Mission

We will train excellent internal medicine physicians in a program that is committed to education and quality health care. As part of this effort, we will recruit and nurture faculty who model high quality patient care, teaching, and research skills. Our focus will be on training the six ACGME competencies using innovative teaching strategies to improve education outcomes. Emphasis will be on a strong didactic experience as well as comprehensive and diverse clinical experiences enabling our residents to care for the entire spectrum of internal medicine. We will maintain a supportive clinical learning environment that supports our residents and reinforces the important concepts of patient safety, healthcare quality, professionalism, and well-being.

Aims

• Train residents to be resilient, well-rounded, board-certified internal medicine providers across a diverse spectrum of clinical settings and patient populations.
• Train residents to provide high-value care that meets the unique needs of the military population, veterans, and families in a variety of clinical environment.
• Prepare residents to be competent in clinical and procedural skills that can be utilized both in the hospital and battlefield settings.
• Graduate residents with the knowledge and professionalism to integrate seamlessly into the larger military health system.
• Graduate residents that are well-prepared to pursue a variety of career paths to include general internal medicine, fellowship training, and/or academic and military leadership roles.

Morning report is our primary educational conference. It takes place every day from 8 a.m. - 9 a.m. All residents, except for those on away rotations, on leave, or on Neurology or Emergency Department rotations, are expected to attend this daily conference. This interdisciplinary core conference delivers education through a variety of formats, from traditional lectures led by subspecialist to case-based lectures led by our own residents and resident teams. We also have monthly ICU and inpatient Cardiology morning reports, as well as morning reports led by residents coming back from outside rotations. Most morning reports start with a 5-minute “knowledge nugget”, which is a brief teaching point let by the chief resident, a resident, an internal medicine staff, or a staff member from another department.

Additional morning report conferences held throughout the year include monthly Officership and Professional Development (OPD) Grand Rounds, “Clinical Updates”, Pizza and Ethics, combined conferences (ex. Emergency Medicine and Internal Medicine combined morning report), Evidence Based Medicine Conferences, and a special DEI-lecture series called “Diversity in Plain Sight”, which aims to shine light on the diverse and unique personal and professional experiences of our colleagues and allow us to learn through honest discussion.

Dedicated ambulatory didactics longitudinal curriculum occurs for small cohorts of residents during clinic week. A well delineated longitudinal Officership and Professional Development curriculum which includes simulation is conducted for each cohort of residents during clinic week. Another didactic opportunity includes weekly board review questions during lunch (lead by residents, attended by sub-specialty staff). This is required for senior residents on elective rotations or on their Y week (clinic week).

Possible electives (Individualized learning)

All internal medicine subspecialties; Medical Ophthalmology, Office gynecology; Otorhinolaryngology; Non-operative Orthopedics; Sleep Medicine; Rehabilitation Medicine; Research; Radiology; Nuclear Medicine; Operational Medicine; Psychiatry; Anesthesia, Medical Informatics, Cardiac Catheterization, Echocardiography, Emergency Medicine ultrasound, 2nd Primary Care rotation, Palliative Medicine, Addiction Medicine, Faculty Development.

Primary Care

Residents do one week in clinics that focus on musculoskeletal medicine, one week of addiction medicine, one week in clinic that focuses on office gynecology and 1-week STI/travel clinic. There is an optional second primary care elective that allows residents to choose additional subspecialty opportunities to include: Psychology, Ophthalmology, Adolescent Clinic, General Surgery, ENT, Oral Maxillofacial Surgery, Urology.

Y weeks (Clinic week)

Adds up to an average of 10 weeks per year for residents. During that week residents have 4-5 half days of continuity clinic, a dedicated half day for ambulatory academics, one half day of IMC Consults, one half day dedicated to quality improvement and patient safety projects and one-half day dedicated to leadership and officer development curriculum (part of military unique curriculum). During the PGY3 year, PGY3s do an additional half day of senior teaching resident during which they mentor, coach, and guide junior learners.

Individualized Learning (Electives)

At least six months of individualized learning (Program Requirement IV.C.3.d) to aid each resident in identifying self-directed learning goals, exposure to specific skill sets for potential career growth and development, and foster research and mentorship with faculty. Residents will have options to choose the following pathways: Operational Medicine, Ambulatory Medicine, Hospital-based Medicine, Research Medicine, or the Traditional Categorical Medicine pathway.

Possible electives (Individualized learning):

All internal medicine subspecialties; Medical Ophthalmology, Office gynecology; Otorhinolaryngology; Non-operative Orthopedics; Sleep Medicine; Rehabilitation Medicine; Research; Radiology; Nuclear Medicine; Operational Medicine; Psychiatry; Anesthesia, Medical Informatics, Cardiac Catheterization, Echocardiography, Emergency Medicine ultrasound, 2nd Primary Care rotation, Palliative Medicine, Addiction Medicine, Faculty Development.

All rotations are organized on day/night shifts. All rotation schedules strictly adhere to ACGME clinical and educational work hour requirements.

