The Internal Medicine Residency of the Medical College of Wisconsin (MCW) is a multi-hospital university program, located on a suburban campus serving a diverse patient population in the metropolitan area of Milwaukee, Wisconsin. In existence since 1925, the MCW Internal Medicine Residency prides itself on a long history of training high-quality internists. Currently, the Department of Internal Medicine is comprised of 122 residents, 74 fellows, and 280 faculty members. Our mission is to provide a comprehensive three-year curriculum in internal medicine training that enables high quality medical school graduates to learn tertiary, secondary, and primary care Internal Medicine skills in both inpatient and outpatient settings.
The Medical College of Wisconsin Internal Medicine Residency Program has been continuously accredited by the ACGME since 1947. In 2011, an ACGME site visit resulted in the Internal Medicine Residency Review Committee awarding us full reaccreditation to 2021.
- Chair is strongly supportive of student and resident scholarship and education.
- Program Director and Associate Program Directors at all training sites, with a strong commitment to furthering residency education and scholarship, as well as the health and well-being of the residents.
- Curricular flexibility allowing you to tailor to specific career goals.
- Education through support and independent decision-making; back-up ALWAYS available.
- In the federal government’s FY 2013, the College received $88.7 million in NIH funding and ranked 43rd among the nation’s 138 medical schools receiving NIH research funding. The Medical College remains in the top third of medical schools receiving NIH funding.
- In MCW's fiscal year 2013, the College received $144 million in total grant awards for research from all funding sources. More than 2,100 research studies were conducted, including clinical trials.
- Among the top 50 Schools of Medicine for NIH FY2013 funding, MCW ranks 3rd for dollars per award. This ranking is above Duke University (4th), Harvard University (5th), Stanford (9th) and Johns Hopkins (12th).
- Active research programs at MCW and VA that include basic science, clinical and health services research.
The opportunity to treat patients in three different types of health care facilities:
- Quaternary Care, Level 1 Trauma, Academic Medical Center – providing care to both Urban Milwaukee, outlying suburban patients, and referrals from all over Wisconsin.
- Regional Veterans Affairs Medical Center – 55,000 patients with complete spectrum of inpatient and ambulatory specialty care.
- Community Hospital – private patients admitted to both private and hospitalist services.
Froedtert Hospital, our primary training site:
- Froedtert was rated one of the Top 10 Academic Medical Centers in the country by United Health Consortium
- Level One Trauma Center
- State-of-the-art, multi-discipline Cancer Care Center
- Active transplant services (bone marrow, lung, heart, kidney, liver, pancreas)
- Extensive campus growth in infrastructure
- Nationally recognized Palliative Care service
- Full electronic medical records system
Clement J. Zablocki VA Medical Center:
- ZVAMC rated as a ‘1A’ facility, for delivering the most complex types of tertiary care. Only 30 VA Medical Centers have received a ‘1A’ designation
- Provides primary, secondary and tertiary care
- 165 acute care beds, and over 500,000 outpatient visits per year
- Special services at the Milwaukee VA that are not offered at all VA’s include: Spinal Cord Injury center, Comprehensive care including Radiation/Oncology, Long Term Care unit, a Geriatric Evaluation and Management Program and a Palliative Care program.
Diverse opportunities for experience in specially-designed rotations
- Ambulatory Immersion (over 30 clinics to choose from)
- General Medicine Consults and Pre-ops
- Private Practice Preceptorships
- Women’s Health
- Research Elective
- Sleep Medicine
- Bone Marrow Transplant
- Palliative Care
Seeing a variety of patients and medical conditions is vital to internal medicine residency training. However, educational sessions that are practical, interactive, and cover the breadth and depth of internal medicine are just as important in producing a successful general internist or subspecialty physician. It is crucial to point out that simply having conferences is not good enough when there are competing priorities. Our philosophy is to provide residents with protected, uninterrupted educational time. The internal medicine residency program provides a coordinated series of educational sessions that are protected from interruption by patient care responsibilities for housestaff. The overall program includes:
Academic Half-Day: every Wednesday throughout the year. This conference series replaces the traditional noon conference. PGY-1 residents have dedicated core presentations Wednesday afternoons to enhance their internship, and PGY-2 and PGY-3 residents meet Wednesday mornings for didactic series and integrated board review designed to expand their knowledge base and to assist with preparation for the ABIM examination.
Noon Conferences: every Monday, Tuesday, Thursday and Friday. Noon reports are held daily and feature a complex or unique case presented by a senior resident and moderated by a chief resident. These conferences are highly regarded and are attended by all interns and residents, as well as GIM and subspecialty faculty. In addition to working through a case with the audience, a PICO question relevant to the case is presented with each case in order to further our evidence based learning.
