The Internal Medicine Residency Program at Cooper offers a well-rounded educational experience characterized by diverse clinical exposure, structured didactic education and strong faculty mentorship. In our categorical training program, residents are exposed to a variety of clinical experiences and are given increasing medical responsibilities over the course of their three years of training. Our program prepares residents for subspecialty training or primary care practice in the inpatient or ambulatory setting. Once a resident chooses a career path, she can tailor a curriculum centered around her future goals. Residents are offered their choice of electives every year to encourage exploration of different specialties. Residents are encouraged to apply for an outside elective during their PGY 2 and 3 years to gain exposure to different health systems.
Our program also offers specialized courses of study for those interested in particular career paths. Our Hospitalist Track provides opportunities to pursue quality improvement projects as well as exposure to hospital administration and/or academic medicine career paths. We also offer a Primary Care Track which emphasizes outpatient, community-based, academic medicine. Finally, our Global Health Elective allows two of our senior residents to travel to Ghana to serve patients in a rural setting.
Medical Teaching Service
The Medical Teaching Service is where residents learn the core of inpatient medicine and treatment. Each inpatient team consists of a teaching Hospitalist, a PGY-2 or PGY-3 senior resident, a PGY-1 resident, and a variable number of medical students. The resident and intern work as a team to care for hospitalized patients under the supervision of the Hospitalist. Bedside teaching rounds are conducted daily and focus on clinical reasoning, physical examination skills, advanced communication skills, and evidence-based diagnosis and management. Each medical team complies with the ACGME required cap of 14 patients.
The recent geographic localization of patients enables us to have closer communication with nursing, ancillary staff and consulting services ultimately leading to better patient care. Proximity to our patients allows us to better communicate treatment plans and any changes that occur throughout the day in an effective manner. The call system is based on a Q4 model with a resident who stays late every 4th day to cover other teaching teams. A dedicated admission team is present for daytime as well as nighttime admissions and newly admitted patients are distributed based on geographic location.
The 4+1 Schedule
Our residency program benefits from a 4+1 schedule. Residents are assigned to one of five cohorts, each led by a third year chief. These cohorts consist of roughly 13 members, including residents from all three class years as well as those completing a preliminary year. The academic year is divided into 10 five-week blocks, with four weeks of each block devoted to traditional clinical rotations such as inpatient floor medicine, critical care, cardiology, night medicine or elective. During these four weeks, residents do not partake in any clinic duties. This minimizes interruption during inpatient rotations and promotes true immersion within each clinical training environment.&
Every cohort cycles through ambulatory week every 5th week. During this time, residents rotate through clinic sites in Camden as well as other suburban sites throughout Southern New Jersey. By design, residents are guaranteed a “golden weekend” at the end of every ambulatory week. This provides a regularly scheduled break during the arduous clinical training of residency and represents our focus on preserving resident wellness. Residents remain in the same cohort throughout their three years of training, which fosters the formation of strong bonds among cohort members. The cohort system helps to bring a sense of community and family to our program and leads to the formation of lifelong friendships.
Cooper University Hospital has a state-of-the-art 30-bed medical intensive care unit (ICU) staffed by nationally and internationally renowned academic intensivists. Our ICU is a tertiary referral center for the entire South Jersey region, which means that we take care of a complex and diverse population of critically ill patients. The unit is multidisciplinary—Internal Medicine residents work alongside residents from Emergency Medicine and Anesthesia—to provide the most advanced care to critically ill patients afflicted by septic shock, respiratory failure, and other medical emergencies.
Over the course of three years, Internal Medicine residents spend roughly 3-4 months rotating on critical care services. During this time our residents become proficient in basic procedures (central lines, arterial lines, paracentesis, and lumbar punctures) and ultrasound technique. We also gain exposure in the management of invasive monitoring and advanced support devices including pulmonary artery catheters, intra-aortic balloon pumps, Impella devices, and VV-ECMO. All senior residents rotate through our “Crit Care Green” rotation, during which we evaluate critical care consults on the floor and respond to rapid responses and codes throughout the hospital. While our residents are never expected to intubate patients on the medical floor, we offer elective rotations in anesthesia for those senior residents who wish to hone their skills in this field.
All of these opportunities ensure that our residents are well equipped to care for critically ill patients; this makes Cooper a great place to train for those interested in critical care. For a list of former residents who went on to pursue careers in Critical Care Medicine, please click here.
Cooper University Hospital has a 12-bed coronary care unit (CCU) and a 36-bed cardiology step down unit with telemetry called the progressive care unit (PCU). We have recently revitalized our cardiology training experience with the creation of a new, combined CCU/PCU service. This service is staffed by one senior resident (PGY-2 or PGY-3) and two interns working under the supervision of a Cardiology fellow and attending. The team takes care of a total of 18 patients on the Cardiology service, including patients in the CCU and PCU. This enables residents to learn about “bread and butter” Cardiology topics such as risk stratification of chest pain, evidence-based management of congestive heart failure, arrhythmias, pericardial disease, and valvular disease, while also following their patients as they transition between the intensive care unit and the floor. In the CCU residents gain the additional experience of caring for patients with acute coronary syndrome, cardiogenic shock, and life-threatening arrhythmias. Throughout this rotation, Cardiology faculty and fellows instruct the residents on the nuances of cardiac auscultation as well as interpretation of electrocardiograms, echocardiograms, and coronary angiograms.