Residents in our training program are preparing to become not only general internists but also military medical officers and leaders, in a time where the latter skills will undoubtedly be required and tested in any position after their training. Our graduating residents have been increasingly tasked to serve in vital military roles, ranging from battalion and flight surgeon positions to intensivists in combat support hospitals. Military unique training opportunities are provided through a variety of educational programs to provide our trainees with the medical knowledge, patient care skills, and systems-based practice understanding to be successful military medical officers.

Our residency training includes an Officership and Professional Development (OPD) Curriculum. This resident driven curriculum focuses on preparing residents for dynamic practice environments once graduating from residency including fellowship, general internist in the military, clinic/service/department chief, operational unit positions, and other positions of high impact and large sphere of influence.

This longitudinal curriculum is delivered by utilization of diverse methods including a series of workshops/presentations featuring guest speakers with diverse military experiences focusing on teaching practical medical and administrative related content regarding their current or past job duties. Secondly, there is a half day during Y weeks (clinic weeks) which is dedicated to trauma specific training including simulation and a number of relevant topics pertaining to military medicine (further outlined below).

Examples of specific military unique curricular elements and opportunities include:

• Fundamental Critical Care Support Course
• Capstone Course which includes Transition to Practice Course
• Combat Casualty Care Course (C4)
• Military Mountain Medicine Course
• Dive Medicine Course
• Sick Call rotations at Troop Medical Clinics on installations
• Sports Medicine and physical medicine and rehabilitation clinic rotations
• Point of Care Ultrasound (POCUS) elective rotation and other POCUS training throughout the didactic curriculum
• Numerous military unique curricular didactics including topics such as sports medicine, special warfare, military finance, military profiling for medical officers, medical retention standards, flight medicine, military utilization panel presentation, deployment readiness, leadership, garrison care.
• Simulation sessions on trauma care, procedural skills
• Military Tropical Medicine course with optional international rotational experience
• Tactical Combat Medical Care Course (TCCC)
• Military Humanitarian Course

All residents are required to maintain Basic Life Support (BLS) and Advance Life Support (ALS) certification throughout residency. These courses are available at Madigan Army Medical Center. All residents complete Combat Care Casualty Course (C4) training prior to graduation (unless they completed Bushmaster training in medical school).

Madigan is a Center of Excellence for simulation-based medical education within the Department of Defense. The internal medicine simulation curriculum is conducted at both the Anderson Simulation Center at the Madigan Annex and the Just In Time Simulation Center within the main hospital and provides residents with state-of-the-art training opportunities to evaluate and manage common and complex medical scenarios, and practice ACLS algorithms, leadership, and teamwork skills in code situations. It also aims to help residents hone their procedural skills in central line placement, lumbar punctures, intubations, thoracenteses, point of care ultrasound and more.

The program provides a robust opportunity to develop leadership skills throughout residency training. These opportunities range from formal lectures to small group discussions to experiential learning. Opportunities start from the first day of training and increasing levels of responsibility are nurtured in a progressive nature over the 36 months of residency. Some examples include:

• Expectation to lead ward or Intensive Care Unit (ICU) teams on a regular basis
• Opportunity to lead residency committees
• Opportunity to serve as a Junior Chief
• Expectation to lead or be involved in quality improvement projects
• Scholarly projects

Our Department of Medicine Research Committee encourages and fosters resident participation and publication of case reports and original research as well as quality improvement and patient safety initiatives. Additionally, we have two Assistant Program Directors for Research and Quality Improvement and Patient Safety. They maintain a database of research opportunities, and work with residents and their research mentors to ensure that they use research time effectively and receive appropriate guidance and coaching to turn ideas into results. This research emphasis has led to a large number of resident-directed projects and publications and helped Madigan residents to consistently excel in scholarship at a wide variety of state, regional and national meetings. Residents find themselves well prepared for academic careers and competitive for fellowship selection through these research endeavors in addition to their expertise as resourceful master clinicians.

Our program has a quality improvement and patient safety (QIPS) graduation requirement for all of our trainees. Our program also has assistant program directors for research and QIPS that can help you in your efforts. Residents at graduation are expected to:

• Complete online coursework necessary to earn the Institute for Healthcare Improvement’s Open School Basic Curriculum in Quality and Safety.
• At a minimum, be an active participant in a quality improvement/patient safety project.

Our program provides ample funding opportunities and support for residents to perform, publish, and present research and scholarly work. Residents have typically been able to attend at least one professional conference during residency with many trainees attending more than one conference over their time in training. As PGY3s our residents also have the opportunity to attend faculty development workshops given by our local Faculty Development fellowship program. Our residents have given many local, regional, and national QIPS and research presentations.

