Inpatient

The training opportunity is outstanding at Huntsville Hospital, which is a highly rated tertiary care facility, often caring for patients with complex disease. Because of a large referral base in Northern Alabama and adjoining areas of Tennessee, we care for a complete array of common community illnesses. Huntsville Hospital, the only teaching hospital in northern Alabama. Along with the UAB-Huntsville Regional Campus, the Medical District provides a golden opportunity to train young physicians to learn the scientific and scholarly basis of internal medicine. Currently, there is a shortage of primary care here, particularly in the surrounding rural areas. In addition, there are thousands of military personnel being relocated here. We anticipate that many of our trainees will stay to provide primary care for the burgeoning community, as do many graduates of the existing Family Practice program. Huntsville Hospital is a tertiary referral center with 900 beds and over 700 physicians on staff. All of our required inpatient wards, MICU, cardiology, radiology, neurology, and psychiatry rotations occur at this site. At Huntsville Hospital and at the UAB-Huntsville Campus residents have access to an extensive list of resources through UAB's Lister Hill Library. These resources include, but are not limited to, UptoDate, MedConsult, PubMed, Harrisons Textbook of Internal Medicine, and a database of hundreds of online journals and other textbooks and research tools. At the UAB-Huntsville Campus traditional library resources are available at Sparks Memorial Library including two librarians, classrooms, meeting rooms, visual and other educational aids. Huntsville Hospital provides space and equipment for the residency program including meeting rooms, on-call rooms, computers, diagnostic and therapeutic facilities, and laboratory facilities. The Interventional Radiology Department currently performs a large array of procedures. The Heart Center offers experience in invasive and non-invasive cardiology. The Emergency Department sees over 50,000 patients yearly in a newly renovated Emergency Room with close to 100 treatment rooms. Huntsville Hospital's Corporate University, adjacent to the hospital, offers innovative training and continuing education opportunities for physicians. It is the home of north Alabama's largest certified American Heart Association (AHA) Training Center. The Training Center staff provides BLS and ACLS courses to physicians, employees, and the community.

The program will pay for the initial ACLS/BCLS certification of all trainees upon entering the residency training program and for re certification thereafter throughout their training in this residency program. Before the starting training, all incoming interns will receive a two-hour workshop on indications, contraindications, and techniques of central venous line placement. Other workshops and explicit training tapes will be made available. During MICU and cardiology rotations, the residents can obtain further training in placement of central venous lines, arterial lines, and right heart catheters. Rotations on subspecialty services at Huntsville Hospital  provide opportunities for training in thoracentesis, paracentesis, and lumbar puncture. All our trainees complete the required number of procedures as indicated by the ABIM. A log of procedures is kept in a web-based electronic system and progress towards completion is reviewed on a semi-annual basis by Program Director. The residents are responsible for documenting their procedures. 

The UAB HIMRP will take measures to ensure that the residents' training focuses on the six ACGME competencies. The rotation schedule will be coordinated so that the residents have the required variety patient care experiences. All schedules will be reviewed carefully so that after the three years of training, each resident receives a minimum of 24 months of meaningful patient responsibility, both ambulatory and inpatient. Also with each year of training, the degree of autonomy and administrative responsibility given to the resident will increase. This goal is achieved by having the R-2 and R-3 residents supervise and/or act as consultants to R1 residents in an in-hospital setting. This supervisory role for the R-2 and R-3 residents is maintained even though there is on-site faculty supervision. The R-2 and R-3 also will manage an increasing volume of patients as compared to R-1 residents.

General Medical Wards

The R-1 residents will be assigned to General Medical Wards at the primary teaching hospital for six months. Residents will also spend a total of six one-month blocks in the Intensive Care Unit setting and 2 months in the Coronary Care Unit setting during their 3 years of training. They will be the primary physicians for the patients throughout their hospitalization and often subsequently in their Continuity Care Clinic. As the resident advances, his/her professional and administrative responsibilities will increase to encourage initiative, leadership skills, and teaching abilities, and to augment critical thinking and decision-making. This will include planning, record keeping, order writing, and ongoing management. The R-2 & R-3 residents will supervise and act as consultants to the R-1 residents and be available at all times. Residents will be given these responsibilities in all settings, subject to review and approval by the attending physician.

