Mission

The Department of Medicine at Naval Medical Center San Diego (NMCSD) is committed to the education of residents in general Internal Medicine. The primary mission of our training program is to provide a well-rounded educational experience in the broad field of internal medicine. We are a multifaceted training program, providing tailored experiences that develop residents into leaders in Internal Medicine. The program provides the opportunity for residents to work and learn in a variety of diverse and unique environments while keeping the Four Aims of the program in mind – Care of the Community, Clinical Excellence, Continuous Improvement and Medical Education.

Aims

Care of the Community

Graduates of the program are well prepared to begin the practice of general internal medicine in any environment, with the additional capabilities expected of those serving in the armed forces. Residents will gain patient-based educational experience that emphasizes diseases and problems common to internal medicine.

Clinical Excellence

Our mission is to train superb internal medicine physicians to pursue careers in clinical practice, academic medicine, research, or administration. Internal Medicine faculty all work in the inpatient and outpatient settings. Given their educational roles in both venues, they are uniquely positioned to educate future leaders in internal medicine. Through one-on-one mentorship and clinical coaching, our residents learn the prerequisite skills necessary for clinical excellence.

Continuous Improvement

The practice of medicine is changing - dramatically. While the doctor / patient relationship is still paramount to providing effective, patient-centered care, there is a growing need to recognize, appreciate, and help mold the systems and environments in which we practice. This requires new graduates to have a firm command of systems of care, quality and process improvement, and transitions of care. The NMCSD internal medicine program and faculty foster a culture of innovation and safe, high-quality patient care.

Medical Education

Many of our internal medicine residency graduates go on to pursue careers in medical education. We believe the rich academic environment, coaching, and diverse mentorship aid residents in their career decision-making process. The emphasis that NMCSD internal medicine faculty place on education is exceptional and includes strong involvement at both the medical student and resident level. Internal Medicine residents receive training on improving their teaching skills and providing feedback. In addition, residents are also taught by leaders in medical education, policy, and accreditation, which allows them to learn the “language” and national trends in medical education.

The program runs a daily hour-long noon conference in the main residency conference room. This conference schedule provides a wide range of topics including case presentations, subspecialty updates, high-yield board review, M&M, and other unique presentations on topics including DEI and social determinants of health. Friday afternoons during the ambulatory week consist of a half-day of academics primarily focusing on ambulatory clinical medicine topics, quality/process improvement, and social determinants of health.

Residents are authorized 1-2 months of elective time in the PGY-1 year, 1-2 months in the PGY-2 year, and 2-3 months in the PGY-3 year. Elective options include:

Most inpatient rotations are organized on day/night shifts of 12 hours or less in length, consisting of six days of duty and one scheduled day off per week. Clinic weeks, elective, research, and most other rotations consist of five days of duty and two days off per week. Intensive care and cardiac care rotations may be day/night shifts or 24-hour call every 3rd day for residents rotating on the service.

Graduates of our program will be well-prepared to begin the practice of general internal medicine in any environment with the additional capabilities expected of those serving in the armed forces. Trainees represent communities and cultures from across the United States that, upon graduation, will practice in operational, inpatient, outpatient, research, and academic settings and potentially participate in additional subspecialty training.

Graduates will serve a diverse group of active duty service members, family members, and retirees in addition to potentially treating foreign nationals and citizens of foreign countries. Residents will gain patient-based educational experience that emphasizes the knowledge and skills needed to manage patients with both acute and chronic diseases common to internal medicine in a wide variety of national and international settings.

• All Internal Medicine Residents are required to maintain Basic Life Support (BLS) and Advanced Life Support (ALS) or Advanced Cardiac Life Support (ACLS) certification throughout residency.
• All residents complete the Combat Casualty Care Course (C4) in San Antonio, TX or the Advanced Trauma Life Support (ATLS) and Tactical Combat Care Course (TCCC) at NMCSD prior to graduation.

Naval Medical Center San Diego has a state-of-the-art simulation center on site. The Internal Medicine Residency Program uses the simulation center as part of its didactic program throughout residency training. Common examples of the use of simulation include critical care and trauma scenarios and procedural skill training, including common internal medicine procedures such as:

• Arterial line placement
• Arthrocentesis
• Central line placement
• Chest tube placement
• Lumbar puncture
• Paracentesis
• Point of Care Ultrasound (POCUS)
• Thoracentesis

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:

• Opportunity to lead hospital or ICU team on a regular basis.
• Career Development Boards for all senior residents
• Intermediate Leadership Course for all senior residents
• Opportunity to lead residency committees.
• Quality improvement projects
• Scholarly projects

The NMCSD Internal Medicine Program believes that it is a physician’s duty to advance our profession through scholarship of discovery, integration, application, engagement, and teaching. To that end, the program strives to ensure that each graduate possesses basic knowledge, skills, and experiences in research and scholarly endeavors. Furthermore, the program aims to provide a rich array of opportunities and mentorship to participate in research projects across the full spectrum of medical specialties and in medical education and quality improvement.

