A Curriculum-Based Residency

The scope of modern medicine is extraordinarily broad.  The faculty and the residency program in Internal Medicine are dedicated to educating and training physicians who will be superior practitioners in General Internal Medicine and the medical subspecialties, and who will be well prepared for their roles in the rapidly changing environment of clinical practice.  Our philosophy is to provide all residents in the program with a solid foundation in all areas of internal medicine through a core curriculum that spans all three years of training and provides substantial depth and breadth.  In addition, each resident is then equipped with the necessary tools and career counseling to utilize our track structure and elective rotations to allow for a highly personalized and self-directed experience.  All residents develop skill in approaching complex as well as common problems that present to the generalist via clinical experiences and didactic sessions on health maintenance, preventive medicine issues, psychosocial medicine and problems confronting the adolescent or geriatric patient.

• Week
• Conferences
• Electives
• Meetings & Events
• Research

Conferences

Morning Report

Monday through Thursday, 7:45-9:00am.; Friday, 9:00-10:00am. Case-based conference for all residents facilitated by the chief residents and attended by the Program Director, Department Chair, or selected faculty.

Classics In Medicine

Monthly, 7:45-9:00am.  Residents review classic and seminal papers in the medical literature.  Past talks have included the 1918 influenza pandemic, the history of mechanical ventilation, the history of drug regulation, and small pox.  
 

Interns' Report

Friday, 12:00-1:00pm. Case-based conference for interns during which time residents hold intern’s pager; facilitated by the chief residents and attended by the Program Director or Department Chair.
 

Medical Grand Rounds

Friday, 8:00-9:00am. General Medicine or subspecialty-related lecture given by University of Vermont faculty or visiting speakers.

Morbidity and Mortality

Monthly on Fridays, 8:00-9:00am. A case presentation from the Medicine service and discussion with a panel to review teaching points about diagnosis and management.
 

Core Curriculum Didactic Conference

Monday, Wednesday, 2nd Tuesday, 12:30-1:30pm. A three-year rotating curriculum covering topics in general internal medicine and the subspecialties.
 

Journal Club

3rd Thursday each month, 1:00-2:00pm. Resident-led discussion of a timely and clinically-relevant journal article with attention to developing appropriate skills in the use of the medical literature.

Medicine Housestaff Meeting

1st Thursday each month. An opportunity to discuss important program or hospital-related issues with all residents, the chief residents, the Program Director and Program Administrator.
 

Teaching Attending Rounds

Mon and Thurs 11-12:00pm, Tues and Wed 10:30-12:00.  Each Medicine wards team meets with a subspecialty or General Internal Medicine attending. On Wednesdays all four Medicine teams meet to share expertise and participate in innovative educational ventures, including medical ethics discussions, Medical Jeopardy, and intern or resident presentations that answer focused clinical questions pertaining to their patients using an evidence-based approach.

Pre-clinic Conference

On your continuity clinic day, 1:30-2:00pm. Residents receive structured readings, literature weblinks, and case questions in advance. Faculty preceptors lead discussions on these ambulatory general medicine topics and reinforce the salient concepts through case problem solving.  A comprehensive GIM curriculum is delivered over the course of residency. 

Outside Electives

Over the past few years, several residents have chosen to pursue medical electives in other parts of the world.  Some recent resident adventures include:

Swaziland

"In the winter of 2005, I spent five weeks in the Southern African country of Swaziland.  During the first four weeks I saw patients in an outpatient clinic in Siteki, a town near the border with Mozambique.  I spent the fifth week touring Swaziland and South Africa.  In the clinic, I saw 40-50 patients each day, the majority of whom had HIV/AIDS.  Typical problems included tuberculosis, esophageal candidiasis, AIDS wasting syndrome, and pelvic inflammatory disease.  I lived at the hospital with an American medical student.  I enjoyed my rotation and the Swazi hospitality, and since my visit, two University of Vermont medical students have scheduled month-long rotations at the same hospital." 

-Erik Rufa, MD

Columbia

"In December, 2004, I did an elective rotation in Medellin and Leticia, Colombia.  I spent the first two weeks in an Infectious Diseases lab doing basic research on malaria, helminth infections, tuberculosis, and leishmaniasis.  I spent the second two weeks working in a village health post in a small town on the Amazon River, bordering Peru and Brazil.  We treated villagers and people from the surrounding community, up to 100-200 km away by boat.  Most of the patients we saw were indigenous Colombians.  It was a fantastic experience, even though I had to muddle through with my less than passable Spanish."

-Lucas Ryback, MD

Nepal

"I performed research in high altitude medicine looking at the changes in airflow in response to a deep breath at high altitude.  This research was performed at Mt. Everest Base Camp, where I also served as the base camp physician for the Mountain Madness Everest expedition.  There I treated patients with high altitude cerebral edema, high altitude pulmonary edema and general altitude illness."