Ward Call Schedule - The "Golden Weekends"

The call schedule is compiled several months in advance and reviewed to ensure that Program values and ACGME parameters are met. Our call schedule was designed by a systems engineer, allowing every other weekend off duty and out of the hospital,  a "drip" admission system capped at 2 admissions per intern per shift, and most weekly work hour totals in the 60 - 70 range.

Night Coverage

A necessary component of the Ward call schedule is the night shift system. This is not Night Float. The Night Shift Team is comprised of residents and interns currently on the inpatient ward block. They  report at 7:30 p.m., after having been out of the hospital for 8 to 10 hours. The Night Team aims to leave the hospital by 9:30 a.m. the following day, and in no instances violates duty hour standards. Specifically, duty periods never exceed 16 hours in duration, and residents aim for 10 hours free of duty (but must have 8 hours free) between scheduled duty periods. These night shifts occur on four consecutive nights (Mon - Thurs) once in a 4 week ward block, and once again on three consecutive nights (Fri-Sun) on a weekend. The night shifts will only be scheduled during inpatient wards and critical care blocks. The Residents on night shift will not be scheduled for their afternoon continuity clinics. During emergency medicine assignments, continuous duty does not exceed 12 hours per 24 hour period. There is no "at-home" call.

Moonlighting

Prior to initiation of moonlighting activities, duly licensed residents will set up an appointment with the Program Director with the purposes of approval of initiation of moonlighting activities. Please note that while on ward rotations residents spend close to 80 hours per week in patient care duties', and any moonlighting during ward months will inevitably exceed the 80 hour per week limit. As such, moonlighting is not allowed during ward and ICU rotations. Every licensed resident must present moonlighting reports to the Program Director.

Ambulatory

Continuity Clinic

The UAB-Huntsville Internal Medicine Clinic currently enjoys a top reputation in the area and provides an opportunity to train residents to provide excellent care to a diverse population. The Huntsville and Madison area is experiencing rapid growth due to industry, with an associated demand for excellent primary care. At the same time there is a large surrounding rural population also in need of excellent comprehensive care.

In addition to continuity practice, our ambulatory curriculum includes experiences in cardiology, pulmonary, endocrinology, rheumatology, geriatrics, and gastroenterology, hematology / oncology, nephrology, infectious disease, and neurology. In addition, sufficient opportunity is available either in Huntsville or in Birmingham for residents to elect rotations in a variety of electives including women's health, student health, adolescent medicine, sports medicine, dermatology, radiology, pathology, HIV clinic, nutrition, nuclear medicine, or any of the medicine subspecialty consultative services or clinics. residents may electively spend time with non-medical subspecialists in psychiatry, dermatology, medical ophthalmology, office gynecology, otorhinolaryngology, non-operative orthopedics, and rehabilitation medicine.

HIV Medicine

The Thrive Clinic serves as the HIV/AIDS ambulatory facility for North Alabama. In 1992, a local group, the AIDS Action Coalition opened the Joe Davis Clinic to help provide medical services to persons infected with HIV in the 12 counties of North Alabama that make up Public Health Area I & II. Over 650 HIV positive/AIDS patients are actively followed here. All medical services are provided regardless of the client's ability to pay. Approximately 65 percent of patients have no insurance. This clinic is located approximately two blocks west of Huntsville Hospital. The Thrive Clinic provides an elective sub specialty experience in infectious disease / HIV medicine.

Giving Back to the Community

The Huntsville Community Free Clinic was established to provide free medical care to those in our community without access to health care benefits. The Community Free Clinic is located one block northeast of the primary teaching facility.

The Medical Mobile Unit

Huntsville Hospital Health System Medical Unit located at the Lincoln Village allows clinical specialists to promote preventive health care through community screengings and education.

Geriatrics

 Focused Geriatrics and Palliative Care training occurs at Huntsville Hospital and affiliated hospice care and nursing home.

