Our History – Goals – Strengths
Florida faces a potential healthcare crisis in the coming years. Although the country in general lacks sufficient internal medicine physicians–especially with recent changes in healthcare laws–Florida trails other states in the number of residency positions available. It ranks 42nd in post–graduate training programs, with only 19 physicians–in–training per 100,000 patients. While the American population in general is aging, this demographic change also affects our state disproportionately. These are significant problems, but they also present an opportunity for internal medicine physicians, who will be in great demand here.
As Florida internal medicine physicians, we at Oak Hill Hospital are helping meet this tremendous need for graduate medical education in our state by creating a new Internal Medicine Residency Training Program. The program was accredited by ACGME in 2013. We successfully matched all 10 positions in the first round of the NRMP and our inaugural class starts training July 1, 2014.
Oak Hill Hospital, based in Brooksville, Florida, is uniquely positioned to provide comprehensive medical education because of our diverse patient population, excellent pathology, and a dynamic and dedicated teaching staff. Oak Hill Hospital offers a full complement of services. We are the regional center for cardiac catheterization and a referral center for oncologic care. A network of ambulatory practices affiliated with the hospital allows us to teach ambulatory medicine in general internal medicine and subspecialties in real world settings.
The Oak Hill Hospital Internal Medicine Residency Program favors resident education over service. We believe that the iterative process of medical decision making is an amalgam of science and art. We will teach you the science and you will practice the art. Teaching in the classroom is important, but training medicine by the bedside is essential, and you will learn by watching, studying, and doing. To learn how to make good decisions in an atmosphere of uncertainty, we will teach critical thinking along with deliberate practice to improve your clinical reasoning skills.
Ward Based System on Inpatient Floors
A supervising attending will be responsible for all of the patient care and teaching for resident teams, but the residents will be provided with the autonomy to develop their clinical skills. Residents are responsible for all admissions, documentation, orders and discharge planning, etc., related to patient care. Routine interdisciplinary work rounds provide representation and foster cooperation among nursing, pharmacy, social work and physical therapy departments.
4+1 Continuity Care Clinic Experience
Resident rotations will be spaced at regular intervals, including four weeks of in-patient wards or subspecialty electives, followed by a one week ambulatory clinic block. We have removed continuity clinics while on inpatient or elective services to eliminate the separation and potential conflict between the inpatient and outpatient spheres. This schedule, paired with seeing patients in community based outpatient clinics, gives our resident outpatient practices real world experience. Please see the 2014 Block Schedule Sample.»
The one week ambulatory block is described below.
The year is divided into 10, five week blocks. This leaves four weeks of vacations and two weeks of electives and holidays.
The First Four Weeks
These will be devoted to the wards, electives, ICU and ER rotations.
There will be no clinic during these blocks.
You will be able to focus all your attention to the management of your patients and be able to complete the tasks at hand since there will be no afternoon continuity clinics.
This improves continuity and reduces handoffs and fragmentation of care.
This also translates to having the whole team together in the afternoons and creates opportunities for more teaching activities.
The four week blocks end on a Friday and this will guarantee the following Saturday and Sunday off. This also translates to maintaining continuity during your electives. You will not be expected to attend to continuity clinics during your elective blocks. The subspecialty experience will therefore be much richer and meaningful.
The +1 (Fifth Week)
- This will be the ambulatory / continuity bock.
- The preceding week will be free.
- Five to six half days of the ambulatory block will be devoted to the continuity practice at the Access Health Care teaching site with hands on supervision by a very motivated faculty.
- Two half days will be at the subspecialty continuity clinic of your choice.
- One half day will be devoted to ambulatory QI projects.
- One half day will be at a variety subspecialty clinics, GI, Cardiology, Gynecology, Dermatology and Orthopedics, Palliative Care, Neurology and Rheumatology.
There will be opportunities to provide care to underserved populations in Federally Qualified Health Clinics as well. Pre-clinic conferences will cover topics dedicated to outpatient medicine.
Modern healthcare is a complex interplay of multiple continuously evolving facets of care. A vital aspect of our ability to understand the dynamics of this system is to understand and incorporate. We will be teaching you basic principles of continuous quality improvement and systems–based practice skills and team work. The Resident Patient Safety and Quality Council will provide leadership opportunities for residents to implement change and foster innovation in the hospital.
The Resident Patient Safety and Quality Counsel will be mentored by the hospital Chief Quality Officer. The IMRP will provide a curriculum that balances didactics with experiential activities. Residents will be mentored by faculty as they develop QI projects for presentation to the hospital leadership. Residents will be taught the basics of the Root Cause Analysis, and Plan Do Study Act processes and will be included in the hospital peer review process.
The projects chosen for our first year are:
- Ensuring accuracy and quality of hand–offs
- High value cost conscious care
Business of Medicine, Health Care Reforms, ACOs
We aim to train our residents in these essential, but frequently ignored, aspects of a physician’s daily life. Organizational behavior, change management, conflict resolution and contract negotiations are vital skills. Oak Hill Hospital has monthly business of medicine conferences where these areas are explored in depth.
Medicine and Law
We have a formal curriculum for teaching those laws and regulations pertaining to medical practice, focusing on malpractice, business and regulatory issues.
Medicine and Art
Quality medical reasoning requires powerful and subtle powers of observation, a particularly elusive skill to train. We join a number of other programs around the country in using art to hone our resident’s observational skills. We are working with the Tampa Museum of Art to develop a curriculum of teaching observational skills which will aid you throughout your career.