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The mission of the Brigham and Women's Hospital/Division of General Internal Medicine (BWH/DGM) Primary Care Program is to train tomorrow’s leaders in general internal medicine. These future leaders are superb clinicians who are committed to making the world a better place and improving the lives of patients locally, nationally and globally. We see the longitudinal patient-doctor relationship as the core of general internal medicine. Radiating from that core are generalist paths that include medical education, health services research, public health, community health, health policy, health delivery innovation, advocacy and global health. To fulfill our mission, the BWH/DGM program leadership is committed to helping our residents find and excel along their path, by providing unparalleled support and mentoring, along with clinical training, didactics and individualized experiences to optimize their personal and professional development.
Our primary care residency program is a family within the larger structure of the BWH internal medicine residency. Key members of the program are our faculty, the primary care chief resident, the primary care residents and our support staff. Over thirty faculty members in the Division of General Medicine serve as the program’s core educators; they are among the most highly rated clinicians and teachers in the Department of Medicine and at Harvard Medical School. Many of these faculty members are actively involved in health services research, community medicine and health policy, and are nationally-recognized figures in the current health care reform efforts. They are individuals that are actively shaping the exciting future for primary care. Our Division has particular areas of research expertise in inequalities in health care, access to care and patient safety.
There are 24 residents in the program, 8 in each year. Each DGM class rotates through the ambulatory blocks together and becomes a close-knit group as they follow a progressive curriculum tailored to each stage of training. During some ambulatory block rotations, DGM interns, juniors, and seniors are grouped on block at the same time so that they have opportunities for supplemental curriculum, inter-class mentoring, and extra-curricular activities.
Medical learning during the DGM residency follows a three year progression. During intern year, residents start by learning the basics of clinical care. Then, during junior year, residents focus on finding their own personal niches while continuing to build clinical and teaching skills. Finally, during senior year, residents master teaching and clinical skills, while further developing their longitudinal projects and planning the next steps for their careers.
The DGM residents have almost twice as many ambulatory blocks across the three years of training as their categorical colleagues, allowing more time for advanced clinical training, additional clinical curriculum and educational experiences that are unique to the primary care curriculum. These include focused “deep-dives” in care of the homeless, local and national health care reform efforts, epidemiology and teaching skills.
Because of their increased ambulatory time, primary care residents have additional conferences including:
• Clinical case discussions (faculty-facilitated discussions of difficult patient cases)
• Expanded Social Justice Curriculum: Born from the longitudinal project of a recent BWH/DGM graduate, the DGM social justice curriculum is a three-year experience that provides focused conferences, elective experiences and field trips led by community leaders to local neighborhoods, homeless shelters and clinics. The curriculum explores the range of needs of underserved and marginalized populations and the extensive community-based resources that are available in Boston. In response to resident feedback, we have added social justice electives, including “deep dives” into Homeless Healthcare, HIV medicine, Prison Medicine and Addiction Medicine.
• Suboxone training
• Nexplanon training
• Motivational Interviewing
• Resident-driven special didactics: These have included a half day on management of chronic pain and a mini-course on writing and publishing narrative medicine, co-taught by a well-published resident and faculty member.
In addition, our DGM residents are given extra time to pursue a longitudinal project in their unique areas of interest. These projects cover a wide range, from medical education, primary care innovation and health services research, to community medicine and beyond.
The BWH/DGM program also sponsors special events for the DGM faculty and residents to encourage closeness between the faculty and the residents. Twice a year, we host retreats focused on professional and personal development for our faculty and residents.
DGM curriculum by year:
Intern year:
Categorical interns: five 2-week blocks
DGM Primary care interns: seven 2-week blocks
Intern year kicks off with Primary Care Bootcamp, a resident-driven curriculum designed and taught by DGM residents and faculty to expose interns to key primary care clinical teaching, including hypertension, diabetes, asthma, COPD, depression, anxiety and routine screening. The DGM interns cover about 80% of the categorical intern ambulatory curriculum by the end of the summer, and are then able to focus on more advanced topics for the remainder of the year. Due to resident feedback, we have focused the remainder of the year on the clinical subject matter related to our core directives (endocrinology, rheumatology, neurology and dermatology). In addition, time is set aside for resident-driven curriculum. This year, we are running a nexplanon training due to strong levels of interest in our intern class. The intern year curriculum also includes special skill-based didactics that cover topics in Social Justice, Quality Improvement and communication with very ill patients.
During intern year, DGM residents have protected time during each of their seven ambulatory blocks to begin work on their longitudinal projects. Interns also dedicate time meeting with their Program Director, DGM faculty and other hospital faculty as potential mentors to explore potential areas of interest.
Intern Schedule
Junior year:
Categorical JARs: five 2-week blocks
DGM Primary care JARs: eight 2-week blocks + 2-4 weeks of elective
In Junior year, DGM-residents use their additional ambulatory block time to explore more advanced clinical topics and to get their longitudinal projects off the ground. To underscore the program’s commitment to academic excellence, all primary care junior residents travel to the Society of General Medicine Annual Meeting courtesy of the residency program. In the last two years, several of our DGM residents have presented their work at the meeting. Junior residents have multiple special skill-based didactics that teach residents how to improve their teaching abilities and cover advanced topics in social justice.
Senior year:
Categorical SARs: variable (typically two 2-week blocks)
DGM Primary care SARs: five 2-week blocks + 3-4 months of research/elective
Since many of our graduates seek primary care jobs immediately after graduation, we dedicate time to professional development in the senior year. Our DGM seniors participate in a half-day workshop focused on job contracts, CVs and job negotiation techniques. They receive training in public speaking and work with the program director to develop and give a noon conference, which is a Grand Rounds level talk given to their entire residency program. Senior residents also have ample time to complete their projects and explore how to make their projects sustainable.
We strongly emphasize teaching skills among our residents, helping them to hone their skills as clinician educators regardless of their own fields of interest. Many of our residents have served as tutors in Harvard Medical School courses and as chief residents at the West Roxbury VA Hospital and Faulkner Hospital during their senior year.
• A hallmark of the BWH/DGM program is the longitudinal project. The goal of this experience is to give our residents the chance to do a “deep dive” in a field of study, project, or experience that helps sustain them as physicians. Our goals for the projects are threefold:
1. Projects should not only be in a resident’s interest area, but should generate genuine excitement for the resident and thus serve as a critical, sustaining outlet throughout residency
2. Projects must improve the quality of life of and care for patients, however broadly defined
3. Projects must be codified and “live on” in the wake of graduation, either as a sustainable project, integrated curriculum, or published/presented findings
In recent years, resident's projects have focused on a wide range of topics, including medical education, physical exam skills, community outreach, health care policy and administration, research, medical writing, and international health. Here are a few recent topics our residents explored:
Our graduates become leaders in general medicine. Many of our residents elect to pursue a fellowship opportunity to develop additional areas of expertise and focus, such as a General Medicine Fellowship, the Robert Wood Johnson Clinical Scholars Program, and the Kraft Fellowship in Community Health. Other graduates have taken faculty jobs at community health centers, academic hospitals and other practice venues, working both as clinicians and clinician educators, clinician-innovators or clinician-investigators. In recent years, paths have included clinical care of the underserved, health policy, medical education, primary care innovation, women's health, geriatrics and palliative care. Many of our graduates become leaders in academic primary care divisions, where they combine patient care with teaching, research and/or administration. Other graduates become administrative leaders in public health departments and other medical institutions. Some have gone on to play important roles in setting state and federal health policy. Please click the menus to the left to read about our recent graduates, as well as our alumni and faculty!
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