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Internal Medicine Residency Program Overview

Overview of the Internal Medicine Residency Program

Mission

Loyola MacNeal Internal Medicine Residency Program honors the esteemed legacy of Dr. Arthur W. MacNeal. As a physician, Dr. MacNeal strove to meet the needs of the community and from his home founded what became MacNeal Hospital. Today, the modern day MacNeal Hospital continues to remain committed through partnership with Loyola Medicine to meet the unique needs of our growing community. Our Internal Medicine program seeks to preserve the tradition of service and inspire within our residents a passion for patient care and a deep fund of intellectual curiosity. We equally believe our residents’ breadth of exposure to complex internal medicine disorders and the opportunity to encounter the first presentation of rare disorders culminate in the creation of well-rounded physicians ready to meet the needs of tomorrow’s patients.

Values

Residents’ well-being is a priority for the Residency Program. The education provided to residents is learner-centered. The patient care provided in the hospital and in the clinic is safe, effective, timely and always compassionate. 

Internal Medicine Residency Curriculum

MacNeal Hospital’s Internal Medicine Residency curriculum is designed to enhance specific skill sets in each academic year of training.

The rotations follow a “4 + 2” schedule format. Residents will rotate in a 4-week inpatient block followed by 2 weeks of outpatient ambulatory medicine. This will allow residents to learn outpatient and inpatient medicine without conflicting responsibilities. Rotations in the 2-week blocks include Addiction Medicine, Women’s health and the IM Continuity Clinic. Residents will also have dedicated didactic time Wednesday mornings during their Medtalks session and dedicated time for administrative work.

R1:

The intern year at the MacNeal Internal Medicine Residency Program focuses on developing skills in general internal medicine. There are rotations in the ICU and Emergency Room to develop patient care skills in critical and emergent settings, and a broad introduction to general internal medicine in the ambulatory setting. The Interns will also have a special rotation – Practice Management. The goal of the rotation is to provide an overview of the US healthcare system. There will be individual teaching sessions to discuss payment models, billing requirements and medical documentation.  The overall goal for the intern year is to attain patient care skills, develop interpersonal communication skills, build one’s foundation of knowledge to support medical decision making, and learn medical documentation skills.

R2:

During the second year, residents transition to being leaders of the internal medicine team. Residents learn to be independent in critical thinking and medical decision-making. Second-year residents independently lead an Internal Medicine Service team under the supervision of faculty, and work alongside a co-senior resident and an ICU Hospitalist managing the Intensive Care Unit. Residents also cross cover and admit patients during their night float rotations. On the Community Inpatient Service Rotation (CIPS) they work with a co-senior resident and an attending, providing an opportunity to replicate the autonomy and independence in patient management of Hospital Medicine. Residents may choose to do an elective rotation this year, which includes a rotation at Loyola University Medical Center or a research month in MacNeal. 

R3:

The third-year resident has more rotations in inpatient subspecialty rotations. This year enhances the resident's clinical knowledge in subspecialties to prepare for the ABIM board exam and continue developing skills to be a well-rounded general internist. At the end of the R3 year, residents are well balanced and confident in both inpatient and outpatient management of general internal medicine patients, and are well-prepared to take the board exam.

Inpatient Rotations:

  • Internal Medicine Service
  • Community Inpatient Service
  • Intenstive Care Unit
  • Emergency Medicine
  • Night Float
  • Inpatient Subspecialty:
    • Pulmonary and Critical Care
    • Cardiology
    • Gastroenterology
    • Endocrinology
    • Infectious Disease
    • Neurology
    • Nephrology

Ambulatory Rotations:

  • Addiction Medicine
  • Diabetes Care
  • Endocrinology
  • Community Medicine
  • Physical Medicine and Rehabilitation/Orthopaedic Surgery
  • Palliative Medicine & Hospice
  • Pulmonary 
  • Hematology and Oncology
  • Rheumatology
  • Medical Spanish

Inpatient Rotation Sample (4 weeks)