Clinicopathologic Conference (CPC): monthly at both FLMH and the VA. Each month an expert clinician is presented with the clinical course, relevant laboratory results and radiological findings of a particular patient and asked to develop a case discussion to present to students, residents and faculty. In addition to learning how our expert presenter would approach a challenging case, radiology and pathology also present relevant findings which lead to an unveiling of the diagnosis.
Morbidity & Mortality Rounds: monthly at both FH and the VA. As there is much to be learned from every case M&M conferences are important learning tools. In addition to the traditional management based M&M conferences, we also present Morbidity, Mortality & Systems Improvement cases four (4) times a year. These are interdisciplinary conferences that focus on a system based issues that may contribute to an adverse outcome. The key products of the conferences are workgroups (including administrators, faculty, residents and staff) who meet subsequently to address the specific issues and improve patient care.
Grand Rounds: Friday mornings. Selected speakers present relevant information on medical topics, new and innovative research or breakthroughs within Medicine.
Core Skills Program (IM 101, 201 and 301): One week of protected learning in each residency year. Sessions are conducted in small groups covering a broad array of topics. IM 301 (for PGY-3s) is dedicated to high yield board review.
Yearly retreats: One- or two-day retreats for each residency class. The retreats are designed to provide residents with ample time for building camaraderie, developing skills necessary for their respective PGY, and providing the program leadership with feedback. The PGY-3 retreat is particularly popular with residents as it is the only overnight retreat! Previous locations have been Wisconsin Dells, Lake Geneva, and The Blue Harbor in Sheboygan.
Evidence-based medicine sessions: A dedicated series of interactive conferences are held during the Ambulatory Immersion rotation, which are designed to enhance residents’ ability to critically appraise journal articles and to encourage them to apply their knowledge in their practice of evidence-based health care.
Every attempt is made to meet the educational goals of each individual resident. Below are examples of curriculum templates for residents in our various training programs. Each rotation is typically a one month block.
Typical Schedule Overview for all PGY Residents (PDF)
Typical Conference Schedule
- Daily: Internal Medicine Noon Report, MICU Teaching Conference, Subspecialty Conferences
- Weekly: Academic Half-Day, Resident Case Conference, Integrated Skills Workshop, Medical Grand Rounds, Board Review, Ambulatory Case Conference, Intern Report
- Monthly: Clinicopathologic Conference, Journal Club, Autopsy Rounds, Morbidity & Mortality Conference
Core Skills Program 101: A week long course designed to help first-year residents transition into the challenging world of internal medicine.
Core Skills Program 201: A two-day long course for second-year residents that highlights key topics for continued learning.
Core Skills Program 301: A week long course for third-year residents specifically geared toward board review and preparation.
Call schedules will vary depending upon rotation. On average, PG-1 residents will have 7-8 months of ward responsibilities, PG-2's 5-6 months, and PG-3's 4-5 months. However, some "ward" rotations do not have any overnight call, so the number of overnight ward rotations is less. In general, interns do more call months than residents, but call frequency is less for interns.
As with any residency program, the implementation of the 2011 ACGME duty hour rules required some changes in call structure. We felt it was important, however, to make changes based on principles that we considered important in residency education, and not just jump to an all night float system in order to meet hospital coverage needs. We first defined the following principles to guide our decision-making:
- We believe there is educational value in having some training in the hospital at night—you will see things and learn things at night that you wouldn't otherwise.
- We believe in team call and team care. Teamwork is essential in today's health care environment and working as a team is also more fun and facilitates learning. When you are on call, it should be with your own team.
- We believe that night float time should NOT take away elective time. Night float months are considered ward months and time has been taken to make this time educational.
- Intern year: VA night float is paired with heme/onc wards to provide exposure to overnight cross cover issues and gain experience with inpatient heme/onc patients.
- Second and Third year: Night float is paired with the VA urgent care center.
- We believe that call schedules and coverage should be tailored to the individual rotations and services, according to educational priorities, rather than applying a "one size fits all" system across all services. For example, the best schedule for learning in an ICU is likely somewhat different than a general medicine ward which is different than a subspecialty ward.
At Froedtert hospital, there are five housestaff teams for general medicine wards and seven "uncovered" hospitalist-PA teams which are covered 24/7 by hospitalist faculty and never by housestaff. Our VA hospital now also has hospitalist teams that admit and cover their own patients 24/7. This allows for admissions to be more spread out, and more importantly to be tailored to the housestaff schedule—thus avoiding admissions during morning rounds, during Academic Half-Day and after 2 a.m.
