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Ambulatory experience

Outpatient service

At our off-site outpatient facilities, residents provide outpatient services and establish their own continuity-of-care practices under full time faculty supervision. Continuity of care is emphasized with residents scheduled to see the same panel of patients over the course of the three-year training period. Our new 6-2 curriculum is set on a fixed schedule where second and third year residents rotate on six weeks of inpatient followed by two weeks of ambulatory. There are weekly didactics that occur on Wednesdays from 9am  to 12pm. Topics discussed include:

  • Ambulatory lectures by faculty
  • Problem based learning initiative
  • Quality improvement projects
  • Journal Club
  • Johns Hopkins modules review

Residents can choose from 15 different templates that maximize subspecialty exposure. Electives in the outpatient setting allow the residents to experience the full range of subspecialty practice. There are also weekly simulation sessions led by a hospitalist and a chief resident where the interns participate in an interactive module on how to approach and manage an acutely sick patient.

Inpatient service

Our active inpatient service provides house staff with the opportunity to manage patients with a wide variety of diagnoses under the supervision of an academic hospitalist or voluntary faculty staff. Each inpatient team, which consists of a resident and two interns, sub-interns and third year medical students, manages up to 20 patients. All admitted patients are on the teaching service and are being cared for by our house staff. A teaching attending is assigned to each team and conducts bedside teaching rounds and didactics daily. The full range of subspecialty services and a new simulation curriculum under Educational Activities enhance the residents training experience.

Cardiac Care Unit

The Cardiac Care Unit and associated Progressive (Step Down) Care Unit provide house officers with exposure to state-of-the-art cardiac services in a world-class center for cardiac and peripheral vascular intervention techniques. The full-time director of the unit supervises the academic and clinical components and a fellow from the Cardiology program is assigned to the unit at all times. Three teams each composed of a resident and an intern, care for the 15 patients in the CCU.

Intensive Care Unit

The Intensive Care Unit is a 15 bed state-of-the-art patient care facility. There are three ICU teams each consists of a senior resident and an intern. House staff are supervised by full-time academic intensivists, who conduct multidisciplinary rounds three times daily. There is 24 hour in-house intensivist coverage and support for the house staff.

Emergency Department

Lenox Hill Hospital's Emergency Department manages approximately 40,000 annual visits. Internal Medicine residents have an average of two months of emergency room experience during their training. The newly opened state-of-the-art emergency room includes complete electronic health records. Residents receive outstanding experience under the supervision of full-time emergency medicine trained physicians.

Affiliations

Teaching affiliations:

  • New York Medical College
  • NYU School of Medicine
  • SUNY Downstate School of Medicine
  • Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
  • Pace University/Lenox Hill PA Program
  • Long Island University Doctor of Pharmacy Program

Electives

Residents are scheduled for six elective rotations during the three years of training. Elective months are composed of inpatient subspecialty consultative and ambulatory components. Residents are also given the opportunity to construct a "customized elective" for which they create their own learning goals and objectives, with the assistance of the program director, in order to meet their individual educational interests and needs.

Educational activities

  7:30am-8:30am 9:00am-12:00pm 12:30pm-1:30pm
Monday     Medicine Subspecialty Lecture Series
Tuesday Resident Morning Report   Medicine Subspecialty Lecture Series
Wednesday   Ambulatory Didactic Session, Journal Club Medicine Subspecialty Lecture Series-Ambulatory
General Medical Conference
Simulation Session (Interns)
 
Thursday     Intern Report
Friday Medical Grand Rounds   Cheif's Seminar

Resident Morning Report

Morning Report takes place once a week and is designed to be a clinical reasoning exercise. It is supervised by carefully selected internist or sub-specialist role models and is structured to address clinical dilemmas and to successfully prepare house staff for the American Board of Internal Medicine certifying examination.

Intern Report

Intern Report is a weekly teaching conference led by an Associate Program Director. Typically, an intern presents an admission and relevant elements of the history and physical exam are discussed. Interns participate in generating a work up, differential diagnosis and management approach to the patient.

Journal Club

Practice of Medicine in the 21st Century

This unique program is geared toward developing skills that internists will need in a post ACA world.

