Transitional Year Residency Program

Curriculum

Bassett Healthcare has a long-standing tradition of teaching physicians and practicing both the art and science of medicine. The Transitional Year written curriculum provides a well-balanced, broad-based clinical year. The program will prepare physicians for a specific specialty or facilitate the choice of a previously undecided-upon career. Residents receive the curriculum during orientation at the start of their training. Generous elective time allows residents to sculpt their curricula to meet specific needs and career goals.

Residents spend approximately half of their training in the inpatient medicine and surgery setting and the remaining time in outpatient experiences. Teaching is facilitated by our dedicated Columbia appointed full-time faculty, which provides a 3:1 faculty-to-resident ratio. Focus on patient care, teaching and research are the highest commitment of our faculty. Residents have the autonomy to progressively assume greater responsibility for patient care decisions as one's knowledge and skills increase over the year of training.

Inpatient Services

Medical Wards: There are four general internal medicine teams on the inpatient service. Care of the patient is substantially provided by the resident and intern. The ward attending's role includes responsibility as consultant and teacher on attending rounds. Additional formal and informal consultative services are readily available from all subspecialties. The intern's responsibilities include, but are not limited to, thorough initial inpatient evaluations, daily progress notes, and all orders deemed appropriate by the inpatient team. The composition of each inpatient team can vary, but traditionally there is one resident and two interns on the ward team. The intern is expected to pre-round on his or her patients before morning rounds and should be able to present the events of the past 24 hours in a clear concise manner. Morning report occurs at 6:45 a.m. with the residents. This exchange of information with the night float resident and all ward residents is chaired by the Chief resident or designee. Attending teaching rounds occur daily. Formal bedside evaluation of patients and teaching related thereto should exceed 4-1/2 hours a week. The resident is responsible for having a patient be examined at the bedside every day. A multidisciplinary team meeting occurs for up to 1?2 hour each day, coordinated by the nursing team leader. While on the inpatient medical wards, all residents have one 24-hour period off each week. Teams are on call every fourth night until 8 p.m. at which time the night float team picks up the service and on-call residents may go home when work is complete.

Night Float: A night float system is in place seven days a week. The night float team, consisting of a senior resident and an intern, manages acute overnight care for the general medicine service from 8 p.m. to 7 a.m. This team evaluates and admits new patients and cross-covers for the patients on the medical service. The senior resident presents a case at morning report each day.

Intensive Care Unit: All training in critical care within the Department of Medicine occurs through participation as a member of the ICU service. There are two full-time staff intensivists that provide supervision and teaching for the team allowing for an in-depth experience in the care of critically ill patients including performance of an array of procedures. The team consists of one resident (PGY-2/3), two interns, and one student. The on call resident takes the admissions. The resident on short call assists in writing notes and is support for admissions. The call schedule is every third night and the resident is off the post call day. Rounds begin at 7:30 a.m. and are shared by the team. Didactic sessions are held daily covering a basic core curriculum for the housestaff rotating through the unit. In addition, the ICU setting affords the opportunity to become certified to perform standard procedures.

Inpatient Surgery: There are two general surgery teams on the inpatient service. Care of the patient is substantially provided by the resident and intern. Daily rounds begin at 6:45 a.m. Interns are expected to see and review all their own patients and be prepared to present at rounds. Evaluation and treatment of patients are reviewed daily by a resident and attending surgeon. At 3:30 p.m. patient beside rounds are conducted by the chief or senior resident. Interns need to be prepared with all the necessary data to review with the team and appropriate management plans for the evening are developed. The intern assumes primary care of his/her patients on an integrated service. Utilizing the help and advice of residents and full-time attending staff, the intern admits and manages emergency and elective cases. Areas of particular interest to the intern can be emphasized. This rotation provides training in the management of patients both pre- and post operative with a wide spectrum of surgical problems. Surgical specialties represented include head and neck, neurosurgery, orthopedic, pediatric, plastic, thoracic, urology, and vascular.

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Outpatient Experiences

Outpatient Department Block: Transitional Year residents must complete four weeks in the ambulatory setting. This experience can include a variety of outpatient clinic settings in the medical and surgical divisions. Other clinics available include the regional clinics, farm safety and health (sponsored by Bassett's New York Center for Agricultural Medicine and Health), preventive cardiology, geriatrics, STD, pediatrics, psychiatry and women's health. This block is designed by the resident and the Program Director.

Subspecialty Clinics: Residents can choose from a variety of medical and surgical subspecialty clinics for electives. The subspecialty experience includes supervised clinics and consultative service functions. Carefully designed curricula and one-on-one teaching make these rotations exceptional experiences.

Emergency Services: A 4-week Emergency Services block is required in the Transitional Year curriculum. This experience provides exposure to emergency patient evaluation, history and physical, ordering appropriate ancillary services, deciding appropriate therapy and disposition, and completion of an adequate record under supervision of an Emergency Services Department Attending.

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Evaluation and Feedback

EVALUATIONS OF YOU AND BY YOU: At the end of each rotation an evaluation is completed by the faculty members you worked with. You are evaluated based on procedural skills, fund of medical knowledge, medical management ability, patient communication and relationship skills, acceptance of supervision, work ethic, patient-centered focus, understanding and application of socioeconomic principles, and medical record completion. It is the responsibility of the resident to establish a meeting time with the attending at the beginning of the rotation to review the curriculum, goals and objectives; in the middle of the rotation to review your performance and to identify areas that need attention; and at the end of the rotation to do a final review of your performance and achievement of the curriculum goals and objectives.

All residents meet twice a year with the Program Director for a performance review. The Program Director uses this time to review evaluations and procedure certification reports and provides feedback on areas for improvement as well as strengths. This is also an opportunity to discuss the resident's future plans.

EVALUATIONS BY YOU: At the end of each rotation you have the opportunity to evaluate the program content, use of ancillary services, and faculty teaching skills. Evaluations by you of the various services and faculty are strongly encouraged. All comments are strictly confidential. Evaluations are collected by the Medical Education Office and are submitted to the Research Institute for a bi-annual summary report. The summary reports are reviewed by the program director and the clinical chiefs (there are no names or rotation dates on these reports). Data collected is used to monitor and improve the quality of the residency training programs.

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