Nationally Recognized Curriculum

Internal Medicine Residency Program

Christiana Care has been a top-rated academic medical center for more than a century. Our residents and fellows experience a rigorous and rewarding combination of academic training and hands-on experience.

The Internal Medicine Residency Program attracts candidates from around the country who value our challenging university-affiliated academic curriculum within a community-based setting.

Our diverse patient mix offers residents exceptional opportunities to diagnose and treat a broad spectrum of primary-care diseases, as well as tertiary-care medical conditions not routinely encountered in smaller hospital settings.

Christiana Care appoints 12 residents to the categorical internal medicine program each year. Additionally, Christiana Care appoints 4 internal Medicine/Pediatrics and 3 Internal Medicine/Emergency Medicine interns each year.

Innovative training blocks

The Christiana Care Internal Medicine Residency was the first program in the country to develop an innovative 4+2 ambulatory block schedule. In this schedule, rather than typical half-day clinics added to all inpatient and outpatient rotations, our curriculum splits the residents’ experiences into inpatient and outpatient blocks of time. The residents’ experience consists of a four-week inpatient-medicine experience alternating with a two-week ambulatory-medicine experience. This design allows residents to completely focus on the rotation. If you are on an inpatient rotation, you will not need to leave in the middle of the day to go to clinic. Similarly, in the outpatient setting, you will not need to run back to the hospital.

The inpatient-medicine experiences will consist of general inpatient medicine at Christiana Hospital and Wilmington Hospital, as well as rotations in the MICU and CICU. Additionally, the inpatient based specialty rotations will occur during the 4 week blocks of time (e.g. cardiology, pulmonary, nephrology, hematology, infectious diseases and neurology).

During each 2 week ambulatory block, residents will spend 2 full days per week in their outpatient continuity practice at Wilmington Hospital. Each resident will also have a half day per week of administrative time to work on research, performance improvement, or other patient care needs, and a half day per week of academic during our protected academic half day (see didactic curriculum). The remaining four days over the two-week block will be spent on subspecialty experiences . Time is available in the schedule that will allow residents to tailor the curriculum to their individual learning needs and career goals.

Teacher-Manager-Learner

The inpatient medicine experience has adopted a “Teacher-Manager-Learner” model.  As “Learners”, PGY-1 residents do just that- learn.  Under the supervision of a PGY-3 resident and an attending physician they broadly build their knowledge in patient care, medical knowledge, communication skills, and professionalism.  Our “Manager” teams allow PGY-2 residents to work side by side with an attending physician which provides greater autonomy.  In addition to building on the knowledge they developed as “Learners”, “Managers” develop skills and knowledge in evidence based medicine, cost effective care, transitions of care, and working in a multidisciplinary team.  Finally, we consider our PGY-3 residents “Teachers” and we provide them the autonomy to lead the team in making medical decisions. Perhaps more importantly we expect them to educate PGY-1 “Learners” (as well as 3rd and 4th year medical students), and role model the skills, knowledge, and attitudes they have developed during their first two years of residency training.  We believe this graduated learning experience builds competency and confidence in our residents to become excellent physicians.

Outstanding support

Christiana Care offers outstanding ancillary support 24/7 so that you are supported by an excellent group of nurses, therapists, patient-care techs, phlebotomists and social workers.

We strictly adhere to the ACGME work-hour guidelines so that you are assured adequate rest.

Some highlights of the program:

  • Largest teaching affiliate of Sidney Kimmel Medical College at Thomas Jefferson University of Thomas Jefferson University, Philadelphia.
  • Two-day, off-site retreats each year in beautiful locations to focus on team-building, leadership, teaching and feedback skills.
  • Resident night float on all inpatient services ensuring compliance with duty hours.
  • A strong academic program and nationally recognized faculty in a friendly, collegial setting.
  • Rotations designed to work with diverse populations in urban and suburban hospital settings.
  • Extensive research and fellowship opportunities, including fellowships at Christiana Care in cardiology, nephrology, sports medicine, patient quality and safety and hospice and palliative medicine.
  • Enhanced patient care due to fewer handoffs.
  • Residencies in Categorical Internal Medicine, Combined Medicine/Pediatrics and Combined Emergency Medicine/Internal Medicine.

Sample PGY-1 block schedule

Sample block schedule for Christiana Care Internal Medicine Residency Program

Sample block schedule for Christiana Care Internal Medicine Residency Program

Sample ambulatory schedule

Monday Outpatient Continuity
Tuesday Subspecialty Outpatient
Wednesday Outpatient Continuity/Admin
Thursday Academic Half Day/Continuity
Friday Subspecialty Outpatient

Innovative call structure

We have a fully integrated night float system on every inpatient rotation. Interns do an average of four weeks of inpatient floor night float and two weeks of ICU night float during the first year. Intern night float is an approximately 13 hour shift nightly six nights per week. Interns are not scheduled for shifts longer than this. Interns on inpatient rotations share “short call” (until 7 p.m.) responsibilities and on average have one of these shifts every three to four days.

Upper-year residents take four to eight weeks of night float on the floors and ICUs in each year. In the MICU and CICU, the upper year residents work a staggered shift schedule without overnight call only on Friday night in the CICU.

A resident’s typical day

Inpatient Floor Services
0600 – 0630 “Start time.” Obtain sign in from on-call team. Critical patients are to be seen immediately.
0700 – 0900 Interns evaluate patients and write progress notes.
0800 – 0900 Medical Morning Report. Attendance is mandatory for PGY 2 and PGY 3 floor residents (optional for interns.)
0900 – Noon Team Work Rounds
Noon – 1300 Core Lecture/Board Review (Mon, Wed, Fri)
1400 – 1630 Admission, chart reviews, etc.
1700 – 1800 Sign-Out. New admissions are reviewed and potential problems are identified.
Intensive Care Units
0600 – 0630 “Start time.”  Obtain sign in from on-call team.
0730 – 0930 Work Rounds. Interns and residents evaluate patients, write notes, order tests.
0930 – 1100 Teaching Attending Rounds
Noon – 1300 Core Lecture/Board Review
1300 – 1600 Admissions, chart reviews, etc.
1600 – 1700 Sign-Out. All patients are reviewed.