MondayTuesdayWednesdayThursdayFriday

7 AM

Sign-out

7 AM

Sign-out

7 AM

Sign-out

7 AM

Sign-out

7 AM

Sign-out

12 - 1 PM

Core Topic Conference

12 - 1 PM

Core Topic Conference

12 - 1 PM

Board Review
 

12 - 1 PM

Core Topic Conference

12 - 1 PM

Resident Report

 

2 - 3 PM

Resident Report

 

 

 

5 PM

Sign-out

5 PM

Sign-out

5 PM

Sign-out

5 PM

Sign-out

5 PM

Sign-out

Ambulatory Rotation Sample: Rheumatology (2 weeks)

MondayTuesdayWednesdayThursdayFriday

8 AM - 12 PM

Continuity Clinic

8 AM - 5 PM

Rheumatology Clinic

8 AM - 12 PM

MEDTalks Session

8 AM - 12 PM

Continuity Clinic

8 AM - 12 PM

Rheumatology Clinic

1 - 3 PM

Musculoskeletal Workshop

1 - 5 PM

Rheumatology Clinic

1 - 5 PM

Continuity Clinic

1 - 5 PM

Administrative Work

Internal Medicine Conferences

The educational experiences of MacNeal Internal Medicine residents are enriched by a robust didactic series and interactive conferences. Below is a template for weekly conferences:

 MondayTuesdayWednesdayThursdayFriday
AM  

 12
MEDTalks*

  
12 1 pmCore
Topic
Core
Topic
Board
Review
Core
Topic
Resident
Report
PM 2 - 3
Resident
Report
   

*For Ambulatory Rotations

MedTalks (8 AM 12 PM)

During the ambulatory 2-week blocks, residents will have a dedicated half day of learning. These sessions will include a varying mix of lectures relevant to practice evidence-based medicine and to provide individualized patient care. There will be lectures to highlight outpatient medicine for the primary care physician, and sessions for residents to hone skills in performing bedside procedures.

  • Ambulatory Lecture Series  a resident-led lecture series to focus on the diagnosis and management of medical problems relevant to the primary care physician.
     
  • Code Blue and RRT Review – residents will have simulation cases to practice management of acutely ill patients to prepare them for management of code blue and rapid response calls in the hospital.
     
  • Evidence Based Medicine Sessions – residents learn how to use medical literature and basic biostatistics measures and apply the findings to specific clinical questions and patient care.
     
  • High Value Care – an interactive lecture and small group series focused on teaching the practice of cost-conscious medicine. Throughout the series, residents gain exposure to different members of the hospital staff including nurses and nurse supervisors, pharmacists and individuals from the finance department.
     
  • Journal Club – a senior resident along with a core faculty member facilitate group discussion and critical appraisal of the selected article.
     
  • Morbidity and Mortality Conference – a senior resident along with a core faculty member engages in the presentation of a case with the intent to create a safe space for review of patient care improvement opportunities. This conference emphasizes confidentiality and promotes patient safety and excellence in patient care.
     
  • Procedure Workshops – residents will undergo hands-on learning of how to properly perform bedside procedures such as: arterial blood draw, arterial line placement, lumbar puncture, paracentesis, peripheral blood draw, pelvic exam, thoracentesis, US-guided central venous line placement, US-guided peripheral IV line placement.
     
  • Quality Improvement and Patient Safety – a lecture series that will discuss principles of quality improvement for residents to become confident in starting their own quality improvement projects. The series will also include interactive sessions and lectures that focus on patient safety.

Noon Conferences (12 – 1 PM)

  • Clinical Pathology Conference – a senior-resident-led conference that features in-depth exploration of the pathophysiology, diagnosis and management of a patient case. It also offers the unique perspectives of specialists who attend and provide rich and insightful commentary about the case.

  • Weekly Core Lecture and Small Group Series – a series that occurs early in the academic year and focuses on the mastery of managing common inpatient conditions.

