Although the strength of the MGH internal medicine residency program is in the extensive experience devoted to direct inpatient and outpatient care, there are many conferences for residents each week as well. These range from interactive case based discussions and workshops to interesting case presentations and formal didactic lectures. These conferences are designed to complement and consolidate the education derived from patient care.
Core Curriculum Conference
Core curriculum conferences are held four days a week (M-Th) from 12:30-1:30pm. Staff members of the MGH and affiliated institutions, who are experts in their respective fields, provide an intensive review of essential internal medicine topics during this time. Early in the year, these didactic sessions cover commonly encountered issues such as chest pain, diabetes, anemia, renal failure, and pneumonia. Later in the year, broader topics are discussed, including lectures on clinical decision making, principles of interpreting diagnostic tests, and techniques to effectively analyze the medical literature. Lunches are provided daily for housestaff during these sessions, and teleconferencing allows those rotating at Newton-Wellesley Hospital to participate as well.
Case Conference is a weekly conference held on most Fridays from 12:30-1:30 pm. This conference focuses on an interesting teaching case chosen by the chief residents. The cases are chosen for their educational value and vary from the common to the esoteric. Residents, who were involved in the patients care, present each case and are followed by a discussion of relevant radiographic images and pathological specimens. A thorough review of the diagnosis or management approach is then given by one or more expert discussants. Throughout the year, joint conferences focus on cases that illustrate the overlap between medicine, emergency medicine, pediatrics, neurology and surgery. In addition, New England Journal of Medicine Clinicopathological (CPC) cases are presented periodically at this conference.
Morbidity and Mortality Conference (M & M)
M & M conferences have a long tradition in the practice of medicine, but especially at MGH. Almost a century ago, Dr. Ernest Codman, an MGH physician, was one of the first physicians to call for the standardization of hospital practices, case reporting, and assignment of responsibility to adverse outcomes.
Today, to recognize that MGH housestaff and faculty uniformly work to provide the highest quality clinical care, M & M is held on the last Friday of each month from 12:30-1:30 pm. At M & M, cases with adverse outcomes are presented and discussed. M & M provides a forum to learn from errors in diagnosis and management in a constructive and safe environment. The Director of Quality Assurance at MGH frequently attends these conferences to offer expertise from a medico-legal perspective.
All junior residents prepare and present an analysis on a current article from the medical literature during noon conference or journal club. Junior residents work with a faculty advisor in the critical appraisal of the chosen paper. The core faculty members who serve in this role are experienced in clinical investigation and medical writing are are available on the day of the presentation to facilitate the discussion and provide feedback at the end of the presentation.
All senior residents research and present a Senior Talk, which is a broad overview of a topic of their choice. Recent examples have included tuberculosis in Haiti, Beta-blockers in heart failure and mask ventilation in respiratory failure. Each resident works with a faculty preceptor to guide his or her research and investigation. Faculty also provide residents with constructive feedback following the presentation.
Resident Report is held daily from 4:30 to 5:30 pm. Residents present cases to the chief residents and a chosen discussant with the goal of fostering an interactive discussion of diagnostic approach and management. This is a more advanced case-based conference and is geared towards the learning needs of the junior and senior residents. Occasionally, didactic workshops on select topics (i.e. ECG interpretation, the use of non-invasive positive pressure ventilation, acid-base interpretation, etc.) will be held at this time throughout the year. Friday resident report is held from 4-5 pm and is welcome to all classes with ice cream served afterwards.
Clinical Research and Career Pathway Sessions
Clinical Research Discussions and Career Pathway sessions are interspersed in the resident report schedule, with the goal of exposing residents to several clinical investigators who have taken different paths to academic success. Investigators discuss their research, but more importantly, focus on the process which launched their investigative career
Journal Club is held once a month during Resident Report and is led by the senior residents. It provides an opportunity to critically review the medical literature in an informal setting designed to encourage discussion. Residents present a brief background followed by a discussion of a chosen article from the recent basic science or clinical literature. Discussion focuses on the methodology and significance of the article and how it impacts current thinking and practice. The review and analysis is mentored by a distinguished faculty member chosen by the presenting resident.
Curriculum Committee is held once a month in place of Resident Report. This session, attended by residents, the chief residents, and the program director, is devoted to the discussion of the current curriculum of the residency program. Topics often include the content or timing of conferences, changes in the structure of inpatient teams, and ideas on how to best accomplish the goals of patient care and medical education.
Intern Report is a teaching conference held three times a week for interns on the Bigelow and Ellison Services as well as ACR. Bigelow Intern Report is held from 7-8 am on Tuesdays and is led by one of the teaching senior residents. Usually, recent patients admitted to MGH are presented, with discussion focusing on shaping a differential diagnosis from the history, physical exam, and basic laboratories. Subsequent diagnostic tests are discussed and the teaching senior then presents his or her general approach to the presenting complaint. ACR Intern Report is held on Wednesday mornings from 7-8am and focuses on the approach to common outpatient complaints. On the Ellison service, there is daily teaching from attendings covering the service including a dedicated oncology lecture series.
Medical Grand Rounds
Medical Grand Rounds are held every Thursday morning from 8-9 am. Medical Grand Rounds emphasizes clinical medicine and presents important new developments in biomedical research. National leaders in academic medicine frequently give Medical Grand Rounds. Many of these leaders are superb clinical teachers from the Harvard University system. The topics for Grand Rounds are distributed to various divisions within the Department of Medicine to enrich the diversity of the presentations. Each of the chief residents presents at Medical Grand Rounds each year, discussing case presentations, topic overviews, or independent research. The Firm Chiefs also organize a select number of Grand Rounds each year. These rounds are usually case based and often involve two cases admitted to the Firm with case presentations by the residents and students.
Physical Finding Rounds
These rounds were started several years ago in an attempt to emphasize physical diagnosis skills in the residency program. Each week a senior resident solicits his or her colleagues for any patients who possess interesting physical findings and be amenable to involvement in a teaching session. Every Friday, after Noon Conference, the senior resident leads a group of residents, interns and students to see these patients and participate in a discussion about the relevant physical exam finding, its historical origins, and modern significance.
Baker Report is held once a week from 11:00am to 12:00pm on Thursdays for the senior residents supervising the Ellison Service teams. One of the Firm Chiefs leads these sessions which focus on broader issues in medicine such as ethics, philosophy, politics, industry relationships, health systems issues, medical quality and others.
Pathology rounds are held once a week for each of the Bigelow teams from 11:45am-12:15pm. Cases are selected by the junior resident in discussion with the pathology department. This conference is not restricted to histology but also oftentimes includes discussion on the appropriate use of diagnostic tests in the fields of microbiology, clinical immunology, and hematology. This helps residents review the primary data and interpret the results of diagnostic tests. .