The Memorial University program in Internal Medicine transitioned to a Competence By Design (CBD) curriculum in July 2019. Our residents engage in EPA completion using our MUNCAT app. They receive guidance from an academic advisor, and have regular performance reviews by the competence committee. Each academic advisor advises 3-4 residents.  Competence By Design will not substantially alter the duration of training in our program. 

Our scheduled training consists of 3 years of core internal medicine leading to ability for further subspecialty training or to do a core PGY-IV year of Internal Medicine training. The program's objectives are based on the Royal College training objectives for internal medicine. The majority of resident training occurs at The Health Sciences Centre but residents will do some rotations at St. Clare's Mercy Hospital.  The residents will also do 1 block of Community Internal Medicine (rural or urban), and 3 blocks of elective experience consistent with the resident's career goals. One block of electives is offered in each of the three years. Resident also have the option of doing up to 3 blocks of research.

The Internal Medicine program has approximately 40 residents and approximately 100 full-time and part-time faculty. The size of the program lends itself to a collegial and close working relationship with faculty and excellent hands-on experience.

Clinical teaching units (CTUs) consist of a mix of subspecialists and general internists. Generally, each CTU consists of a senior resident, 2 PGY 1s, and 1 or 2 senior medical students.

On Call Responsibilities

Call is delivered through a blended model with both traditional call (24 hours) and night float call (15 hour shifts).

PGY 1s share a mixture of call responsibilities including the traditional 24 hour call with a maximum of 1:4 while on CTU and medicine rotations, home call on neurology and blended call on CCU. Junior residents are always supported by in-house senior residents on call.

PGY 2s and 3s participate in call delivered through the night float call model, totaling 1 block each year.  Residents may also do some call shifts while on CTU, CCU and ICU.  

3 blocks as a junior CTU ward resident
2 blocks CCU
1 block elective in second 6 blocks
1 block of night float (4 weeks) to be dispersed throughout the year
1 block ambulatory general medicine clinics
2 one-block medicine selectives (subspecialty rotations)
2 blocks of ICU
1 block of mandatory community experience (to be done with a St. John's internist doing community based practice at St. Clare's Mercy Hospital, or also in Grand Falls-Windsor, Carbonear or Corner Brook - resident will decide well in advance where they do the rotation). 

1 block Senior Day Float
3 blocks as senior CTU ward resident
1 block elective, pre-CaRMS
1 block night float (4 weeks) to be dispersed throughout the year and split with a selective
7 blocks of a 1-2 block selective rotation on the different subspecialty services

The resident will meet with the Program Director during the PGY 3 year to discuss rotations that will satisfy the requirements of the Royal College and as well will meet the future academic practice needs of the resident. For those residents doing a clinical 4th year, the residents will spend 2 blocks of that year as a junior consultant on a CTU, 1 block critical care, 1 block ambulatory, 1 block community medicine. The other 8 blocks are elective, as planned with the coordinator for the PGY 4 year.

All residents have mentors and are required to work on and complete a research or other scholarly project (which can be QI/QA or medical education). At the beginning of their training program, the resident will be provided with a mentor (i.e. member of the faculty), who will encourage and help guide the research interest of the resident. Each academic year, there is a Research/Scholarship Day.  Further funding may be available should research be accepted at a national/international conference.  Monetary prizes are also awarded.  There is a scholarship curriculum embedded in the medicine half day schedule including critical appraisal.

A Master's Degree in Clinical Epidemiology is also available for interested residents. This course is taught by internal medicine faculty affiliated with the Division of Clinical Epidemiology and is also popular with residents from other specialties.

There is a dedicated PGY 1 Bootcamp that runs during the first week in July which includes simulation, case-based sessions and didactic lectures to help with the transition to residency.

Morning Report occurs 3 times weekly at the Health Sciences Centre. These rounds cover a mix of interesting cases and subspecialty topics, as well as including special topics such as Internal Medicine relevant radiology rounds. ECG rounds take place on Fridays at the Health Sciences Centre.

There are also noon-time rounds every weekday except for Thursday, with Medical Grand Rounds taking place virtually each Friday from September to June.

There is an academic half-day for PGY 1 residents that occurs on Tuesday afternoon from 2:00 pm to 5:00 pm and runs from July - December.  PGY 2 and PGY 3 residents have academic half-day on Thursday afternoon from 2:00 pm to 5:00 pm from July - December.  From January - June, PGY 1 and PGY 2s attend half day together on Thursdays from 2:00 pm to 5:00 pm.  This is protected time for the Internal Medicine residents. 

A simulation teaching program is firmly established.  These sessions are both low and high fidelity.  There are multiple sessions throughout the year and are available for all residents.  There are senior medicine rounds for examination preparation and discussion of cases - protected time for PGY 2, 3 and higher.

PGY 3 residents have protected time to prepare for the Royal College exam from January to June of the exam year. There is also a formal curriculum for senior resident teaching that runs from September to June.

Conference leave is permitted on an annual basis. Residents are encouraged to take advantage of conference opportunities. Residents receive $3000 to be used during 3 years of training ($1000/year).  Residents who do a PGY 4 year are entitled to an extra $1000 funding. Lead Medical Residents are provided with an additional $1500 funding.

There are a number of assessments used by the Program's Competency Committee to determine resident promotion.  

CBD curriculum EPAs are completed regularly (3-4/week is suggested) and are captured using the MUNCAT app. Longitudinal assessments are also completed by supervisors at the end of each rotation with narrative feedback. 

We also have 360 evaluations on CTU rotations to help assess real life communication and collaborative competencies.

Residents also get protected time for OSCEs. Feedback on OSCEs is immediate with guidance for future performance. All evaluations may be reviewed with the Program Director and Competency Committee.