Internal Medicine Residency Scholarly Activity

At MacNeal, our internal medicine program strives to nurture resident interest in scholarly activity. Residents are encouraged to attend and present at national and regional conferences. In recent years, our residents have presented abstracts and posters at conferences such as Regional and National ACP, SGIM, ICAHO, CHEST, ATS and LUMC Research Day. Residents may use the annual CME to assist with the costs associated with conference attendance.

Prachi Jain, R3, ACP IL Chapter Norther Regional Annual Residents's and Medical Students' Day 2019


Our residents also have the opportunity to showcase their research or clinical case reports and vignettes at our annual Resident Research Day. Awards are presented for first and second place clinical vignette posters and oral research presentations.

Quality improvement is also emphasized at MacNeal. Every resident is given the opportunity annually to participate in a quality improvement project. Each quality improvement project is overseen by a dedicated faculty mentor. Quality improvement projects are also encouraged to be submitted as part of Resident Research Day. Awards are presented for first and second place quality improvement project posters.

Recent Quality Improvement Projects Include:

  • Appropriateness of telemetry use in the general medical floor
  • Hyponatremia Management: A focus on inpatient timed labs
  • Improving Bipap use in the general medical floor for critically ill patients
  • Improving colorectal cancer screening in clinic
  • Inceasing pneumonia vaccination in patients < 65 years-old
  • Management of uncomplicated cystitis
  • Optimizing use of interpreter services among Spanish speaking patients
  • Resident Wellness

Internal Medicine Resident Publications and Presentations from Recent Years:

2019-2020

Push Enteroscopy in the Diagnosis of a Gastrointestinal Bleed Caused by Diffuse Large B-cell Lymphoma. Mukarram Amine MD, Amit Srivastava MD. Presented at San Antonio ACG Conference 2019

The Trending Injury: E-cigarette and Vaping Associated Lung Findings. Jasti M, Farooq U, Sanchez P, Shingada K, Junia C. Presented at SGIM 2020

If the Test Fits: Diagnosis to Aid in the Treatment of Influenza. Raul Rodriguez M.D.; Diana Espinoza M.D.; Christine Junia M.D. Presented at ACP Northern IL Regional Conference 2019

Mind the Gap: Inpatient Management for Elevation in the Globulin Gap. Shelden Rodrigues MD, Buddhi Hatharaliyadda MD, Christine Junia MD. Presented at ACP Northern IL Regional Conference 2019

Outcomes of Vasoconstrictor Induced Non-occlusive Large Bowel Ischemia: A Systematic Review. Umer Farooq MD, Manasa Jasti MD, Zahoor Ahmed MBBS, Muhammad Tayyeb MBBS, Farhan Khalid
MBBS, Natalie Tapaskar MD, Daniel C Hidalgo MD. Presented at MacNeal Resident Research Day

Factors that may increase the odds of requiring home oxygen upon discharge in patients admitted for COPD exacerbation. Diana Espinoza, Sindhu Joseph, Manuel Manrique, Swathi Rao. Presented at CHEST 2019

Euglycemic diabetic ketoacidosis in a newly diagnosed type 2 diabetic treated with Empagliflozin. Robert Lichtenberg, Paola Sancez, Swathi Rao MD. Presented at ACP Northern IL Regional Conference 2019

"Just some dizziness", or is it? A case of brainstem AVM presenting as central vertigo. Fanny Giron, Farah Ciftci-Olsen, Swathi Rao. Presented at SHM 2019

Is Colonoscopy Necessary after an Acute Diverticulitis Event, in Adults less than 50 years old?.Published in Gastroenterology, Volume 156, Issue 6, S-253. Daniel Alcantar, Richard Fernandes, Christine Junia MD. October 2019

Ustekinumab for Concomitant Crohn's Disease and Psoriasis. Umer Farooq. Presented at ACG 2019

The emerging role of frailty as a prognotic model in end stage liver disease: A Systematic Review. Amlish B. Gondal , Umer Farooq , Pushpa Khanal , Khush Bakhat MD. Presented at DDW 2020


 

2018-2019

It is a Medical Emergency! Act Fast - A Case Report of Painless Aortic Dissection. Anusha Yanamadala MD, Sanjay Kumar MD, Robert Lichtenberg MD. Submitted to European Heart Journal 2019.