There, under the guidance of a Board-certified geriatrician, you will concentrate your efforts to become competent in the diagnosis and management of common geriatric conditions. Our objectives are designed to give you the opportunity to become an outstanding geriatrician. You will concentrate on issues specific to older adults, and learn to recognize conditions appropriate for referral or palliative care. What differences must be recognized in disease presentation in the geriatric population? What comprises excellent comprehensive care of hospitalized geriatric patients? As a member of a multidisciplinary team, you will work closely with rehabilitation services to learn elements of functional status and how they relate to inpatient care and discharge planning. Learning to communicate effectively and in a comforting way when addressing end of life issues with patients and family members is a key skill. 

Neurology

The Neurology Service at Huntsville Hospital care for a wide variety of neurologic disorders in the inpatient and outpatient settings.

Based at the Neuro & Spine Center,  and there is close interdisciplinary collaboration with Neurosurgery, Rehabilitation Medicine and Pain Management Services. You will become competent in the diagnosis and management of common neurological disorders, and recognize conditions that are appropriate for referral to a neurologist.

Emergency Room

The Emergency Medicine  occurs at Huntsville Hospital, the region's only state designated Level I Trauma center, with MedFlight air ambulance service. You will also work in the fast track care for minor emergencies, gaining valuable experience for office practice. You will gain skill in the  evaluation and management of neurological, gynecologic, orthopedic, ophthalmologic, otolaryngologic, dermatologic, and psychiatric emergencies. Learning to Effectively prioritize and perform tasks related to diagnosis, treatment, triage and disposition of emergency room patients will serve you well in any practice setting.

The Emergency Medicine rotation is scheduled for one month in the PGY2 year and one month in the PGY3 year.

Intensive Care

Under the guidance of Board-certified pulmonary / critical care specialists, as a member of a multidisciplinary team, you will become competent in the comprehensive care of critically ill patients admitted to our MICU service at Huntsville Hospital. As you gain the medical knowledge and organizational skills necessary for the care of critically ill patients, your responsibilities will advance. You will master basic concepts including ventilator management, hemodynamic monitoring, treatment of pain, use of sedation, management of acute renal failure, and nutrition of the critically ill patient. There will be ample opportunity to become proficient in procedures. More importantly you will learn to compassionately address end of life issues with patients and family members.

PGY1 residents will have a 1.5 month rotation in the MICU. PGY2 residents will spend 3.5 months in the MICU, and PGY3 residents will spend 2 months in the MICU.

Procedures

Interns and Residents  are provided with the opportunities to learn the indications, contraindications, complications, limitations and interpretations of specific procedures; they develop technical proficiency in performing these procedures. The diagnostic and therapeutic procedures required for certification by the American Board of Internal Medicine will be directly supervised by an experienced critical care specialist, a senior resident, or an attending physician both in the inpatient and in the ambulatory care setting.

The required procedures are as follows:

  • Advanced Cardiopulmonary Resuscitation - required course
  • Access techniques to obtain venous and arterial blood - (didactic and experiential)
  • Abdominal paracentesis - (didactic and experiential)
  • Thoracentesis - (didactic and experiential)
  • Arthrocentesis (Knee) - (didactic and experiential)
  • Central Venous Line placement - (didactic and experiential)
  • Lumbar puncture - (didactic and experiential)
  • Nasogastric intubation - (didactic and experiential)
  • PAP smear and endocervical culture - (didactic and experiential)

Residents will have the opportunity to achieve competency in additional procedures. The program recognizes that individuals' manual dexterity and confidence vary, and procedures are conducted for the patients' benefit and not to fulfill an arbitrary quota. Residents will have opportunity to acquire additional procedural skills, determined by the training environment, residents' practice expectations, the availability of skilled teaching faculty, and privilege delineation.

The additional procedures for which competency based training are available are as follows:

  • Arterial line placement
  • Bone marrow aspiration
  • Bladder catheterization
  • Elective cardioversion
  • Endotracheal intubation
  • Pulmonary artery balloon flotation catheter placement
  • Skin biopsy (punch)
  • Temporary pacemaker placement
  • Ambulatory electrocardiographic interpretation
  • Treadmill exercise testing, supervision and interpretation
  • Topical chemotherapy for external genital warts
  • Electrocardiograms & Echocardiograms
  • Chest roentgenograms and other more complex imaging studies
  • Gram stains of sputum and other body fluids
  • Microscopic examination of urine
  • Spirometry
  • KOH and saline wet prep examinations of vaginal discharge for clue cells, monilia and trichomonas

The sponsoring institution will pay for the initial ACLS/BCLS certification of all trainees upon entering the residency training program and for re-certification thereafter throughout their training in this residency program. Before the start of training, all incoming interns will receive a two-hour workshop on indications, contraindications, and techniques of central venous line placement. Other workshops and explicit training tapes will be made available.