-Jason Fought, MD

Meetings and Events

Retreats

Day long retreats are held annually for each class in a casual environment outside the hospital.  This day offers an opportunity for the class to develop as a team and discuss issues specific to their level of training.  Topics include how to teach and mentor medical students, the evaluation and feedback process, case presentation skills, successful work and teaching attending rounds, and managing a team.  Career planning and the changing environment of medical care are also discussed. 

ACP

Residents are encouraged to participate in the annual, Vermont ACP chapter meeting each fall as well as the national ACP meeting in the spring.  Over the past several years, our residents have presented novel case vignettes and innovative research projects that have earned them the opportunity to present at the national level.  We have also had several resident winners at the national ACP abstract competition in recent years.  Some of our winners include:

2005: Diane Hakey, MD - Sarcoidosis and Calciphylaxis with Interferon Therapy

2004: Patricia Kao, MD - Intestinal Ischemia Secondary to Idiopathic Myointimal Hyperplasia of Mesenteric Veins: Case Report and Review of the Literature

2003: Robert Dubin, MD - Silo-Filler’s Disease Treated with Inhaled Nitric Oxide:  The Double-Edged Sword of Nitric Oxide Species

Nate Madsen, MD

Erik Rufa, MD

Resident Research, Presentations and Scholarly Activities

Cardiology	Infectious Diseases
Endocrinology	Nephrology
Environmental and Occupational Medicine	Pulmonary / Critical Care
Gastroenterology	Rheumatology
General Internal Medicine	Toxicology
Hematology / Oncology

 

Eric Gauthier, M.D. (Mentor, Peter Van Buren, M.D)

Title: Modulation of FKBP12.6 (FK506) and Ryanodine Receptor Isoform Expression in Failing Human Atrial and Ventricular Myocardium: Implications in Failure and Remodeling after LVAD Implantation

Research Award Winner, ACP Regional Meeting, October 2004

Presented at the ACP Annual Session, San Francisco, April 2005

Title: RT-PCR of Cardiac Specific M-RNA's for the Detection of Acute Myocardial Infarction

Presented at the ACP Regional Meeting, October 2003

Research Award Winner, ACP Regional Meeting, October 2003

Nieta Green, M.D. (Mentor: Philip A. Ades, M.D.)

Title: Effects of Exercise and Cardiac Rehabilitation on Cardiovascular Outcomes     

Published in Cardiology Clinics of North America. 2003. 21:435-448.

Caroline Lyon, M.D., MPH 

Title: Not Your Typical Myocardial Infarction: A Case of Takotsubo Cardiomyopathy

Clinical Vignette Award Winner, ACP Regional Meeting, October 2004

Presented at the ACP Annual Session, San Francisco, April 2005

Title: Aerobic Capacity in Patients Entering Cardiac Rehabilitation

Submitted to Circulation, 2006

Markus Meyer, M.D. (Mentor: Martin LeWinter, M.D.)

Title: Cardiopulmonary Bypass Facilitated Adenoviral Cardiac Gene Transfer

Title: Contractilin: A Designed Inotrope that targets the Key Molecular Defect in Heart Failure

Research Award Winner, ACP Regional Meeting, 2001

Research Award Winner, ACP Annual Session, April 2002

Title: ERCP Induced Myocardial Infarction and Stroke with Spontaneous Resolution

Presented at the ACP Regional Meeting, 2002

Title: Adenoviral mediated gene therapy with contractilin, a recombinant anti-phospholamban protein, improves the contractile performance of diabetic mouse hearts

Presented at the ACC Annual Meeting, 2002

Title: Cardiovascular Collapse in a 77-Year-Old-Woman with an Asthma Exacerbation following Bronchodilator Treatment

Published in Chest, 2002

Mikesh Shah, M.D. (Mentor: Deborah Ornstein, M.D.)

Title: Cardiac Primitive Neuroectodermal Tumor (PNET) – A Case Report

Presented at the ACP Regional Meeting, October 2003

Susanne Trost, M.D.  (Mentor: Martin LeWinter, M.D.)

Title: Cardiopulmonary Bypass Facilitated Adenoviral Cardiac Gene Transfer 

Title: Diabetic Cardiomyopathy: Current treatment options

Published in Cardiovascular Medicine. 2001. 3(6):481-492.

Title: Heat shock protein 70 and myocardial stunning in transgenic mice

Research Award Winner at the ACP Regional Meeting, October 2002

Research Award Finalist at the ACP Annual Session, April 2003

Nathaniel Madsen, M.D.

Title: A Curious Myocardial Infarction and Brussels Sprouts

Clinical Vignette Winner at the ACP Regional Meeting, October 2005

Endocrinology

David Axelrod, M.D.

Title: Hypogonadism and Compression Fractures

Presented at the ACP Regional Meeting, October 2002

Robert Dubin, M.D.

