Tinsley Harrison Internal Medicine Residency Program                        Excellence Without Ego

Categorical Track

The objective of the Categorical Track is to provide a broad experience in the comprehensive field of internal medicine. Residents develop skills both in primary patient care and consultative medicine. The multiple hospitals and clinics provide diversity in patient populations and practice settings, contributing to the breadth of experiences for the Categorical Track residents. Graduates from this track will be prepared to practice general internal medicine or enter subspecialty fellowship training.

Responsibilities and Schedule

R-1 Residents (PGY-1) 
pgy1 2The goal of the initial year of training is to acclimate the R-1 resident to internal medicine in a way that allows for the assumption of progressive responsibility for patient care under appropriate guidance and supervision. Thus, the R-1 resident is the physician with primary responsibility for the patient's care. Most of the first year is spent on inpatient services, including both general medicine and subspecialty wards. Although patient census is highly variable, each intern typically cares for 4 to 8 patients at any given time. Admissions are always evaluated in close association with the supervising R-2 or R-3 resident, though writing orders and initiating therapy remain the R-1 residents' prerogatives.

Each service has a single attending physician who is a full-time faculty member. Attending physicians are always available to advise and assist. In addition, all medical and surgical subspecialty consultants are immediately available 24 hours a day. R-1 residents are generally not required to draw blood or start peripheral I.V.'s since these tasks are routinely performed by laboratory technicians and nursing staff. R-1 residents participate actively in the teaching of medical students rotating on their ward services. In addition to ward rotations, each Categorical Track R-1 resident has a month in the following areas: subspecialty consults, ambulatory medicine, geriatrics, and inpatient block (training in ultrasound and procedures, health disparities, cost conscious care, and patient safety).

R-2 Residents (PGY-2) 
pgy2The second year of training is aimed at expanding the breadth of the resident’s knowledge base while providing an in-depth exposure to state-of-the-art practice of the various medical subspecialties. The PGY-2 year is almost evenly split between in-patient ward rotations and consultation services, mostly in the subspecialties.

Other rotations include neurology/palliative care, VA Hospital walk-in clinic, and an elective month. On subspecialty in-patient services, the R-2 resident serves as the team leader and further develops supervisory and teaching skills while working with R-1 residents and medical students. On consultation services, the R-2 resident initially evaluates patients and then presents the findings and recommendations to the consult attending physician for review and discussion. Consultation services also include participation in subspecialty clinics, conferences, and other activities of the divisions. Didactic and bedside instruction is provided in the special skills and techniques inherent to the various subspecialties.

R-3 Residents (PGY-3) 
pgy3As in the PGY-2 year, time is evenly divided between ward and consultation services. While the consult rotations are similar to the PGY-2 year, the majority of ward months for the R-3 residents are spent on the general medicine inpatient services at University Hospital and the VA.

The intention is to match the most senior and experienced residents with the rotations that require more responsibility for patient care, supervising and teaching. Working closely with the attending physician, the R-3 resident coordinates work rounds and teaching rounds for the team.