Frequently Asked Questions for the Internal Medicine Residency Program–Everett

Residents and faculty are educated on the theory of competency based medical education and how it has formed the assessment and evaluation system used at our program. On the day to day level, residents are observed and direct, timely feedback is given by clinical preceptors, regardless of rotation. Daily evaluation tools such as the Mini-CEX are utilized to provide direct observation feedback and in-the-moment coaching. Teaching faculty help evaluate and coach residents through all of their patient interactions and management decisions.

Residents are also evaluated via a number of more official tools across their rotations: clinical preceptors complete rotation evaluations at the end of each month, clinical staff and peers contribute to feedback via multi source feedback evaluations, self-assessment is completed at least twice a year. Additionally residents receive evaluation and feedback on their morning report presentations and go over outpatient performance on their clinic panel with their continuity clinic preceptors. They are given their ITE scores as well as evaluation and feedback on patient simulation experiences. Residents have access to all evaluations completed on them through the MedHub learning management system, and also receive aggregated summative feedback at minimum twice a year via the Clinical Competency Committee and review of that feedback with the Program Director. This aggregated data from all evaluations breaks down strengths and areas of development according to the competencies and that information as well as plans for improvement are then discussed with each resident.

Residency is a period of intense learning and growth. This can also be a very stressful time and the risk for burnout is high. With that in mind, we have created a robust wellness curriculum to promote mental health, overall wellbeing and stress reduction. Some of the highlights of this program include wellness half days during all outpatient months, a resident retreat in the fall, and an hour dedicated to wellbeing during the start of every other academic half day. Residents will also not experience any 24-hour call shifts during training, as we believe maintaining work life balance is an important part of wellbeing.

During inpatient months residents admit patients via a “drip model” with each team admitting 1-2 patients per day. This model allows the resident and attending to maximizing learning and take a deeper diving into each case. Residents also rotate on night medicine; this rotation is divided into afternoon admitting and overnight cross cover shifts. We believe this system enhances learning and promotes work life balance.

Working with, supervising and teaching learners is an important part of physician training. Our residents are fortunate to have the opportunity to work with 3rd and 4th year medical students from Washington State University and the University of Washington. WSU Internal Medicine residents work with and supervise these students on many rotations including inpatient medicine, ICU, ER and select subspecialty service lines. The program also has dedicated didactics and training to help residents become more effective teachers.

The goal of the preliminary year is to provide a strong foundation in general medicine.  We believe this training is critical for success in the residents intended area of specialty. With that goal in mind, our preliminary year residents have the same number of inpatient, outpatient and ICU rotations as our categorical year residents. However, the program allows preliminary year residents to have greater flexibility in selecting electives as we recognize each trainee may have different needs during their first year of training.

Prelim residents have the same continuity clinic schedule as their categorical colleagues. They will spend 1 full day a week in continuity clinic during the majority of their rotations. It is essential they have the opportunity to develop relationships with their primary care panel across a year’s time and learn the communication and medical management skills that come from this experience. They can translate those skills to their future specialties.

Unlike traditional programs, our curriculum builds the major internal medicine sub-specialty rotations (hematology-oncology, rheumatology, endocrinology, geriatrics, cardiology, gastroenterology, infectious disease, pulmonology) into resident three year schedules as “selectives”. Residents will experience almost all of these selectives as part of their pre-determined block schedule. Therefore, residents can use their elective months for second looks at favorite selectives, clinical rotations outside of the major sub-specialties (anesthesia, radiology, dermatology, psychiatry, etc.), additional primary care setting electives (private practice primary care) or inpatient electives (private hospitalist), or for non-clinical rotations such as research or QI months. We are also developing opportunities for shorter electives in niches of medicine such as addiction medicine, sports medicine, procedure rotations, OBGYN/women’s medicine, and transgender medicine.

The Structured Learning Curriculum is made up of three components, morning report, weekly academic half-day and noon-conferences. Morning report case conferences are run by wards team residents and facilitated by faculty. The audience gets to discuss and brainstorm through an active case on one of the inpatient services. Academic half-days happen every Wednesday from 1pm-5pm. This is protected time for all residents to gather in the classroom setting and work on core internal medicine content-knowledge that is built on the ABIM blue-print. Content experts (typically sub-specialists) deliver and facilitate high-yield topics with an emphasis on a flipped-classroom model. Academic half-days also house essential content such as our POCUS, DEI, wellness, and QI curriculums (among other curricula). Finally, we hold a number noon conferences throughout the year, including M&M, Grand Rounds, MQRC among others.

Strong mentorship is an important component of a successful training program. WSU IM residency has a structured mentorship program that helps residents develop and succeed in achieving their career goals. Prior to the start of the academic year, residents are paired with a mentor based on their personal and professional interests. Mentors meet regularly with their mentee throughout the year and advocate for the residents success during training.

The Pacific Northwest offers a wide range of rural and urban, indoor and outdoor experiences for all types of interests. The beauty of the water and mountains surrounding the Everett and Seattle areas cannot be overstated. Folks love getting out and hiking, biking, skiing and boating throughout the different seasons. The area may be known for drizzle, but with a bit of rain gear in hand, most outdoor activities remain accessible year round, and the summers are gorgeous, dry and comfortable. Seattle and Everett both have a variety of great food, theatre, music, and museum options. Everett has a lower cost of living than many large cities, is accessible and easy to navigate on a busy schedule, and offers many family friendly activities for residents moving with families. The people out west are friendly, and the medical community here in Everett is incredibly supportive and invested in the development of our trainees.

Each of our residents has continuity clinic approximately 1 full day a week throughout their one/three years with us. The specific day of the week they have clinic remains static throughout the majority of their rotations. Allocating residents one full day of clinic a week lets them come to clinic poised to take care of their outpatient panel, as opposed to running from a full day of inpatient work squished into a half day, as occurs in many traditional programs. Maintaining clinic openings weekly throughout most months of the year also enables continuity of patient care and patient-provider relationships, as opposed to less frequent clinic in say an X+Y model.

Residents also spend 5-7 half days a week in continuity clinic during their dedicated ambulatory months each year (PGY1 2-3 ambulatory months, PGY2 and PGY3 1 ambulatory month.