• Madigan Army Medical Center, Tacoma, Washington
• Puget Sound VA Healthcare System, Seattle, Washington
• Sacred Heart, Spokane, Washington
• Deaconess ICU, Spokane Washington
• Tacoma General, Tacoma, Washington
• Good Samaritan Hospital, Puyallup, Washington
• Providence Centralia Hospital, Centralia, Washington

Our program offers rotations to fourth year medical students interested in applying to internal medicine. Rotations are typically four weeks long (can be split into two-week blocks) and can be requested in a variety of clinical environments (see list below)

• Inpatient (Wards)
• Critical Care (ICU)
• Cardiology
• Hematology Oncology
• Endocrinology
• Rheumatology
• Pulmonary
• Nephrology
• Allergy Immunology
• Gastroenterology
• Infectious Disease
• Internal Medicine Clinic/Consult Clinic

To schedule medical student rotations or interviews, you must be a U.S. military HPSP or USU medical student. Please send an email to dha.jblm.gme-acad-o.list.internal-medicine-cmr@health.mil and include the following: 

• Preferred rotation dates and rotation experience (Inpatient wards, cardiology, ICU, etc...)
• Indicate if you would like to interview with us during your rotation

Interviews are offered from May through October 15th annually. Interested applicants can schedule an interview virtually or in person by contacting dha.jblm.gme-acad-o.list.internal-medicine-cmr@health.mil.

Program graduates take the American Board of Internal Medicine (ABIM) Certifying Examination. This exam is offered annually in August. All Internal Medicine physicians who have met the standards for Board Certification in general internal medicine are considered Board Eligible for a period of seven years. During this period of board eligibility, the candidate may apply for the certifying examination in internal medicine. To be eligible to take this exam, graduates must complete all pre-requisites required by the American Board of Internal Medicine by August 31st.

We believe it is critical that Madigan Internal Medicine residents leave our institution prepared to educate others. To this end we offer many opportunities. Uniquely, we offer a dedicated “senior teaching rotation” opportunity where senior residents will either be supervising interns in their continuity clinic or they will be assisting the chief of medical residents in coming up with educational activities for morning report. Otherwise, trainees have opportunities to practice and hone their skills as educators from the outset of training in both formal and informal settings. 

Some examples of teaching opportunities available to all trainees in our program include:

• Interns and residents teach third- and fourth-year medical students on ward, intensive care unit (ICU) and elective rotations throughout the academic year.
• Residents participate in teaching interns in both the inpatient and ambulatory setting throughout the academic year.
• Medical Student Lecture Committee: a resident-run committee that organizes and delivers lectures on medical topics to rotating medical students throughout the academic year
• All residents are scheduled to develop and present evidence-based medicine presentations (using the PICOT format) during the ambulatory phase of the curriculum over the course of their residency training.
• Residents have the opportunity to design and deliver other educational sessions in lecture or small group format throughout the academic year.
• Any trainee may sign up to earn a Certificate in Health Professions Education from the Uniformed Services University while in residency training.
• Senior residents may participate in a 2 or 4 weeklong faculty development rotation.

Faculty supporting the Internal Medicine Residency program have a wide range of subspecialty representation, including:

• Critical Care
• Cardiology
• Hematology Oncology
• Endocrinology
• Rheumatology
• Pulmonary
• Nephrology
• Allergy Immunology
• Gastroenterology
• Neurology
• Dermatology
• Infectious Disease
• IMC Consult
• Primary Care
• Palliative Care
• Geriatrics

Internal Medicine Clinic (IMC) Advisor Program

Each internal medicine resident is assigned a general internist on arrival to the program, who will serve as their IMC advisor over the course of their three-year residency. This IMC advisor will also frequently be assigned with the resident as a preceptor during their continuity clinic to provide consistency of supervision and care. The advisor will often see and take care of acute issues in patients assigned to that resident’s continuity panel when that individual is not available due to residency rotation requirements, leave or TDY. This individual will also review and cosign telephone consults completed by the resident addressing patient issues that are not otherwise associated with a clinic visit staffed with another faculty member.

Mentor Program

The internal medicine mentorship program is a voluntary, informal option for interested residents. Residents who would like a mentor outside their assigned IMC advisor due to subspecialty interests or other positive educational and professional interactions can approach faculty directly or can request one through their program leadership. Residents desiring a specific fellowship may want to have a point of contact with a staff physician in that department to help with career choices. Residents may want a mentor with a strong military background if they have future operational medicine aspirations. Other mentors may assist with research interests or personal hardships. Mentors are available upon request.

The Madigan Internal Medicine Residency Program is committed to and responsible for promoting resident well-being and providing a supportive educational environment. The learning objectives of the program will not be compromised by excessive reliance on residents to fulfill non physician tasks. Didactic and clinical education will be the top priority in training internal medicine residents.

The program and institution have a rich array of resources available for trainees to help support their health and wellness including a peer support program, behavioral health resources, financial planning resources, chaplain services, and military and family life counseling.

Finally, our program has a series of events designed to promote camaraderie among our team. For example, every Fifth Friday, residents on ambulatory or elective rotations are excused from clinical duties to participate in a fun, out of the workplace event. Residents maintain a social committee that is very active in planning year-round activities outside of the workplace. Our program hosts fitness competitions, disseminates kudos, has an annual intern welcome picnic, holiday party, and end-of-year banquet to celebrate our accomplishments and friendships.