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Inpatient Training Facilities and Resources

One of the program's greatest strengths is the patient population. As a major tertiary referral center, St. Joseph's is the busiest hospital in the state as defined by the number of patient contacts. St. Joseph's also has a large primary care referral base allowing house staff to receive extensive training in common ambulatory problems, as well as the more unusual disorders referred to tertiary care institutions. Other resources range from advanced technology to the human touch of excellent nurse educators and a large ancillary staff. The superb core medical library with extensive information services is complemented by internet and CD-ROM reference search capabilities that exist on medical wards. Internal Medicine residents also take full advantage of learning from their peers who work within the other 10 residency training programs at St. Joseph's.
The inpatient medical service consists of 168 medical beds, a telemetry unit, and over 70 adult ICU beds encompassing medical, cardiac, surgical, trauma and neuroscience critical care units. During the critical care rotation, Internal Medicine housestaff play an integral role in the management of  medical and cardiac ICU patients under the supervision of board-certified medical intensivists, who provide critical care unit staffing 24/7. Housestaff play a major role in the care decision-making for their patients at every level of acuity from the ambulatory environment to the critical care unit.
During the three-year program, house staff have opportunities to take electives in all Internal Medicine subspecialty fields and in such important related disciplines such as Sports Medicine, ENT, and Radiology.

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The Mercy Healthcare Center's mission focuses on caring for all members of our community with dignity and respect.  In 2004, the Mercy Healthcare Center moved to our new modern facilities after a $600,000 renovation.  This new Center has a patient education center, a new resident workroom with built-in desk space. Each room is wired to allow us to implement a facility-wide EMR.  Patients are seen with and without insurance utilizing a hospital-based plan that provides full access to physician care and formulary medications within an evidence-based clinic setting. Mercy Healthcare Center provides well-rounded educational opportunities in an ambulatory setting to its residents.  The clinic's feedback and evaluation system has been presented at the national APDIM (Association of Program Directors Internal Medicine) conference.
All categorical residents participate in our outpatient clinic, while preliminary interns have the option of having a continuity clinic.  Residents assume responsibility for their panel of patients throughout the spectrum of care.  Subspecialty consultation is available to patients as needed.  The Healthcare Center provides specialized individual experiences through its on-site social workers and interpreters, diabetic education, pulmonary rehabilitation, dietician services and subspecialty clinics.  Current subspecialty clinics include: podiatry, dermatology, cardiology, infectious disease, pulmonary, breast evaluation and treatment, gastroenterology, wound care, and anticoagulation clinic.  Residents take an active role in decisions on management of the health center, including formulary changes, through their input at monthly ambulatory center meetings.

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Residents learn both ambulatory medicine and important aspects of billing and practice mechanics that will prepare them for a career in the current healthcare environment. The resident physicians benefit from precepting by full-time and community-based faculty. The Mercy Healthcare Center is currently participating in two nationwide studies on hypertension, including one working with the Neurology department on hypertension and stroke.

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Formal teaching occurs at several different levels. There are daily didactic noon conferences with topics ranging from advanced critical care to board review sessions, from ambulatory medicine to geriatrics. Lectures include monthly Tumor Board, a Med-Path conference, and Morbidity and Mortality Conferences. Morning report emphasizes both practical management and formal evidence based decision-making. Daily bedside teaching rounds with our inpatient academic hospitalist faculty members include learning proper bedside examinations and basic pathophysiology of managing inpatients In each of these settings, the emphasis is and always will be on appropriate patient care. Also, approximately, half of the University of Arizona College of Medicine students rotate through the medical center for third year clerkships and variety of fourth year electives. This opportunity provides interns and residents the chance to become teachers and learners, a necessity in modern medical practice.
Instruction is given in basic statistics, through weekly journal club meetings, which are essential for the interpretation and utilization of medical literature to solve complex clinical issues. Residents are counseled in the use of modern techniques by faculty and staff to obtain information that is critical in patient care. These are the skills required of every modern physician, which is one of the many goals of education at St. Joseph's.

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The internal medicine residents at St Joseph's also participate in many various scholarly activities. As part of the ambulatory experience the intern is encouraged to present an interesting case and topic at a noon conference. Additional opportunities include a clinical vingnette/poster presentation at the regional meetings at the American College of Physicians. There is ample opportunity to participate in research and clinical projects within the Department of Internal Medicine.
Residency training at St Joseph's provides all the attributes of a large university medical center with the benefits and unique learning opportunities of a major metropolitan community hospital. Graduates are well-equipped to flourish in our modern, constantly evolving healthcare environment, for any specialty, including outpatient general internal medicine, inpatient hospitalist or one of the many subspecialties of medicine.

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PGY1-C
SJHMC Medicine wards: seven months
Critical care: two months
Ambulatory medicine: one month
Selectives in ambulatory subspecialties: one month
*Elective: one month
Total:  12 months

PGY1-P
SJHMC Medicine wards: six months
Critical care: two months
Ambulatory medicine: one month
*Elective:  three months
Total: 12 months

PGY2
SJHMC Medicine wards: four months
Critical care: two months
Geriatric medicine: one month
*Elective:  five months
Total: 12 months

PGY3
SJH Medicine wards: three months
Critical care: two months
Ambulatory medicine: one month
*Elective:  six months
Total:   12 months

*Core electives include cardiology, endocrinology, gastroenterology, geriatrics, hematology, infectious disease, nephrology, oncology, pulmonary, and rheumatology

Rotations that include 24-hour call
Rotation  Frequency
SJHMC Medicine wards:   Every fifth night on-call
Critical Care 
  Resident:   Night-float system
  Intern:   Every fourth night on-call

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