For Whom the Lobe Folded...When? Jyothsna Bandaru MD. Robert Lichtenberg MD. Presented at National Lipid Association Annual Scientific Sessions, May 2019. 

Sensitivity of Serum Free Kappa/Lambda. Vallanki K, Portocarrero P, Chin J. Presented at Loyola University Medical Center Research Day 2019.

2020Isabel to the Rescue. Jose Zabala MD, Farah Ciftci MD. Presented at American College of Physicians and Society of Hospital Medicine Annual Scientific Sessions, 2019.

Suicide by Self-Neglect. Jose Zabala MD, Farah Ciftci MD. Presented at American College of Physicians and Society of Hospital Medicine Annual Scientific Sessions, 2019.

Unusual Culprit of Sepsis. Jose Zabala MD, Farah Ciftci MD. Presented at CHEST Annual Scientific Sessions, 2018.

Medullary Thyroid Cancer as Miliary Pattern. Jose Zabala MD. Presented at CHEST Annual Scientific Sessions, 2018.

Diffuse Parenchymal Lung Disease in patients with Rheumatoid Arthritis. Malvika Kaul MD, Lauren Sullivan DO. Presented at CHEST Annual Scientific Sessions, 2018.

Recurrence Rate of Diverticulitis (Acute or Complicated) in Young Adults. Daniel Alcantar MD, Sanjay Kumar MD, Paola Sanchez MD, Christine Junia MD. Presented at UVA Liver and Gastroenterology Conference, 2018.

An Unexpected Finding of Pylephlebitis as a Complication of a Liver Abscess. Daniel Alcantar MD, Fanny Giron MD, Christine Junia MD.  Presented at American College of Physicians Annual Scientific Sessions, 2019.

Is Colonoscopy Necessary After An Acute Diverticulitis Event In Adults Less Than 50 Years Old? Daniel Alcantar MD, Sanjay Kumar MD, Richard Fernandes MD, Claudia Rodriguez MD, Christine Junia MD, Michael Sprang MD. Presented at Digestive Diseases Week, 2019.

Factors that may increase the odds of requiring home oxygen upon discharge in patients admitted for COPD exacerbation. Malvika Kaul MD, Swathi Rao MD, Manuel Manrique MD, Diana Espinoza MD, Sindhu Joseph MD, Bradford Bemiss MD. Published CHEST Journal.

Anti-Glomerular basement Membrane Negative and C-ANCA Positive Goodpasture. Sanjay Kumar MD, Anmol Barnwal MD, Christine Junia MD.  Published in American Society of Nephrology Annual Kidney Week Supplemental Journal, 2018.

5-Oxoprolinemia - An Underdiagnosed Cause of High Anion Gap Metabolic Acidosis. Sanjay Kumar MD, Malvika Kaul MD, Ann Marie Canelas MD. Published in American Society of Nephrology Annual Kidney Week Supplemental Journal, 2018.

Primary Plasma Cell Leukemia Presenting as Bloody Diarrhea. Sanjay Kumar, Anmol Barnwal, Christine Junia. Presented at the 6th International Conference on Advances in Hematology and Oncology, 2018.

Impact of Atrial Fibrillation on 30 Day Readmission Rate of Takotsubo Cardiomyopathy: A Nationwide Analysis. Keeret Rai, Sanjay Kumar, Moh Gad, Manpreet Kaur, FNU Jithidar. Presented at American College of Physicians Annual Scientific Sessions, 2019.

 

Internal Medicine Residency Educational Resources

MacNeal’s Internal Medicine Residency Program is continually striving to identify unique learning opportunities to prepare our residents for the demands of clinical practice. We recognize the impact of experiential learning and the benefits of training with the use of simulations. Our program uses SimMan® to simulate high-fidelity immersive scenarios for our residents. Simulations also help us to emphasize the importance of teamwork. When learning from simulations we prioritize the importance of listening and respecting others point of view, and maintaining confidentiality to create a safe learning environment.  

