Program Overview

BWH/DGM Primary Care: Our Mission

The mission of the Brigham and Women's Hospital/Division of General Internal Medicine (BWH/DGM) Primary Care Program is to train tomorrow’s clinicians and leaders in general internal medicine. Our graduates are superb physicians who pursue diverse careers in primary care, public health, medical education, research, community health, health policy, healthcare delivery innovation, advocacy, medical humanities and global health. They are committed to improving the lives of patients locally, nationally and globally.

We are dedicated to helping our residents find their path and excel in any area of their choosing by providing unparalleled support and mentorship, rigorous clinical training, a multi-faceted curriculum, and customized experiences to optimize each resident’s personal and professional development.

The BWH/DGM Primary Care Residency

Our primary care residency is a close-knit family within the larger community of the BWH internal medicine residency. Key members of the program are our program director, teaching 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. Our faculty reflect a wide spectrum of interests including health services research, community medicine, health policy and advocacy, medical education, and care of vulnerable populations. They include nationally-recognized leaders in all of these domains.  Our Division has particular areas of research expertise in health care inequities and disparities, access to care, clinical innovation, health policy and economics, and patient safety.

Program Structure

There are 24 residents in the program, 8 in each year. Each DGM class rotates through their ambulatory blocks together across all 3 years of residency and becomes a cohesive cohort as they follow a progressive curriculum tailored to each stage of training.  Twice per year, DGM interns, juniors, and seniors rotate together on ambulatory allowing opportunities for supplemental curriculum, peer mentoring, and community-building. Program-wide retreats occur twice per year during these two blocks. The BWH/DGM program also sponsors special events bringing together the DGM faculty and residents to foster mentoring, networking and socializing.

DGM residents have almost twice as many ambulatory blocks across the three years of training as their categorical colleagues, allowing more in-depth ambulatory training, a comprehensive curriculum tailored to the future PCP, and relevant elective experiences including homeless medicine, addiction medicine, women’s health, adolescent health, LGBTQ health, healthcare innovation, and others. Most DGM residents also elect to participate in a second continuity clinic (either in a different primary care setting or sub-specialty) in their junior and/or senior year.

Intern Year

Seven 2-week primary care blocks

DGM internship is focused on giving you a firm grounding in outpatient practice through a foundational curriculum and through ample time in continuity clinic. Each block also allows for protected time to cultivate mentoring relationships and to explore extra-clinical areas of interest. Interns meet with their Program Director multiple times over the course of the year for additional mentoring and guidance.

Junior Year

Eight 2-week primary care blocks, plus 2-4 weeks of elective

Junior residents’ curriculum is multi-faceted and includes: in-depth teaching around clinical topics in primary care, clinical epidemiology, health policy, social justice, quality improvement, and reflective practice. Junior residents are given protected time to begin work on their longitudinal projects.  To underscore the program’s commitment to professional development, all primary care junior residents travel to the Society of General Medicine Annual Meeting.  Many of our DGM residents have presented their work at the meeting.

Senior Year

Five 2-week primary care blocks, plus 10-12 weeks of research/elective

As many of our graduates seek primary care jobs immediately after graduation, we dedicate time to professional development in the senior year with a curriculum focused on preparing residents for independent practice and pragmatic skills including CVs, public speaking and job negotiations. Senior residents 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 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.

Curriculum

Our clinical curriculum follows a three-year progression.  Intern year is focused on the foundational evaluation and management principles of the most commonly encountered clinical entities in primary care. Junior and senior year encompass the advanced management of a broad range of clinical topics pertinent to the generalist. Throughout all three years, the curriculum focuses on learning evidence-based medicine and how to critically appraise the medical literature.

In addition to the above, curricular learning in DGM encompasses the following expanded offerings:

  • Social Justice Curriculum: A three-year experience that arms our residents with the knowledge and skills to address health inequities. Through curricula, skill-building workshops, and opportunities for reflection, residents cultivate a racial and social justice oriented approach to the provision of healthcare in both clinical and systems-level domains. As part of the advocacy arm of the curriculum, residents make a yearly visit to the State House to meet with legislators and advocate on a health-related topic of their choosing.
  • Quality Improvement Curriculum: A longitudinal skill-based curriculum focusing on quality improvement and patient safety including a personal project.
  • Clinical Problem-Solving: A forum to review residents’ own challenging primary care cases with experienced faculty.
  • …and more: Suboxone training, Nexplanon training, reflective practice, communication skills (including motivational interviewing and communication around serious illness), clinical epidemiology, health policy and additional topics tailored to residents’ interests.

Longitudinal Projects

 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 any area of interest. Projects must fulfill the following objectives:

  • Generate genuine enthusiasm for the resident and serve as a sustaining outlet throughout residency
  • Improve the quality of life or care of patients, broadly defined
  • “Live on” after graduation, either as a sustainable program, integrated curriculum, or published/presented findings

In recent years, resident's projects have focused on a wide range of topics, including medical education, community outreach, health care policy and administration, research, medical writing, and international health. A few examples include:

  • Creation of a Latina Women’s group focusing on improving health literacy and community building for patients at the Phyllis Jen Center
  • Development of Primary Care Journal Club – a popular recurrent evening event for primary care residents, fellows and faculty
  • A resident-run workshop for medicine residents on long-acting reversible contraception
  • Creation of a start-up company to assist patients in diabetes self-care
  • Quality improvement project at Uphams Corner Community Health Center to integrate residents into the patient centered medical home model

Many of our residents have presented their projects as scholarly work at SGIM or other national conferences and receive mentorship and financial support to do so.

Graduates of the Program: Where Do They Go?

Our graduates pursue an exceptionally diverse range of career pathways. Many of our graduates practice general medicine while also cultivating an additional area of clinical or extra-clinical expertise. Our graduates practice in highly diverse settings throughout the U.S. and internationally including community health centers, private practices, innovative healthcare organizations, academic medical centers and government-affiliated systems such as the Veterans Administration and the Indian Health Service. Many pursue academic pathways as clinician-educators, clinician-innovators or clinician-investigators. Many go on to major leadership roles in academia, government, and public health. Many have spearheaded novel initiatives aimed at transforming healthcare delivery and others have gone on to play important roles in setting state and federal health policy. We proudly maintain an active alumni network and our alumni are highly invested in mentoring and advising our current residents.

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