Department of Medicine

University of Pittsburgh

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General Internal Medicine Fellowship Program

The University of Pittsburgh General Internal Medicine Fellowship Program is a 2-year program designed to prepare future leaders in academic general internal medicine. The program is broadly divided into two tracks, Clinician-Researcher and Clinician-Educator, which represent the major career paths of academic generalists. The Program has an outstanding record of training leaders in research and education: 76% of the Program’s 71 graduates from 1983 through June 2013 remain in academic medicine.

Program Calendar

March 1, 2015 Application deadline for July, 2016
April/June 2015 Candidate interviews for July 2016
July 1, 2015 Offer letters prepared for 2015
April 15, 2016 Application deadline for 2016 Institute for Clinical Research Education, Master's program in Clinical Research or Medical Education
July 1, 2016 Fellowship begins

Major Fellowship Tracks

The Clinician-Researcher Track is for individuals who wish to pursue a career in clinical research. This track provides the skills and experiences necessary to develop, execute, interpret, and secure funding for clinical and health services research studies. The foundation of this track is the Master of Science in Clinical Research Program, sponsored by the Institute for Clinical Research Education (ICRE). Fellows in the track complete a mentored research project, develop a full-length grant proposal ready for submission, and participate in the clinical and teaching activities of the Division of General Internal Medicine.

The Clinician-Educator Track is designed to train future leaders in medical education. The foundation of this track is the Master of Science in Medical Education Program, which is also sponsored by the Institute for Clinical Research Education (ICRE). Fellows in this track follow an integrated program of didactic material and precepted teaching experiences to enhance their skills in classroom and clinical instruction, curriculum development, professional leadership, medical education, and medical administration. In addition, they take core research curriculum courses offered through the ICRE, complete a mentored research or curriculum development project, and participate in the clinical and teaching activities of the Division of General Internal Medicine.

Fellowship Areas of Interest/Concentration

In addition to the “career-defining” Clinician-Researcher and Clinician-Educator tracks listed above, the fellowship program is composed of several areas of specific content interest, which allow a trainee to concentrate in a particular area of interest. These specialty areas include, but are not necessarily limited to:

Women’s Health

The Women’s Health Fellowship is based within the Section of Women’s Health, a vibrant and growing part of the Division of General Internal Medicine under the direction of Dr. Melissa McNeil. The Women’s Health Fellowship was one of the original funded Women's Health Fellowships initially offered through the VA Healthcare System in 1994. The purpose of the fellowship is to develop academic physicians with an interest in women's health research and education. Women’s Health fellows may participate in either the Clinician-Investigator track or the Clinician-Educator track. Clinical duties are primarily through the Pittsburgh VA Comprehensive Women’s Center, a twice-designated VA National Clinical Center of Excellence. An important component of the Women’s Health track is the weekly Women’s Health seminar, held every Monday at noon. Contact Dr. Melissa McNeil at mcneilma@upmc.edu for more information about this area of interest.

Health Services Research/Clinical Epidemiology

The Division of General Internal Medicine has a remarkable breadth and depth of clinician-investigators, most based at the Center for Research on Health Care (CRHC) and the VA Center for Health Equity Research and Promotion (CHERP), involved in all aspects of health services research, including comparative effectiveness research, efficacy trials of care interventions and guidelines, cost-effectiveness and decision analysis, medical informatics, quality of care interventions, and health policy and health care financing. Fellows with interest in these topics will find a wide array of projects and mentors for their fellowship experience. In addition, the Fellowship program has strong ties with the Graduate School of Public Health, other University of Pittsburgh schools and departments, and with RAND Pittsburgh through the RAND-University of Pittsburgh Health Institute.

Medicine-Pediatrics

The University of Pittsburgh offers a combined Medicine-Pediatrics fellowship track, designed specifically for dual-trained individuals who wish further academic training. Medicine-Pediatrics fellows participate in either the Clinician-Investigator track or the Clinician-Educator track. Fellows’ clinical and teaching activities occur in both general medicine and pediatric settings. Contact Dr. Kevin Kraemer at kraemerkl@upmc.edu for more information about this area of interest.

Underserved Care

The Program for Health Care to Underserved Populations (PHCUP) is a national leader in promoting community-academic partnerships and coordinating free health care to the underserved populations of the Pittsburgh area. PHCUP partners innovatively with communities in need, catalyzing a spirit of service and volunteerism within the health profession, and articulating the individual, health system, and societal benefits of the unique models of service and care that result. Fellows interested in exploring research and educational possibilities in underserved care are encouraged to contact Dr. Thuy Bui at buit@upmc.edu.

Health Care Disparities

The University of Pittsburgh has a significant interest in health care disparities. In conjunction with the VA Center for Health Equity Research and Promotion (CHERP) at the VA Pittsburgh Healthcare System, Division members conduct interesting and significant research into the cause, impact, and solutions to health care disparities based on gender, ethnicity, and disease. Fellows interested in exploring research and educational activities in health care disparities are encouraged to contact Dr. Michael Fine via email at finemj@upmc.edu or michael.fine@med.va.gov, or by phone at (412) 688-6000 x4867.