General medicine ward teams have one attending, one resident, two interns, one sub-intern and two junior students. For Froedtert general medicine wards, overnight call is five (5) nights for residents and ten (10) for interns. In 2012, the VA wards changed to incorporate an intern night float system; this change was driven by the housestaff and designed to create more continuity within teams.
The Froedtert MICU has two teams of five housestaff; each person takes call for their team every fifth night. An intern is always paired with a senior resident.
The Froedtert cardiology, transplant and oncology services as well as the VA oncology service do not have overnight call. This is so that housestaff are never post-call and can be present for all daytime educational activities on these specialized services.
PG-2 and PG-3 residents each do 12 nights of night float per year which is coupled with an Ambulatory - Urgent Care rotation.
While on an elective month, interns and residents do not have night or weekend coverage responsibilities, however all housestaff while on an elective are designated to have either a weekend or week of jeopardy where they could be asked to provide coverage for a co-resident if needed.
Medicine-Geriatrics Combined Residency
The combined Internal Medicine-Geriatrics residency program is the latest innovation in combined residencies at the Medical College of Wisconsin. The Med/Geriatrics residency is designed to offer flexibility, preparedness and expanded career options while building upon the strengths and interests of the individual resident. The program will provide the internist with the required knowledge to provide first-rate geriatric care to the tidal wave of baby boomers that are increasing in age every day. At completion of the four-year program, graduates are Board eligible in both medicine and geriatrics.
Clinical Investigator Track
A clinician-investigator track is available for selected applicants. Most candidates have graduated with a PhD from medical school. The program is designed in accordance with the Research Pathway requirements of the American Board of Internal Medicine, and provides a trainee with three years of basic biomedical research with two years of clinical rotations. Research activities can be done under the auspices of the Basic Science Departments, or one of the subspecialties clinical services. Upon completion of this special five-year program the resident is eligible for certification by the American Board of Internal Medicine. It is also possible to continue this pathway with subspecialty fellowship training, resulting in Board eligibility in both internal medicine and a subspecialty.
Medicine-Pediatrics Combined Residency
The Medical College of Wisconsin offers a four-year combined Internal Medicine-Pediatrics residency program. Six positions are available each year. At the completion of the four years of training, graduates are Board eligible in both medicine and pediatrics.
The training consists of alternating internal medicine and pediatric four-month blocks. Integrated rotations are offered in a number of subspecialties. Continuity clinics occur weekly in both medicine and pediatrics. An integrated medicine-pediatrics educational conference is held monthly.
Regular Board Review Sessions
- Faculty-led board review sessions 2-3 Wednesdays per month during senior resident Academic Half Day
- Utilizes board style questions and emphasizes general and topic specific test taking strategies
- Active participation is encouraged with the use of an audience response system.
High-Yield Board Review Course
- A week long course held in the spring of each resident’s PGY 3 year
- Residents are relieved of all other responsibilities to attend
- All major ABIM certification exam topics covered by faculty with experience leading ACP Recertification Exam Preparation sessions or writing ACP In-Training Exam or ABIM certification exam questions
Medical Knowledge Improvement Plan
- Program leadership assists residents in identifying personal learning styles and guides their selection of the board review resources that best fit their needs
- Residents with identified test taking difficulties are given individualized assistance with board preparation
- Insurance-covered neurocognitive testing is available for residents seeking special accommodations for the ABIM certification exam
- A library is kept up to date with the major resources utilized by residents for board preparation, including MedStudy ® and MKSAP ® (text and computer resources).
Scholarly Project Support
- Classes in abstract writing and project planning
- Program leadership advises residents pursuing projects and provides recommendations for projects and faculty mentors
- Faculty in Clinical and Translational Science Institute (CTSI) available for free consulting on research project planning
- Free biostatistics advising and data handling
Research Methods Workshop
- Classes in basic research methodology and basic biostatistics
Abstract, Presentation and Manuscript Review Service
- Program leadership available to review all research and case report abstracts, presentations, posters, and manuscripts prior to submission or conferences
Resident Scholarship Fund
- Program provides subsidization of resident expenses for national meeting presentations
- Free poster printing
Our residency program welcomes and embraces diversity. MCWAH has established an Underrepresented in Medicine (URM) group on campus. Housestaff from the MCWAH residencies and fellowships on campus comprise the URM Housestaff Committee. Two of our residents, Tia Vernon, MD and Senait Tesfai-Barker, MD are members of this committee. For additional information, please view the Underrepresented in Medicine (URM) website.