Each ICU rotation features a simulation session containing:

  • scheduled dedicated time to become familiar with the defibrillator and review how to perform and assess quality chest compressions.
  • simulations utilizing the interactive SimMan® who features palpable pulses, manual blood pressure, lung, heart and bowel sounds.
  • simulations featuring the opportunity to interpret labs and ECGs in real time.
  • simulations to practice ACLS and RRT scenarios with an interdisciplinary team.
  • the opportunity to take on the role of code leader, recorder, compressor, respiratory support and administer medications.  

Other educational resources:

  • Access to a comprehensive online resource of electronic textbooks and journals through the Loyola Health Sciences Library
  • ACP subscription provided by the program for online CME accredited modules
  • Computer and personal device access to UptoDate
  • MKSAP board review books
  • Program subscription to online modules from the American Medical Association
  • Program subscription to online modules from the Institute of Healthcare Improvement

Teaching Internal Medicine Students

At MacNeal, we have the fortune of honing our teaching skills starting intern year with medical students from Loyola, Midwestern University and Saint George's University.

There is the opportunity for each intern to be paired with either a third year medical student or physician assistant student, and for the senior resident to be paired with a sub-intern. This will allow interns to start developing important skills of teaching, supervision, evaluation and providing feedback prior to leading a team as a senior resident, and will provide senior residents with additional skills in managing a larger team. To maintain balance and learning opportunities, we do not schedule more than one student per resident.

We encourage residents to work closely with their students to review history, exams and plans for each shared patient, and to identify learning opportunities.  Discussing learning topics together can be helpful to student and resident alike, as teaching often allows us to review and cement concepts, and test our own understanding. Giving feedback is also an important skill to practice, and will allow the students to identify their own strengths and weaknesses to improve throughout the rotation.

Internal Medicine Resident Wellness

R1 Retreat 2018

Resident well-being is considered a fundamental and essential part of our program. Our program recognizes the unique challenges that residents face as they work to complete training. We appreciate that resiliency is a fundamental component of wellness. We offer opportunities for our residents to engage in developing personal insight. The importance of insight encompasses learning to be self-aware, to accept limits, to acknowledge uncertainty and to problem solve. We provide opportunities for the resident to obtain support both from individuals within and outside the Internal Medicine Department, placing an emphasis on self-care. Lastly, we emphasize the value of meaning and purpose in one’s work and personal life.

  • The following are regularly occurring events and offerings designed to help our residents develop and maintain resiliency during residency:
    • Quarterly Schwartz Rounds – An interactive dialogue consisting of panelists from diverse disciplines speaking about topics that affect our ability as providers to provide compassionate and comprehensive care.
    • Resident Wellness and Resiliency Committee – A committee of Internal Medicine and Transitional Year Residents who work to address issues related to wellness and resiliency and assist the program with event planning.
    • End of Block Social Events – After work events for residents and faculty to come together and relax following each block with food and conversation.
    • Small group sessions offered by faculty
    • Access to the Employee Assistance Program which is a professional counseling service offering free and confidential help for day-to-day concerns or difficult times offering free in-person professional consultations.
    • Annual retreats are offered each year of residency – retreats feature team building exercises, a wellness session and time to relax outside of the hospital as a resident class.
    • Each resident has a core faculty member designated to meet with and mentor the resident at regular intervals throughout their time at MacNeal.
    • Use of validated tools like the Maslach Burnout Survey to annually help individuals confidentially

Internal Medicine Salary & Benefits

Salary 2020-2021:

  • PGY1= 58,153

  • PGY2= 60,540

  • PGY3= 62,122

  • PGY4= 64,475

  • 20 days of vacation per year
  • Paid education days
  • Yearly educational stipends

Additional Benefits:

  • Malpractice insurance
  • Health, dental and vision insurance
  • Life and accident insurance
  • Disability insurance
  • Workers’ compensation
  • 401(k) retirement plan