During MICU and cardiology rotations, the residents will receive further training in placement of central venous lines, arterial lines, and right heart catheters. Rotation on subspecialty services at the primary teaching hospital will provide opportunities for training in thoracentesis, paracentesis, and lumbar punctures. Additionally, trainees can rotate through the Interventional Radiology Department for additional opportunities to learn procedures.

All our trainees will complete the required number of procedures as indicated by the ABIM. A log of procedures will be kept in a web-based electronic system and progress towards completion reviewed on a semi-annual basis by Program Director. The residents are responsible for documenting their procedures. 

Electives

Residents may elect to spend a block of time with a medical subspecialist who is a member of the voluntary faculty. They will acquire knowledge and insight into the unique aspects of that medical subspecialty, including the indications for referral to that medical subspecialty, the evaluation and management of the referred medical problems, and consultative medicine in that subspecialty. There will be a Letter of Agreement in place with each subspecialist and a Subspecialty Education coordinator identified for each site.

Residents may electively spend time with non-medical subspecialists in psychiatry, dermatology, medical ophthalmology, office gynecology, otorhinolaryngology, non-operative orthopedics, and rehabilitation medicine. 

Didactics

Morning Report

On Tuesday, Wednesday, and Thursday attending rounds are augmented by Morning Report where instructive clinical cases are presented and discussed in a didactic setting.

Grand Rounds (weekly)

Journal club (monthly)

Morbidity & Mortality Conference (every 4 weeks)

Back to School every Wednesday

The program schedules a dedicated half-day per week for didactic presentation series attended by all residents not on call or post-call, regardless of their rotation assignment. The curriculum includes general IM and subspecialty topics conferences in the areas of psychiatry, dermatology, medical ophthalmology, office gynecology, otorhinolaryngology, non-operative orthopedics, rehabilitation medicine, and radiology. The curriculum repeats every two years.

Other topics include:

General Health Maintenance / disease prevention
Pain Mgmt
Adolescent Medicine
End of Life Care
Clinical Ethics
Medical Genetics.
Quality Assessment and Improvement
Risk Mgmt
Medical Informatics
Law and Public Policy
Physician Impairment
Substance Abuse
Domestic Violence
Physician Burnout / Fatigue

Lifelong Learning Habits

Quality Improvement

We will promote incorporation of a "real world" QI curriculum across all aspects of the residency  Residents will spend time with faculty mentors to help guide them through the planning and implementation of a QI project. We will create a combination of didactic sessions and experiential learning opportunities.  Residents will receive a set of current, relevant references. As part of the rotation, Residents will explore the definition of error, adverse event, and quality of care, and utilize the Patient Healthcare Matrix Tool at least 4 times during each of their years of training. This tool helps to identify flaws in the system, rather than faults of individuals who work in the system, a key trait of effective quality improvement tools.

They will consider methods for measuring quality and examine how latent errors in complex systems permit injuries to occur. They will explore the legal and regulatory environment in which QI takes place. The resident will participate in hospital-based QI activities, and depending on the resident's schedule will participate on hospital committees. Each resident will then select a QI project with the assistance of a faculty mentor. We will ask residents to consider potential projects before beginning the rotation. Topics will include medication safety, medical record reviews, surveys, and analyses of potentially problematic processes. Projects may be identified in response to incidents that occur. The resident will write a brief report and present the results directly to the relevant committee or team. Faculty mentors will meet with residents regularly during the rotation to select and supervise projects. Core faculty members will provide mentorship throughout the year, typically supervising 2 to 3 residents each.

Scholarly Activity

Our Program provides residents with opportunities to participate in Scholarly Activity. The Program supports residents who present their published papers or accepted abstracts at national meetings are supported for registration, travel, and hotel for their role as the primary presenter.

 The Program sends a medical jeopardy team every year to Alabama/Mississippi ACP meeting.

Residents are required to participate in didactics, morning report, QI projects, Morbidity & Mortality Conference