Night Medicine rotations vary between coverage of the Medical Teaching Service, the ICU, and the Cardiology service. Residents can expect to have roughly 6 weeks per year of night rotations. The ICU is covered by an intern, a senior resident, and an in-house Critical Care fellow. Critical care attendings also remain in-house overnight to provide an extra layer of support. The Cardiology service is covered by an intern, a senior resident, and an in-house Cardiology fellow. Although adequate supervision is always provided on both of these rotations, there is plenty of autonomy for interns and residents to learn how to manage patients in acute settings.
Night Medicine on the Medical Teaching Service is split between a “Covering Night Team” and an “Admitting Night Team.”
The Covering Night Team consists of one intern and one resident. The intern covers six medicine floor teams, each consisting of a maximum of 14 patients. The intern is also responsible for any patient being transferred from the ICU to the teaching floor teams. The covering resident provides supervision in the care of these patients and completes any direct admissions from outside hospitals to the teaching floor teams. On covering nights, residents learn how to manage patient complications and identify acute situations that may require escalation of care.
The Admitting Night Team consists of one intern, one resident, and a night admitting hospitalist. Both intern and resident work together to complete a maximum of 10 admissions from the Emergency Department to the medicine floors. Each admission is presented to and supervised by the night admitting hospitalist. This rotation gives residents the opportunity to work up undifferentiated patients and guide the course of their hospital stay. It also strengthens our ability to triage patients between observation units, medical floors, or critical care units.
Through our partnership with MD Anderson, Cooper University Hospital has become a leader in cancer treatment in the South Jersey region. During our time as senior residents, we rotate through the hem/onc floor and are able to care for patients with a variety of disease processes including those with acute leukemia requiring induction chemotherapy, small cell lung cancer, different lymphomas, and febrile neutropenia amongst others. We work closely with a dedicated hem/onc fellow and attending while on this rotation. We also understand the importance of a multidisciplinary approach to the treatment of these patients by working closely with pharmacists, social workers and nurses.
Within the 4+1 schedule, every fifth week is reserved for protected ambulatory training time. Residents spend six to seven half-day sessions in outpatient continuity clinic, while the remaining sessions are dedicated to suburban clinic, didactic sessions, and simulation experiences. Having dedicated time devoted to the outpatient setting allows for improved continuity of care and the development of a group practice environment.
Each resident spends the majority of his or her sessions in a designated primary site: the Resident Clinic at 3 Cooper Plaza in Camden, the Cooper Internal Medicine office site in Gloucester or the Camden VA Primary Care Clinic. In addition to their primary sites, residents also have 2-3 half sessions in suburban clinics with attending supervision. There are additional opportunities for residents to spend a half session practicing in the HIV clinic or conducting home nursing visits.
To enhance the educational experience of our residents, we have created a half-day didactic session that occurs on Tuesday afternoons during ambulatory week. These sessions are run by our Resident Clinic Director, Dr. Alexandra Lane, and are specifically devoted to pertinent topics in outpatient medicine. During our Tuesday afternoon sessions, residents also discuss updates to the group’s resident-run Quality Improvement (QI) project. The Tuesday afternoon didactic session ends with use of our SIM center to simulate advanced diagnostic and emergent cases. Dr. Ritesh Patel, Assistant Program Director, provides support and guidance during our SIM sessions. Our Chief Residents and PGY-3 senior residents are directly responsible for creating the simulation cases, as well as running the cases and providing teaching and feedback afterwards.
Sample Ambulatory Week Schedule
|AM||Primary Clinic Site||Suburban Clinic||Suburban Clinic||Telephone Medicine (Admin)||Primary Clinic Site|
|PM||Primary Clinic Site||Didactics/SIM/QI||Primary Clinic Site*||Suburban Clinic||Primary Clinic Site|
*this session is used for an additional Primary Care Didactics specifically for Primary Care Residents conducted by the Primary Care PD, Dr. Jenny Melli.
The hospitalist track provides a unique opportunity for residents to gain a deeper insight into what hospitalist medicine at an academic center entails. It is a longitudinal elective with central requirements focused on subjects not specifically taught during residency such as: billing, utilization review and contract negotiation. This track also provides elective options that are catered to a resident’s specific interests including developing research projects, consult medicine and bedside teaching. While focusing primarily on academic hospital medicine, there are also opportunities to rotate at one of Cooper’s sister sites for exposure to community-based practice or to rotate with a nocturnist. Each resident is paired with a hospitalist mentor based on mutual interests.
Primary Care Track
Please click here for more information.