  • Clinical Reasoning is a skill that must be practiced in order to master. In order to avoid making diagnostic errors (mistakes) doctors must acknowledge dual process theory and not allow quick, intuitive system one to govern unchecked by slow, deliberative system two. Built upon the writings of Croskerry, Kassirer, Graber, and others residents explore cases that challenge them to become de-biased and avoid the traps of early closure, anchoring, availability and other sources of diagnostic mistakes.
  • Evidence Based Medicine is the set of skills needed to engage in life-long learning. It is also the basis of Practice Based Learning and Improvement. Our residents systematically pick apart different kinds of clinical literature both to keep up to date and to understand how to measure the validity and therapeutic effect of clinical research.
  • High Value Care is a set of deliberate exercises that teach residents to be less wasteful in their care. Given that close to 40% of current US health care expenditures are wasted, these may be the most important lessons learned by residents in a post Affordable Care Act world.
  • Quality and Safety is our curriculum that helps the internist participate in the new quality and safety movement. Solving real problems, residents learn to use the tools of quality improvement and patient safety. These highly interactive sessions are not only helping us with our goal of "safest care available" but also prepare graduates to become leaders in their future organizations.

Peabody Club

Our new curriculum in medical humanities is not offered anywhere else in this way. The Peabody Club is named for Francis Peabody who so famously said, "the secret of caring for the patient is to care for the patient". The curriculum is offered in a variety of venues including bedside teaching, role play, simulation, small and large group interactive discussions and even self directed learning. It covers palliative care (the relief of suffering), medical ethics, geriatrics (caring for one of our most vulnerable populations), and cultural competency (shrinking the disparities in caring for minority groups).

Stanford 25 Sessions

Do you know how to recognize a Trendelenburg gait? Have you ever seen a patient with Grey-Turner's sign? We have. Each week, program leadership goes out on the floors and in the clinics and reviews a chapter of the "Stanford 25" physical diagnosis curriculum. These 25 physical exam skills are considered essential components of every internist's tool box. When we first started the Stanford 25 sessions we thought that residents would be bored to review skills last taught in medical school. The truth is that with up to 30 months of experience treating patients, putting these skills into perspective is like teaching a weekend warrior to lead a safari expedition.

Medicine Subspecialty Lecture Series

The Medicine Subspecialty Lecture Series includes the relevant topics in a variety of subspecialties including gastroenterology, cardiology, hematology/oncology, nephrology, HIV medicine, pulmonology, infectious disease, rheumatology, allergy/immunology, endocrinology, dermatology, critical care and palliative care in a core curriculum.

General Medical Conference

Our general medical conferences are given by one of our PGY-2 or PGY-3 residents. Each resident will present a comprehensive evidence-based review of a disease entity or topic of their choice. Our faculty provides assistance with preparation, literature search and review of the presentation.

Medical Grand Rounds

Medical grand rounds include clinico-pathological conferences, and combined medical-surgical conferences that are presented by both Lenox Hill Hospital faculty and nationally known guest speakers addressing medical topics of current interest.

Chief's Seminar

The Chief's Seminar is a novel practice based teaching curriculum for resident education. The curriculum incorporates MKSAP based crossword puzzles, concept map techniques and small group interactive sessions.

Simulation Center

The simulation program at Lenox Hill includes a curriculum tailored to the level of training. PGY-1 trainees are exposed to the approach to the sick inpatient, the physical exam, and scenarios involving basic organ dysfunction syndromes. The PGY-2 and PGY-3s curriculum involves simulation of complex cardiovascular, respiratory, metabolic and neurologic diseases and ACLS protocols. These sessions, which employ a Laerdal SimMan Essential mannequin, are led by critical care faculty, hospitalists and chief residents. The SimMan sessions are intended to stimulate the development of critical thinking skills central to training in Internal Medicine.

Additional academic components

A wide variety of academic resources are available within the hospital. In addition to our Health Science Library, house staff have institutional-wide access on the hospital network to EMIL-the Electronic Medical Information Library (electronic access to full-text articles from 6000+ clinical journals), Up-To-Date, DYNAMED, MDConsult, Cardiosource Plus and the Cochrane Database of Systematic Reviews. Residents are also provided with their own Lenox Hill e-mail account, and home access to multiple online resources.

