Internal Medicine Program Overview

The Internal Medicine Residency Program matriculated its first class in 2011. Originally an AOA accredited program, it received ACGME accreditation in 2015. A unique feature of this program is its emphasis on cost conscious medical care and the difficulties faced by physicians practicing in rural America. The program provides residents with a diverse learning environment by utilizing primary, secondary and tertiary training sites in western North Carolina, all rich with pathology.

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Inpatient Training

• Inpatient Internal Medicine training is done at UNC Health Blue Ridge
• We have two medicine teams in the inpatient setting. Team 1 is run by core medicine faculty and team 2 is a hospitalist-run service.
• Team 1 is made up of 2 interns and PGY2 + PGY3 first half of the year, and only 1 upper level second half of the year.
• Team 1: Cap of 12 + 2 admissions daily on regular months can swell to 14+2 on winter/flu season based on average census of the hospital.
• Our hospital has a 16-bed medical intensive care unit staffed by critical care specialists.
• UNC Health Blue Ridge has two emergency departments with more than 55,000 visits each year.
• Our emergency department employs telestroke technology
• UNC Health Blue Ridge uses a fully integrated EMR, including computerized physician order entry and voice recognition software for dictating digital notes.

Ambulatory Training

• Ambulatory general internal medicine training is done at Mountain Valley Health Clinic, located on the UNC Health Blue Ridge campus.
• Subspecialty training is done at various subspecialty offices within UNC Health Blue Ridge and the Salisbury Veterans Administration.
• Residents also have opportunities to rotate through community practices in the area.
• Ambulatory training has a 1.5 hour per week didactic held at the continuity clinic for those on Ambulatory Medicine and Geriatrics.

Intern Night Float

• Intern night float consists of two, 2 week blocks of nights (Sunday-Friday).
• In addition, interns will do 7-8 Saturday night call a year.
• Interns do not take call in the ICU
• Interns do approximately 5 admissions at night
• Interns start doing cross coverage of patients on the medicine services beginning in January of each year.

Resident Night Float

• Resident night float consists of two, 2 week blocks of nights a year (Sunday through Friday).

Post Call Days

• Interns and residents check out new admissions and discuss overnight issues with the day teams between 6:30 and 7am
• If they have completed their work, they may leave at 7am and will not be scheduled to return until the next day.

Outpatient Training at UNC Health Blue Ridge

Outpatient Internal Medicine comprises a large portion of Internal Medicine training. It is an important part of IM even if you are planning on being a hospitalist or subspecialist. We believe that solid training in outpatient medicine is essential to creating a well-rounded internist. All continuity clinics are done at Mountain Valley Health Clinic, which is located on the UNC Health Blue Ridge campus. The clinic has a phlebotomy lab, anticoagulation clinic and a pharmacist present at the clinic for part of the week. Additionally, we have a full time patient navigator to help with anything from transportation to paperwork. Given our diverse patient population, we use digital interpreter technology that allows us to have a live interpreter at all times.

FAQs About Continuity Clinic

• Faculty to Resident ratio is 1:4 leaving ample time for bedside teaching
• Nurse to Resident ratio is 1:2
• Fully integrated EMR is used in clinic and the hospital
• Attending physicians see all intern patients for the 1st 6 months
• Patient population is diverse with 45% Medicare patients and 20% privately insured patients
• The clinic also sees a large number of charity patients
• Patient numbers are: PGY1s 4-5, PGY2s 5-7, PGY3s 7-10 per half day

Ancillary Offerings in the clinic

• Diabetes Education
• Clinical Pharmacist
• Spirometry, POC testing, EKGs, IV fluids

FAQs About Inpatient Medicine

Who makes up the Team 1 team?
Team 1 is made up of 2 interns, a PGY2 and a PGY3.

What is the average census on Team 1?
The team 1 works on an innovative new team structure focused on resident learning and progression to autonomous care. The team is capped at 15 admissions, and receives up to three admissions daily. We comply fully with the ACGME patient cap of 9 patients per intern.

What is the patient population like?
We have a very diverse population of patients both socioeconomically and culturally. Given that we are a primary care center and the problems with access to care in WNC, most patients come in with problems that are undiagnosed for long periods of time before presentation.

What is the continuity clinic like?
Our categorical residents see their own continuity panel of patients at Mountain Valley Health Clinic. The ambulatory training site provides comprehensive care to both low income, under or uninsured patients as well as insured patients. Patients referred there are often medically and socially complex, providing excellent outpatient training for the resident physicians. The night float resident is on call for the clinic after business hours.

Will I get enough autonomy
The short answer is yes. Here at UNC Health Blue Ridge, we have created an environment of graded autonomy so that each resident can work independently while having an adequate safety net. Support and guidance are important to us and the faculty pride themselves on maintaining open dialogues about every patient. We also entrust upper level residents with the autonomy to be teachers to the interns and maintain a healthy team dynamic.

Consults and Electives

Subspecialty Rotations - Residents complete at least one block of each subspecialty during the three-year training period:

• Cardiology
• Endocrinology
• Gastroenterology
• Geriatrics
• Hematology/Oncology
• Infectious Diseases
• Nephrology
• Neurology
• Pulmonology
• Rheumatology
• Women’s Health

In addition to the above rotations, the following rotations are also available for electives:

• Orthopedics
• Urology
• ENT
• Ophthalmology
• Private outpatient IM
• HIV clinic
• Palliative Care/Hospice
• Radiation Oncology
• Radiology
• Interventional Radiology/Anesthesiology
• Administrative/Research Combination Month
• Dermatology