Dear Faculty Member,
Welcome to The University of Toledo Internal Medicine Residency Program. We are honored and grateful to have you as part of our program. We know you will find your involvement personally and professionally fulfilling.

We understand the multiple demands on your time, and commitments. We are thankful that you help all of us reach our goal of excellence in resident education. We hope to educate the residents using bedside teaching and evidenced-base medicine in a supportive environment. You have our sincere thanks for all your efforts.

We know that there is sometimes confusion with many of the requirements placed both on the resident and the faculty members of a residency program. The purpose of this manual is to give you practical guidance on the minimum requirements needed to have a successful resident rotation and experience. Moreover, this manual provides you with the basic information necessary for compliance with the requirements of the Accreditation Council for Graduate Medical Education (ACGME) and the Residency Review Committee (RRC).

The second half of this manual is dedicated to present to you the achievements and progress of our residents the last three years. All this could not have happened without your active participation, valuable input and mentorship. Again, thank you for your contributions to our program.
Sincerely,

 

Ragheb Assaly MD
Professor of Medicine
Program Director

 

Acknowledgement and Program Structure

Chairman Joseph Shapiro, MD

Program Director R. Assaly MD

Asst. Program Director D. Kaw MD

Asst. Program Director B. Hinch MD

Asst. Program Director T. Sodeman, MD

Chief Resident Usman Ahmad MD

Coordinator Edie Reynolds

Core Faculty

Dr. Malhotra
Dr. Ratnam
Dr. Kleshinski
Dr. Duggan
Dr. Mahajan
Dr. Skeel

Subspecialty Coordinators

Oncology
Dr. Veltri

Pulmonary
Dr. Olson

Critical Care
Dr. Hernandez

Hematology
Dr. Shahadeh

Nephrology
Dr. Ratnam

Cardiology
Dr. Pandya

Endocrinology
Dr. Bourey

Gastroenterology
Dr. Sodeman

Geriatrics
Dr. Iwagu

Infectious Disease
Dr. Duggan

Rheumatology
Dr. Kahaleh

Mentorship Groups

Joseph Shapiro

Ragheb Assaly

Dinkar Daw

Shoba Ratnam

Youngsook Yoon

Deepak Malhotra

Sam Bittar

Bryan Hinch

C. Georgescu

T. Sodeman

Residency and Fellowship Information

The Department of Medicine sponsors a fully Accreditation Council Graduate Medical education (ACGME) accredited 3 year Internal Medicine Categorical Residency Program, a fully ACGME accredited 1 year Preliminary program. The Department of Medicine sponsors six ACGME accredited fellowships that include Cardiovascular Diseases including General Clinical Cardiology, Interventional Cardiology and Electrophysiology, Infectious Disease, Nephrology, Pulmonary Critical Care, Sleep disorders and Oncology.

The Internal Medicine Residency Program underwent major changes in the last three years. In November 2007, Albert Geha, Residency Coordinator retired and Edith Reynolds became the Residency Coordinator. In April 2008 Ragheb Assaly, M.D. was promoted from Associate Program Director to the Internal Medicine Program Director after this post was occupied by the chairman of the Department of Internal Medicine Dr Joseph Shapiro as an Interim Program Director. In addition Thomas Sodeman M.D and Dinkar Kaw M.D, Bryan Hinch M.D joined as associate program directors replacing Rekha Chaudhary M.D who relocated at the University of Cincinnati January of 2010 as an Associate Program director, and Anand Mutgi, M.D. who stepped down as Associate Program Director in July 2007.

In addition to the above changes in the administrative personnel, major restructuring and improvements in the curriculum, rotations design and scholastic environment took place during the last three years. With the help from the faculty from both the University of Toledo College of Medicine and St. Vincent Mercy Medical Center we have successfully completed our first 18 month cycle for the core- curriculum didactics delivered during a half day protected time for residents education.

We have developed a mentorship program, designed to support our residents in their patient care, medical knowledge, interpersonal and communication skills, professionalism, and scholarly activities in addition to offering guidance to the residents in their career plans and in any other matter of relevance to the profession. The residents are divided into 12 groups, each group consists of one attending volunteered to mentor and 3-4 residents scheduled to meet once weekly.

An enormous and organized effort is been focused on quantifying the six educational competencies. These efforts resulted in establishing the score card with expectations based on the PGY level.
To help assess the resident’s medical knowledge in addition to the monthly feedback and global assessment (new innovations) we introduced another tool of measuring this competency. We introduced a monthly test which covers the topics of the core curriculum discussed the previous month. This test allows us to measure the medical knowledge competency in a prospective and dynamic way. The following week after the test, two of the third year resident’s one from UT Medical Center and one from St Vs present a critique session of the questions included in the test.
We use several tools to assess patient care competency. In addition to the New Innovations, we employed, the procedures log performed successfully, the Mini-CEX, and the attendance at the simulation lab exercises.

Significant effort was made in restructuring the admitting rotation and the interaction with emergency department. Given the busy nature of the ED now the admitting resident covers only 15 days a month while the rest of the days both senior admitting residents collaborate to work on a practice based learning project.
In addition to the resident’s well being, in the restructuring of the schedule, emphasis is placed also on patient safety and transition of care. This is all detailed in a different section of the manual. To advance the mission of educating lifelong learners (residents) a tremendous emphasis was placed on incorporating the Practice based learning (PBL) competency in resident’s education.
Each senior (PGY2/PGY3) during their admitting month are required to collaborate to complete a PBL project. Examples of completed projects are available in this manual. Finally, in June of each year the residents will present their PBL projects and compete for the William Sodeman Jr PBL award. Another tool to measure PBL is chart auditing and self-reflection when completing the autopsy forms where the residents summarize how the information learned from autopsy changes their practice.

To quantify system based learning competency we introduced care coordinator daily morning meetings to discuss the patients disposition and challenges in placing these patients. In addition the residents are encouraged to participate in the hospital committees such as pneumonia committee, congestive heart failure committees to get exposed to the quality benchmarks the hospital and all the health care systems strive to achieve.

We also use several tools to assess professionalism. Attendance, timely completion of medical records, logging duty hours. Tracking the time lapsed of patient dictation after discharge.
In addition to the supervising faculty, communication skills are assessed by clinic nurses and medical intensive care unit clerks.
The residents and the faculty are educated on signs of fatigue and stress. Emphasis is placed on making sure that transition of care is done in an efficient way. To achieve this goal a schedule design has been established with emphasis on hand off and tools to assess this process is introduced to the global assessment (new innovations). Finally, the residents teaching skills are always evaluated by faculty, peers and medical students.

The core internal medicine program works very closely and guides our six fellowships. This is accomplished through regular quarterly meetings between the fellowship PDS and coordinators with the residency committee of the core program on the education level. The core program, organized three fellow symposia named after the late cardiology program director Dr Thomas Walsh.
With the leadership of our chairman and with the help of our internal medicine faculty, and the guidance and the support of the graduate medical education office as well as the college of medicine our Internal Medicine residency accomplished several important milestones. The rolling average in the ABIM pass rate is 97.2% with more than 98% of the graduates taking the exam between 2007-2009. An amazing record of peer reviewed publications, national meetings abstracts, local and national awards all detailed in the last section of the manual.