Fundamental Critical Care Support course

The High Value, Cost-Conscious Care Curriculum (HVCCC) has been jointly developed by the American College of Physicians (ACP) and the Alliance for Academic Internal Medicine (AAIM) in an effort to shape the habits of future physicians regarding cost-consciousness and stewardship of resources, hopefully to instill stringent long-term practice behaviors. The overarching goal of this curriculum is to teach internal medicine residents to deliver high value cost conscious care with a simple 5 step model.

  1. Understand the benefits, harms, and relative costs of the interventions that are routinely ordered
  2. Decrease or eliminate the use of interventions that provide no benefits and/or may be harmful
  3. Choose interventions and care settings that maximize benefits, minimize harms, and reduce costs (using comparative-effectiveness and cost-effectiveness data)
  4. Customize a care plan with the patient that incorporates their values and addresses their concerns
  5. Identify system level opportunities to improve outcomes, minimize harms, and reduce healthcare waste

This seminar series starts in April through June at a critical period when PGY-1 trainees are preparing to transition into PGY-2 residents.

Nutritional and Culinary Education Program

Click here to learn more about Lenox Hill Hospital's Nutritional and Culinary Education Program

The Physician Alcoholism and other Addiction Training Program (PAAT) is an immersive learning experience where the resident physician participates in a weeklong seminar with residents from other NYC residency programs. The resident learns about every aspect of alcoholism and substance abuse through various lectures and interactive teaching modules. The resident physician will even be teamed up with an Alcoholics Anonymous buddy at the start of the program and will attend an AA meeting with this buddy. After the meeting the resident will discuss all aspects of addiction and recovery with their buddy for a completely immersive experience.

HIV Care training

The department offers a track for training internal medicine residents interested in specialized HIV care. Successful care of HIV patients requires physicians with specific medical knowledge, a compassionate approach, and a capacity for managing a complex myriad of medical and social issues. This program will allow specialized clinical training for this generation of physicians who will take the lead in shaping the care for HIV-infected patients. Learn more about the HIV Care Training Program

Primary care track

The Department of Medicine at Lenox Hill Hospital has developed a primary care track for the internal medicine residency. This track provided enhanced and focused training for physicians with a desire to practice community-based general internal medicine. The aim of this program is to develop and support primary care providers who provide compassionate, efficient, and evidence-based comprehensive care to the communities they serve. Learn more about the Primary Care Track.

Schedule

All inpatient rotations take place at Lenox Hill Hospital.

Outpatient rotations are located at the following facilities:

  • Lenox Hill Medicine - East 85th Street
  • Retroviral Disease Center - East 64th Street, NYS designated AIDS center
  • Queens Long Island Medical Group - Astoria, NY

The academic year is divided into a fixed "6 - 2" - schedule. Residents rotate on 6 weeks of inpatient services followed by 2 weeks of ambulatory services. The following is yearly breakdown based on each post-graduate year (PGY).

Residents Schedule

PGY-1 Categorical

Four Week Blocks

Two Week Blocks

GMF (4 months)

Night Float (2-4 weeks)

ICU (1 month)

Stepdown Telemetry (2 -4 weeks)

CCU (1 month)

Vacation (4 weeks)

Stepdown Telemetry (2-4 weeks)

Ambulatory (12-14 weeks)

Elective (2 weeks)

 

 

PGY-1 Preliminary

Four Week Blocks

Two Week Blocks

GMF (5 months)

Night Float (2-4 weeks)

ICU (1 month)

Stepdown Telemetry (2 -4 weeks)

CCU (1 month)

Vacation (4 weeks)

Stepdown Telemetry (2-4 weeks)

Ambulatory (2 weeks)

 

Elective(6 weeks)

PGY-2 Categorical

Four Week Blocks

Two Week Blocks

GMF (2 months)

ICU consult/Rapid Response Team (2 weeks)

Stepdown Telemetry (1 month) - 2 weeks days/2 weeks nights

Palliative Care (2 weeks)

CCU (1 month)

ID consult (2 weeks)

 

Neurology Consult (2 weeks)

 

ED (2 weeks)

 

Night Float (2-6 weeks)

 

Vacation (4 weeks)

 

Elective (4 weeks)

PGY-3 Categorical

Four Week Blocks

Two Week Blocks

GMF (2 months)

SHO/Day Float (2 weeks)

ICU (1-2 months)

