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. 

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
  • Day Float
  • Night Float
  • Inpatient Subspecialty:
    • Pulmonary and Critical Care
    • Cardiology
    • Gastroenterology
    • Endocrinology
    • Infectious Disease
    • Neurology
    • Nephrology

Ambulatory Rotations:

  • Addiction Medicine
  • Diabetes Care
  • Endocrinology
  • Community Medicine
  • Pulmonary Clinic
  • Otolaryngology (ear, nose and throat)
  • Physical Medicine and Rehabilitation/Orthopaedic Surgery
  • Palliative Medicine & Hospice
  • Hematology and Oncology
  • Rheumatology
  • Medical Spanish

Inpatient Rotation Sample (4 weeks)

Monday Tuesday Wednesday Thursday Friday

7 AM

Sign-out

7 AM

Sign-out

7 AM

Sign-out

7 AM

Sign-out

7 AM

Sign-out

12 PM — 1 PM

Core Topic Conference

12 PM — 1 PM

Core Topic Conference

12 PM — 1 PM

Board Review
 

12 PM — 1 PM

Core Topic Conference

12 PM — 1 PM

Resident Report

   

3 PM — 4 PM

Resident Report

3 PM — 4 PM

Intern Assessment

 

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)

Monday Tuesday Wednesday Thursday Friday

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 PM — 3 PM

Musculoskeletal Workshop

1 PM — 5 PM

Rheumatology Clinic

1 PM — 5 PM

Continuity Clinic

1 PM — 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:

  Monday Tuesday Wednesday Thursday Friday
AM    

 12
MEDTalks*

   
12 1 pm Core
Topic
Core
Topic
Board
Review
Core
Topic
Resident
Report
PM  

3  4
Intern
Report

 

3  4
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 [hysician, 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.
  • 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.
  • 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.

  • 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.

  • Journal Club – a senior resident along with a core faculty member facilitate group discussion and critical appraisal of the selected article.  

  • High Value Care Conference – 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.

  • 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.

  • 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 research and 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, and AACE. Residents are provided with an annual stipend to assist with the costs associated with conference attendance.

Pinar Smith

(left) Pinar Smith R3 at American Association of Clinical Endocrinologists Conference, 2017.


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:

  • Choosing Wisely: Anticoagulation in VTE
  • Increasing Appropriate Documentation of Opioid Prescribing and Monitoring in MCIM Clinic
  • Improving Severe Hyponatremia Management in an Urban Community Hospital
  • Improving Adherence to 2018 ADA Guidelines for HbA1c Testing in Spanish-Speaking Patients with Diabetes
  • Improving Asthma-Related Quality Measures at MacNeal Center for Internal Medicine
  • Implementation of Daily Interruptions of Sedation and Spontaneous Breathing Trials in the Loyola Medicine MacNeal Hospital Intensive Care Unit

Internal Medicine Resident Publications and Presentations from Recent Years:

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.

Isabel 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.

2018

A conspicuous lung mass with an inconspicuous diagnosis. Ranju Kunwor, Ann Marie Canelas. Presented at ACP Northern IL 2017.

A Rare Case of Tumor Lysis Syndrome in Metastatic Renal Cell Carcinoma treated with Pazopanib. Prachi Jain, Paola Sanchez, Farah Ciftci, Lauren Sullivan.

Brodifacoum Laced Synthetic Marijuana Toxicity: A fight against time. Sanjay Kumar, M.D, Christine Junia, M.D.

Carcinoid – An Interesting Differential to IBS. Richard Fernandes MD, Claudia Rodriguez MD, Christine Junia MD.

Epigastric pain post-PCI: A rare atheroembolic complication of a common procedure. Ranju Kunwor, Ann Marie Canelas, Presented AT CSCTR/AFMR Meeting, April 2018.

Flecainide Toxicity: Slowing down to Speed Up. Sri Mahathi Kalipatnapu MD, Robert Lichtenberg MD, Charles Kinder MD, Christine Junia MD.

Gingival Hyperplasia Secondary to Amlodipine Use. Claudia Rodriguez MD,  Farah Ciftci MD.

It can always be Lupus! Pseudo pseudo-meig syndrome without ascites in Systemic Lupus Erythematosis (SLE), a rare initial presentation. Priyanka Sharma MD, Lauren Sullivan DO.