Title: Angiotensin-Converting Enzyme Inhibitors Increase Basal Glucose Uptake in Human Skeletal Muscle

Presented at the American Diabetes Association Annual Meeting, San Francisco, June 2002

Title: Extra-Pancreatic Effects of Nateglinide, with and without Metformin and Troglitazone in Human Skeletal Muscle

Peter Ward, M.D.

Title: Hemodynamic Collapse After Beta-Blocker Therapy in a Young Man with Thyrotoxicosis and Low-Output Cardiac Failure

Presented at the ACP Regional Meeting, October 2005

Environmental and Occupational Medicine

Erik Riesenfeld, M.D. (Mentor: David Kaminsky, M.D.)

Title: Radon Awareness and Mitigation in Vermont: A Public Health Survey

Presented at the ACP Regional Meeting, October 2004

Robert Dubin, M.D.  (Mentor: David Kaminsky, M.D.)

Title: Silo-Filler’s Disease Treated with Inhaled Nitric Oxide: The Double-Edged Sword of Nitric Oxide Species

Clinical Vignette Award Winner, ACP Regional Chapter, October 2002 

Clinical Vignette Award Winner, ACP Annual Session, April 2003

Gastroenterology

Adam Chodosh, M.D. (Mentors, Rocco LaSala, M.D. and James Vecchio, M.D., and Hagan Blaszyk, M.D.)

Title: Seasonal Pattern of Onset in Lymphocytic Colitis

Presented at the ACP Regional Meeting, October 2004

Published in Journal of Clinical Gastroenterology. 2005. 39 (10):891-3.

Patricia Kao, M.D. (Mentor: James Vecchio, M.D.)

Title: Intestinal Ischemia Secondary to Idiopathic Myointimal Hyperplasia of Mesenteric Veins: Case Report and Review of the Literature

Presented at the ACP Regional Meeting, October 2003

Clinical Vignette Award Winner, ACP Annual Session, New Orleans, April 2004

Michael Kelley, M.D. (Mentor, Richard Zubarik, M.D.)

Title: Oriental Cholangiohepatitis in Rural Vermont

Presented at the ACP Regional Meeting, October 2005

General Internal Medicine

Jennifer Ayer, M.D. and Nathan Ayer, M.D. (Mentor: Mark Levine, M.D.)

Title: Descriptive analysis of minimum clinical requirements on hospital discharge summaries of patient’s under the care of internal medicine physicians other than their primary care provider

Stephen Baad, M.D. (Mentors: Richard Pinckney, M.D. and Steven Grant, M.D.)          

Title: The Effect of Hospitalists on the Length of Stay for Community Acquired Pneumonia

Nicole Hynes, M.D. (Mentors: Richard Pinckney, M.D. and Steven Grant, M.D.)

Title: The Effect of Hospitalists on the Length of Stay for Community Acquired Pneumonia

Chris Hebert, M.D. (Mentors, Mark Levine, M.D. and Richard Pinckney, M.D.)

Title: Internal Medicine Residents’ Attitudes Towards Obesity and Weight-Loss Counseling

David Axelrod, M.D.  (Mentor: Mark Levine, M.D.)

Title: Prevalence and Desirability of Physician Advice to Overweight Patients

Deborah Lang, M.D.  (Mentor: Terry Rabinowitz, M.D.)

Title: The Fate of Consultation Recommendations Made For General Medicine Patients

Presented at the ACP Regional Meeting, October 2002

Title: Characteristics of Psychiatric Inpatients Receiving Consultation From Medical and Surgical Consultants and the Fate of the Recommendations Made

Presented at the Association for Psychosomatic Medicine National Meeting, November 2000

Research Award Winner at the ACP Regional Meeting, October 2000

Presented at the ACP Annual Session, April 2001

Cynthia Smith, M.D.  (Mentor: Richard Pinckney, M.D.)

Title: Predictors of False-Positive Screening Mammograms in Vermont

Mark Teruel, M.D.  (Mentor: Mark Levine, M.D.) 

Title:  Management of Elderly Women Following Hip Fracture

Hematology / Oncology

Teresa Fama, M.D. (Mentors, Marie Wood, M.D. and Hyman Muss, M.D.)

Title: Patient Preferences for the Adjuvant Treatment of Breast Cancer

Julian Sprague, M.D. (Mentor: Marie Wood, M.D.)

Title: Validation of Cancer Family History Questionnaire

Mary Chamberlin, M.D.  (Mentor: Marie Wood, M.D.)

Title: Prognostic Features of Melanoma Diagnosed in Chittenden County Compared to US

Cynthia Smith, M.D. and Susan Trost, M.D.) (Mentor: Richard Branda, M.D.)