ICU consult/Rapid Response Team (2 weeks)

CCU (0-1 month)

Medicine consult (2 weeks)

Senior Admitting Resident (2 weeks)

Geriatrics (2 weeks)

 

ED (2 weeks)

 

Night Float (2 weeks)

 

Stepdown Telemetry (2 weeks)

 

Vacation (4 weeks)

 

Elective (6 weeks)

 

Call Schedule

Floor Call

  • Every 4th long call 7am - 8pm
  • Admit 2pm - 7pm
  • Sign out to NF at 8pm

Night Float

  • Six nights/week 8pm-7am (9am on Saturdays)
  • Saturday night off

ICU/CCU Call

Three teams split the following shifts over a block:

  • Short Call 7am - 4pm
  • Long Call 7am - 8pm (ICU); 7am - 7pm (CCU)
  • Night Shift 8pm - 7am (ICU); 7pm - 7am (CCU)
  • Weekend short call team does not come in

Subspecialty electives

Electives are comprised of inpatient subspecialty consultative and ambulatory components. Some of our electives include:

Gastroenterology
Cardiology
Hematology/Oncology
Nephrology
HIV medicine
Pulmonology
Infectious Disease
Rheumatology
Allergy/Immunology
Endocrinology
Dermatology
Critical Care
Palliative Care
Research
Private Office
Off-site elective

Primary care track

At the Department of Medicine at Lenox Hill Hospital, we recognize the urgent need for primary care physicians. To meet this need, we offer a Primary Care Track that complements our Internal Medicine Residency program with enhanced and focused training for physicians with a desire to practice community-based general internal medicine. The aim of this program is to develop and support primary care providers who offer comprehensive, compassionate, efficient and evidence-based care to the communities they serve.

Program overview

The principal goals of the program are to:

  • Provide systematic clinical and didactic training in health maintenance, disease prevention, and culturally competent diagnostic and therapeutic care in the outpatient setting
  • Provide opportunities to work with subspecialists and a range of practitioners in multispecialty settings
  • Provide longitudinal private physician mentorship
  • Provide career development and support
  • Provide ample exposure and guidance in performing common ambulatory procedures
  • Develop skills in qualitative research, practice improvement, and quality improvement
  • Develop skills in patient and community education
  • Support individual development and implementation of a practice or quality improvement project for our main ambulatory site
  • Support group development and implementation of a primary care reading curriculum

Leadership

Director: Becky Mazurkiewicz, MD, MPH

Dr. Mazurkiewicz completed her undergraduate training at the University of Michigan and medical school at Georgetown University School of Medicine before moving to the Mount Sinai Hospital in New York City to complete an internal medicine residency, a general internal medicine fellowship and a Master’s in Public Health. She is currently the Director for the Primary Care Track of the Internal Medicine Residency, the Director of Resident Scholarly Activity including the Quality Improvement Project experience, and the Site Director for the Acting Internship at Lenox Hill Hospital in New York, NY.

Chief Senior Residents (AY 2017-2018): Jeff Le, DO and Ashita Ganguly, MD

Dr. Le is originally from Toronto, Ontario. He graduated from the University of Rochester with a degree in Music, with concentrations in piano and vocal performance. After completing the post-baccalaureate program at the University of Pennsylvania, he received his D.O. from the New York College of Osteopathic Medicine. His interests include primary care, sports medicine, and preventive medicine.

Dr. Ganguly graduated from Texas A&M University College of Medicine. She is currently a third-year resident in the Primary Care Track at Lenox Hill Hospital. Her interests include healthcare policy and high-value, cost-conscious care. She is thrilled to serve as this year’s Primary Care Track chief senior co-resident, serving as a liaison between the residents and the primary care faculty.

Eligibility

Three Primary Care positions will be offered at each academic level. Trainees may enter the Lenox Hill Primary Care Track through the NRMP Match or apply to transfer into the program by the completion of PGY1 if space is available at the discretion of the director of the Primary Care Track. Participants should be prepared to engage in all aspects of the track and are required to attend all didactics when not on vacation, night float, or ICU, as well as participate in all track projects.

Certification

Trainees will fulfill all Accreditation Council for Graduate Medical Education (ACGME) requirements and become eligible for the American Board of Internal Medicine certification by the completion of the three years of their training.