Methamphetamine induced vasculitis: A matter of life and limb. J. Bandaru, C. Junia. Presented at ACP Norther IL Meeting, IL. 2017.

More danger than we knew - Hypokalemic periodic paralysis triggered by alcohol consumption. N. Doshi, P. Sanchez, C. Junia.

Pneumocystis pneumonia with Acute respiratory distress syndrome - A rare initial presentation of Human Immunodeficiency Virus. Anusha Yanamadala, M.D; Ann Marie Canelas, M.D.

Pulmonary Embolism, a diagnosis to remember in Sickle Cell Disease. J. Munoz Mejia, N. Gandham, C. Junia. Presented at ICAHO 2017.

Salmonella empyema: a rare complication associated with immunocompromised state resulting in sepsis. Anusha Yanamadala, M.D; JuanPablo Portocarrero, M.D; Ann Marie Canelas M.D. Presented at ATS International Conference, CA 2018.

That Ground Glass! Diffuse Parenchymal Lung Disease(DPLD) in patients with Rheumatoid arthritis (RA); Importance of differential diagnosis. Malvika Kaul MD, Lauren Sullivan DO. Presented at SGIM Annual Meeting 2018. CO.

The uremic heart: Role of echocardiogram in diagnostic evaluation and monitoring of uremic pericarditis and myocardial involvement. Anusha Yanamadala, M.D; Christine Junia, M.D.

2017

Hrudya Abraham MD, Jacquelin R Chua MD, Ailda Nika MD. (2017) Gouty panniculitis: A rare manifestation of gout. To be presented at: National SGIM, Washington, DC. National SHM, Las Vegas, NV.

Hrudya Abraham MD, Sajan Thomas MD Amit Srivastava MD. (2017). Sump Syndrome: A rare complication of choledochoduodenostomy. To be presented at National SHM, Las Vegas, NV. (2016). Presented at Brooklyn Hepatology Symposium, Brooklyn, NY.

Ann Bunyan MD, Isha Shrestha MD, Ann Marie Canelas MD. Fatty blood: Role of Insulin Infusion and Plasmapheresis in Hypertriglyceridemia-Induced Acute Pancreatitis.

Ming H Lee MD, Hrudya Abraham MD, Farah Ciftci-Olsen MD. (2017). A Hidden Killer: Complete Dissection of the Ascending and Descending Aorta Induced by Gram Negative Aortitis. Presented at National SHM; Las Vegas, NV and National ACP; San Diego, CA.

Anmol Baranwal MBBS, Sindhu Joseph MD. (2017). Quality and Value-Focused Decision Making in Heparin-Induced Thrombocytopenia: The Impact of the American Society of Hematology’s Choosing Wisely Initiative. Presented at American Society of Hematology National Conference; San Diego, CA.

Serin Edwin MD, Sindhu Joseph MD and Rashmi Rodrigues MD, PhD. (2017). Coping Self-Efficacy in HIV-positive patients: What the numbers look like. Poster to be presented at: SHM's Annual Meeting, Las Vegas, NV.

Serin Edwin MD, Anmol Baranwal MD, Mrinmayee Naik MD, Swati Gobhil MD, Srilatha Mulamalla MD and Joseph Frasca MD. (2017). The Infection in Inflammation: Diagnosing Clostridium Difficile in Inflammatory Bowel Disease. Poster to be presented at: National SHM Conference, Las Vegas, NV.

Swati Gobhil MD, Sindhu Joseph MD. A Different Take on Cholecystitis: Let’s go back to the Anatomy Lab. (2016, 2017). E-Poster accepted at: ACP Northern Illinois; Chicago, IL. Poster presented at: National SHM. Las Vegas, NV.

Malvika Kaul MD, Ann Bunyan MD, Kenneth Lee MD, Lauren Sullivan DO. (2017). Severe Diffuse Axonal Polyneuropathy and West Nile Virus Infection. Poster to be presented at: National SGIM 2017; Washington, DC.

Molecular Imaging and Precision Medicine in Head and Neck Cancer. Mena E, Thippsandra S, Yanamadala A, Redy S, Pattanayak P, Subramaniam RM. PET Clin. 2017 Jan;12(1):7-25. doi: 10.1016/j.cpet.2016.08.009. Review.