Title: Severe lactic acidosis and hypoglycemia as a rare presentation of Non-Hodgkins Lymphoma

Presented at the ACP Regional Meeting, October 2002

Presented at the ACP Annual Session, April 2003

John Wright, M.D. and Neil Zakai, M.D. (Mentor: Mary Cushman, M.D.)

Title: Validation of a Venous Thrombosis Risk Score For Medical inpatients

Presented at the ACP Regional Meeting, 2003

Erik P. Rufa, M.D.

Title: Is It the Pill or the Shot?: Skin Necrosis During Anticoagulation

Presented at the ACP Regional Meeting, October 2005

Infectious Diseases

Matthew Arentz, M.D. (Mentor, Beth Kirkpatrick, M.D.)

Title: Superior Mesenteric Artery Syndrome in a Patient with AIDS: A Case Report

Regan Holdridge, M.D. (Mentor, Beth Kirkpatrick, M.D.)

Title: The Novel Oral Typhoid Vaccine M01ZH09 is Well-Tolerated and Immunogenic in Two Vaccine Presentations

Adam Mack, M.D. (Mentor, W. Kemper Alston, M.D.)

Title: Catastrophic Outcomes Associated with Clostridium Difficile Colitis

Jennifer Wolfson, M.D. (Mentor: Beth Kirkpatrick, M.D.)

Title: Fap1 and Coagulase-negative Staphylococcus: A Possible Virulence Factor

Title: Saphenous Vein Graft Mycotic Aneurysms: An Unusual Complication of MRSA Bacteremia in a Hemodialysis Patient

Presented at the ACP Regional Meeting, October 2004

Presented at the ACP Annual Session, San Francisco, April 2005

Trevor Dennie, M.D.

Title: Fever, Elevated Transaminases and Splenomegaly in an Adult Patient with Bartonella Infection

Presented at the ACP Regional Meeting, October 2005

Nephrology

Diane Hakey, M.D.

Title: Sarcoidosis and Calciphylaxis with Interferon Therapy

Clinical Vignette Paper Winner,  ACP Annual Session, San Francisco, CA  April 2005

Carina Cartelli, M.D. (Mentor: Chris Holmes, M.D.)

Title: Thrombocytopenia and Continuous Renal Replacement Therapy (CRRT): A Retrospective Chart Review

Tobin Hoppes, M.D. (Mentor: Alan Segal, M.D.)

Title: A Novel K Channel in the Apical Membrane of Renal Proximal Tubule

John Wright, M.D. (Mentor: Wolfgang Weise, M.D.)

Title: HUS in the Elderly – A Manifestation of Prostate Cancer

Presented at the ACP Regional Meeting, October 2003

Ron Levy, M.D.

Title: Effect of Glomerular Filtration Rate on Survival in Patients Treated with Implantable Cardioverter Defibrillators

Presented at the ACP Regional Meeting, October 2005

Pulmonary / Critical Care

Nicole Belanger, M.D. (Mentor, Theodore Marcy, M.D.)

Title: Has the Vermont Comprehensive Tobacco Control Program Improved Physician Adherence to the Tobacco Use and Dependence Guidelines?

Jason Fought, M.D. (Mentor: David Kaminsky, M.D)

Title: Evaluating the Effects of a Deep Breath on Airflow at Altitude:  A Potential Test for Early Interstitial Edema

Todd Whitman, M.D. (Mentor, David Kaminsky, M.D.)

Title: Do We Really Need to Correct for Lung Volume When Interpreting the Diffusing Capacity?

Krish Bhadra, M.D. (Mentor, Scott Wagers, M.D.)

Title: High Fractional Inspired Oxygen in Airway Hyperresponsiveness: Oxygen Worsens Asthma!

Research Award Winner, ACP Regional Meeting, October 2005 

Rheumatology

Priscilla Carr, M.D. (Mentor: Edward Leib, M.D.)

Title: Patterns of Follow-up After Osteoporosis Screening

Michael Kelley, M.D. (Mentor, Christine Jones, M.D.)

Title: Anti-Synthetase Syndrome Masquerading as Bird Fancier's Lung

Presented at the ACP Regional Meeting, October 2005

Toxicology

Dean Stephens, M.D. (Mentor: Anthony Tomassoni, M.D., M.S.)

Title: A Rare Cause of Acute and Prolonged Delirium: Ethyl Chloride Inhalation

Presented at the ACP Regional Meeting, October 2005

Thomas Oliver, M.D.  (Mentor: Alan Segal, M.D.)

Title: Metabolic Acidosis Secondary to Ethylene Glycol Ingestion

Presented at the ACP Regional Meeting, October 2002

Erik Riesenfeld, M.D.

Title: An Unresponsive Family: Clues To Poisoning

Presented at the ACP Regional Meeting, October 2003

David Axelrod, M.D.

Title: Methotrexate Toxicity

Presented at the ACP Regional Meeting, October 2001