Clinical experience

Primary Care Track participants have the same number of required inpatient blocks as the categorical residents do; however, during ambulatory blocks, PGY2 and PGY3, Primary Care residents have four continuity sessions, one private office session, two special sessions, and two academic sessions per week.

Continuity Clinic Site

The continuity clinic site for primary care track residents is a NCQA-certified Patient Centered Medical Home in Astoria, Queens.  Lenox Hill Hospital residents provide exceptional primary care to their panel of patients as well as urgent care to their patients and patients of other providers in Astoria and beyond. Despite its commute, assignment to this clinic is highly coveted by categorical residents given the exposure to urgent as well as continuity care, the diverse patient population, and our ability to perform ambulatory procedures such as pap smears, I+Ds, suturing, ear irrigations, fluorescein eye staining, and IV hydration.

Private office sessions

During the ambulatory block, PGY2 and PGY3 Primary Care Track participants will spend one session per week in the office of a seasoned private practitioner. Such an experience will allow residents another opportunity for continuity in ambulatory patient care as well as the ability to view and participate in the inter-workings of a private office.

Primary care selective

Each academic year, residents will participate in a two-week primary care selective block, which will replace one inpatient block. During this rotation, you will work with your private office mentor as you would during an ambulatory block; however, you will also be given the opportunity to spend time working with practitioners who specialize in adjacent fields such as wound care, nursing home/rehabilitation services, nutrition and obesity medicine, and more that will vary by PGY level in order to maximize the breadth and diversity of your experiences. Residents are also welcome to explore similar experiences that they have arranged for themselves - for example, previous residents have scheduled a time to shadow at an alternative medicine office and at the Department of Health.

Primary care senior resident

As a PGY3, you will have the opportunity to act as a preceptor in the clinic. In this role, you will guide and educate a PGY1 or PGY2 as they formulate an assessment and plan from their HPI, physical exam, and review of the current medical records, including medication reconciliation. Through both observing and reviewing your colleague's patient interactions, you will facilitate the development of core clinical skills, knowledge and competencies. The resident preceptor will be responsible for guiding pharmacotherapy decisions, patient counseling, and monitoring of drug therapy, to optimize therapeutic outcomes for a given patient as well as adding an addendum to the patient note. An attending will co-sign the note at the end of the encounter after discussion with you and the PGY1/2 you are supervising.

Didactics and workshops

Monthly, Primary Care Track residents meet as a group in order to participate in track-specific education, support, and guidance. The content of meetings varies on a monthly basis but can include primary care-related didactics, skill- and career-building workshops, and guidance on ambulatory academic projects that are not otherwise covered in such depth in the categorical ambulatory curriculum. Meetings last roughly one and a half to two hours, generally begin at 5:30 pm to facilitate attendance.

Previous topics for primary care didactics include health literacy, career development, billing and coding, hormone replacement therapy, contraception, smoking cessation, wound care, healthcare navigation, nutrition and weight management, incontinence, podiatric care, splints and braces, outpatient antibiotics, osteopathic medicine, primary care emergencies, and ostomy care. Previous topics for primary care workshops include resident teaching skills, CV dissection, job search and interviewing, finger stick glucose checks and insulin administration, incision and drainage, basic ambulatory suturing, knee arthrocentesis and injection, breast and pelvic exams, splinting and bracing, bladder scanning, straight catheterizations, ear irrigations, IV placement, and dermatologic shave and punch biopsies. 

Lenox Hill Hospital has purchased a patient care simulator for ambulatory procedures, which is utilized in track meetings.

Ambulatory quality improvement

Primary care track participants are required to choose an ambulatory topic as the subject of one of their two required academic projects during their residency. Participants are given an introduction to quality improvement and practice-based learning improvement initiatives, evidence-based medicine and qualitative research to assist them in this endeavor. Mentorship on such a project will be provided by any member of the ambulatory faculty and time is provided during primary care track monthly didactics to discuss progress and obtain feedback from the group. It is expected that the results of this project will be submitted as an abstract to a regional or national conference, if not for publication.

Mentorship and career development

In addition to the skill- and career-building workshops mentioned above, each Primary Care Track participant meets with the director of the track biannually for feedback related to meeting track objectives and to ensure he or she is appropriately progressing toward his or her career goals.