The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer. Sheikhbahaei S, Mena E, Yanamadala A, Reddy S, Solnes LB, Wachsmann J, Subramaniam RM. AJR Am J Roentgenol. 2017 Feb;208(2):420-433. doi: 10.2214/AJR.16.16532.

The Current and Evolving Role of PET in Personalized Management of Lung Cancer. Mena E, Yanamadala A, Cheng G, Subramaniam RM. PET Clin. 2016 Jul;11(3):243-59. doi: 10.1016/j.cpet.2016.02.010. Review.

2016

Michael Abendroth MD MBA, Ann Bunyan MD, Eugene Kligman MD. (Nov 2016). Rhabdomyolysis and Legionnaire's Disease: Diagnosis Disguised by a Mechanical Fall. Poster presented at the ACP Northern Illinois Chapter Residents' and Medical Students' Day; Chicago, IL.

Hrudya Abraham MD, Ann Bunyan MD, Mrinmayee Naik MD, Sindhu Joseph MD. (2016). Being a Medicine SuperSLEuth: Does my patient also have thrombotic thrombocytopenic purpura? Poster accepted at: ACP Northern Illinois; Chicago, IL.

Hrudya Abraham MD, Rizvi Syed MD. (2016). Heart Failure -A Rare Initial Manifestation of Systemic Lupus Erythematosus. Presented at Midwest SGIM, Cleveland, OH.

Hrudya Abraham MD, Rani Kasinchetty MD. (2016). Hidden in the Skin. Presented at: Midwest SGIM, Cleveland, OH.

Anmol Baranwal MD, Jay Patel MD. (2016). Enoxaparin toxicity masquerading as tumor lysis syndrome. E-Poster accepted at: ACP Northern Illinois; Chicago, IL.

Anmol Baranwal MD, Ann Marie Canelas MD. (2016). Perianal swelling: Is it abscess or something else? Poster presented at: International Conference on Advances in Hematology and Oncology (ICAHO); Coeur d’Alene, ID.

Anmol Baranwal MD, Venkata Puskoor MD, Sindhura Reddy MD, Ann Marie Canelas MD. (2016). Metastatic choriocarcinoma with paraneoplastic hyperthyroidism. Poster presented at: Society of Hospital Medicine: Annual Meeting; San Diego, CA.

Rani Kasinchetty MD, Lauren Sullivan DO. (2016). Typhoid Fever Presenting as Acute Pancreatitis. Poster presented at: Midwest SGIM; Cleveland, OH.

Ranju Kunwor MD, Anmol Baranwal MD, Ann Marie Canelas MD. (2016). The cruelest truth hidden behind the silence! E-poster accepted at: ACP Northern Illinois; Chicago, IL.

Pinar Smith MD, Joseph Frasca MD, Sindhura Reddy MD. (2016). Diagnosis of pituitary adenoma after bowel preparation. Resident Research Day, MacNeal Hospital.

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:

  • Onsite librarian, Lily Wang, MD, MS is available five days a week to assist with literature searches and to teach one-on-one sessions.
  • Access to comprehensive library collections including:
    • UpToDate
    • OVID ejournals – 445 titles
    • AccessMedicine – featuring 145 eBooks, guidelines, drug information and more
    • Isabel Diagnostic Support: a differential diagnostic database
    • Cochrane database of systematic review
    • VisualDx
    • MicroMedex Gateway
    • Exam Master online
    • Free interlibrary loan service to borrow books and articles.  
  • Medical librarian, Lily Wang, MD, MS who is available remotely to assist with literature searches and to teach one on one sessions.
  • Access to comprehensive library collections including:
    • UpToDate – creation of a personal account is available.
    • OVID ejournals – 445 titles
    • AccessMedicine – featuring 145 eBooks, guidelines, drug information and more
    • Isabel Diagnostic Support: a differential diagnostic database
  • Cochrane database of systematic review
    • VisualDx
    • MicroMedex Gateway
    • Exam Master online
    • Free interlibrary loan service to borrow books and articles.

Teaching Internal Medicine Students

At MacNeal, we have the fortune of honing our teaching skills starting intern year with medical students and physician assistant students from Loyola, Chicago Medical School, Midwestern University and Rush.

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.