The program has a scholarship requirement for graduation. Categorical residents at graduation are expected to complete at least one scholarship activity during three years of residency.

Modern health care institutions are complex adaptive systems. Our program strives to provide highly reliable, safe, and effective care for all our patients while providing high quality medical education for all learners that train in our institution. We practice a continuous quality improvement lifecycle to meet these goals and we aim to instill these habits in our trainees. We offer both program and institution level training opportunities to learn the knowledge and skills necessary to practice high quality continuous process improvement and effective patient safety practices.

Our program has a quality improvement and patient safety graduation requirement for all our trainees. Internal Medicine residents should work toward completing the annual NMCSD Patient Safety and Quality GME Objectives. This includes completing one QI/PS educational activity per academic year in a progressive fashion, completing online coursework necessary to earn the Institute for Healthcare Improvement’s Open School Basic Curriculum in Quality and Safety, completing command training in Root Cause Analysis (RCA), and participating in at least one QI/PS engagement activity per inpatient rotation. All PGY-3 residents will complete an M&M review and departmental presentation.

Graduates of the NMCSD Internal Medicine Residency Program are universally sought out for assignments across the DOD and are highly competitive for fellowships in all specialties. Residents training in our program have the unique advantage of being able to work with and form relationships with the subspecialty programs, the majority of which are all represented at NMCSD. The program supports dissemination of scholarly activities through publication and conference attendance.

NMCSD supports residents in their military officer development by providing military unique curriculum and professional development through military-specific training and career development.

• Scripps Green Hospital in La Jolla, California
• Scripps Memorial Hospital in La Jolla, California
• University of California San Diego (UCSD)

Our program offers rotations to fourth year medical students interested in applying to internal medicine. Rotations are typically four weeks long and can be requested in a variety of clinical environments (see table below). Unless otherwise noted, all subspecialty rotations are a mix of outpatient clinic and inpatient consult services.

Third-year medical students may be accommodated on a space-available basis within the above rotations.

Please visit our Medical Student Rotation informational page to see a listing of available medical student rotations offered at NMCSD.

Interviews are offered from June through September annually. Interested applicants can request an interview virtually or in person by emailing the Internal Medicine program at: dha.san-diego.San-Diego-NMC.list.nmcsd-im@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 ABIM by August 31st. For additional details, please visit the ABIM website.

Teaching is considered a core competency for trainees in our program. 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:

• Residents teach third- and fourth-year medical students on hospital medicine, intensive care and elective rotations throughout the academic year.
• Residents participate in teaching interns in both the inpatient and ambulatory setting throughout the academic year.
• All residents are scheduled to develop and present two evidence-based medicine presentations (using the PICO format) 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.

None.

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

• Advanced Endoscopy
• Cardiology
• Cardiac Electrophysiology
• Endocrinology
• Gastroenterology
• Hematology & Oncology
• Hepatology
• Infectious Diseases
• Interventional Cardiology
• Nephrology
• Pulmonology & Critical Care
• Rheumatology

NMCSD Internal Medicine Program has a nested mentorship program, where-in we create mentorship groups composed as PGY1, PGY2, PGY3 residents, a fellow or chief resident mentor, and a faculty mentor. The program attempts to create mentorship groups, based on career goals and specialty interest. Assigned faculty mentors meet with their resident mentees at least twice per year. Residents are free to choose additional mentors on their own. The goals of this program are to help the mentee address their personal, military, and professional (clinical) goals including a review of relevant career pathways within the military, the trainee’s CV and individualized learning plan.

Our program takes resident well-being and work-life balance seriously. Our schedule is structured to balance the provision of robust clinical training with reasonable time away from the workplace. Residents receive one day off in every seven days on inpatient rotations (e.g., hospital medicine, CCU, ICU) and two days off in seven on outpatient and elective rotations. PGY-1 trainees are authorized 21 days of days away from training while PGY-2 and PGY-3 trainees are authorized 28 days away from training per year. All trainees are authorized 12 weeks of parental leave in accordance with DOD policy should they wish to utilize it during training (birth parents get an additional 6 weeks of convalescent leave after delivery).

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.