Camp,” with the focus on knowledge and skills needed for beginning interns. There is morning report three mornings a week for residents and one morning a week for interns (with the residents carrying the interns’ pagers). All the subspecialty divisions have their own clinical conferences, grand rounds and research conferences. Residents are encouraged to attend when they are on those services or based upon their interest.

What is the patient mix?
At UHCMC we have about 1/3 tertiary or quaternary referral patients; 1/3 come from an undeserved urban population; and 1/3 community based internal medicine. The patient population at CVAH is both primary care and tertiary care, and comes from the greater Cleveland area and surrounding counties.

What is the Primary Care Block?
All categorical interns spend four weeks on the Primary Care block early in the PGY1 year. Interns are introduced to their clinic preceptors and patients, and have protected time for small group learning sessions focused on ambulatory and primary care issues. We are committed to having a balance between the inpatient and outpatient educational venues, and the Primary Care block for PGY1s reflects the commitment of the program and general medicine faculty to ambulatory education.

What is the relationship between UHCMC, CVAH, Case Western Reserve University, MetroHealth and the Cleveland Clinic?
UHCMC is the primary academic affiliate of Case Western and is part of a large, regional health care system that along with the Cleveland Clinic affiliated system account for about 80% of healthcare in Northeast Ohio. UHCMC and the CVAH are the primary academic partners for the Case Western Reserve School of Medicine, and all attendings are part of the full time Case Western Reserve University School of Medicine faculty. The Chair of the Department of Medicine at Case and UHCMC is the primary academic chair for Internal Medicine at the medical school. The hospital is physically connected to the medical school, facilitating research and teaching collaborations. MetroHealth is a Case-affiliated hospital located on the west side of Cleveland with a separate chair and residency. The Cleveland Clinic also has a separate a chair and residency, and has a medical school tract (the Cleveland Clinic Lerner College of Medicine) that is separate from the main medical school but is affiliated with Case. The Department of Medicine at Case/UHCMC/CVAH has outstanding clinical programs, but what sets us apart from the other medical centers in Cleveland and Ohio is the academic breadth and depth of the faculty [e.g., the NIH funding for the Department of Medicine at Case/UHCMC is over $ 60 million, vs. $ 17 million at the Cleveland Clinic and $6 million at Metro].

What is the salary?
The current PGY1 salary is $47,233. (Cleveland has one of the lowest costs of living of any major metropolitan area…………so the salary goes farther at Case).

Where will I live?
Most residents live within a mile or two of the hospital in Cleveland or one of the inner ring suburbs (Cleveland Heights, Shaker Heights). Housing in these areas is safe, very inexpensive compared to other large metropolitan areas, and convenient to the hospital.