Program Structure

Summer Program - 1st Year

All first-year fellows start fellowship with an intensive set of summertime MS courses to order to bring everyone to the same level methodologically. MS in Clinical Research students take 9 credits over the first summer: Clinical Research Methods (3 credits), Biostatistics (4 credits), Computer Methods (1 credit, 1 week only), and Measurement in Clinical Research (1 credit). MS in Medical Education students take 5 credits over the first summer: Clinical Research Methods (3 credits), Measurement in Clinical Research (1 credit), and Curriculum Development (1 credit).

MS in Medical Education students make up the first summer’s excess time with 1-2 half days of outpatient precepting and seven Tuesday morning Integrated Summer Series Sessions (Tuesdays 8am to 11:30am during July and August; UPMC Lawrenceville Family Medicine Clinic conference room). This series is conducted in concert with Pediatrics, Adolescent Medicine, and Family Medicine fellows, PharmD residents, and some chief medical and pediatric residents. The series covers a number of education and professionalism topics including presentation skills, one-on-one clinical teaching, giving feedback, teaching physical exam skills, mentoring, medical decision making, teaching the basics of H&P, teaching clinical presentations, and small group facilitation.

Research Projects

All fellows complete at least one research project and are expected to present results at the Society of General Internal Medicine Annual Meeting (or similar meeting) and to submit the findings for publication in peer-reviewed journals. For Clinician-Researchers, the project will typically involve a clinical or health services research project of their own design, usually attached or complementary to an ongoing, existing research project in the Division. For Clinician-Educators, the project will typically involve the design, implementation, and evaluation of an educational intervention, such as a new curriculum, course, or educational program directed at medical students, residents, or post-graduates or other education-focused topic. Although we encourage independent, primary research, fellows are encouraged to balance pragmatism with idealism and to choose projects that are feasible in a two-year period of time. Final ideas and proposals are generally finalized during the fall of the first year.

Clinical Program

Clinical care is an integral part of our fellowship training program. All fellows will have some clinical responsibilities, although the mix of inpatient and outpatient care varies with the particular area of interest. In general, Clinician-Educators will spend 1 half-day per week of continuity outpatient clinic and 2 half-days per week precepting intern and resident outpatient clinic. Clinician-Researchers will spend 1 half-day per week in continuity outpatient clinic and 1 half-day per week precepting. Fellows also serve as the Attending of record for an inpatient team residents, interns, and medical students. Inpatient attending is generally 2 months per year for Clinician-Educators and 1 month per year for Clinician-Researchers, at either the VA Medical Center, UPMC Presbyterian/Montefiore, or UPMC Shadyside, depending upon the fellow’s primary clinical assignment.

Teaching Opportunities

Learning to teach effectively in clinical and classroom situations is a critical and necessary skill for academic general internists. This is true for both Clinician-Educators and Clinician-Researchers. Opportunities to practice and hone teaching skills are available in a number of venues during the Fellowship:

  • Outpatient Precepting: As described above, all fellows will precept the residents’ outpatient continuity clinic. A faculty member (clinical mentor) will always be present during precepting sessions. The faculty member is expected to observe teaching and to give periodic feedback.
  • Inpatient Attending: A faculty member is expected to be present for 2-3 hours each week to observe fellows’ inpatient teaching and to give feedback.
  • Medical Student Attending: Clinician-Educator fellows spend one month each year meeting for one hour per day with 3rd year medical students during their internal medicine clerkship. Fellows give feedback on oral presentations and H&P write-ups.
  • DGIM Journal Club: The Division holds a weekly Journal Club on Fridays from 10am to 11am. Fellows are expected to present a critical review of a paper at this forum once during each year of fellowship. Fellows meet with a fellowship faculty member after the presentation to receive written and verbal constructive feedback.
  • Medical Education Journal Club and Research Seminar: Clinician-Educator fellows have the opportunity to present new findings from the literature on medical education and research-in-progress at these conferences.
  • Combined Fellows Seminar: September through June, the General Medicine, Medicine-Pediatric, General Pediatric, Adolescent Medicine, and Family Medicine fellows meet 2 Tuesday mornings of the month to discuss research project progress and to learn about professional issues, leadership, and cultural competence. Each fellow presents at this seminar twice each year and has the opportunity to discuss and receive feedback on their project(s) during this forum.
  • Women's Health Seminars: Women’s Health fellows have teaching opportunities in this weekly seminar.
  • Other Teaching Opportunities: Many fellows participate in other medical student teaching (e.g. Medical Interviewing, Advanced Physical Diagnosis) and resident teaching (e.g. Pre-Clinic Conference) opportunities.
Mentoring

Establishing successful relationships with mentors is one of the most important predictors of academic success during fellowship and beyond. A mentor may provide career and academic guidance, feedback, support and review of ongoing research, methodological expertise, moral support, introduction to key personal contacts, and serve as a role model for the type of desired academic career. Fellows in the Program typically have 3 types of mentors: 1) a primary career mentor (THE mentor) who will provide primary career guidance and oversee all aspects of the fellowship experience; 2) a research mentor who will provide guidance, expertise, and support for fellowship projects (note: this may be more than one individual, especially if more than one project); and 3) a clinical mentor who will provide guidance and feedback for clinical activities, especially precepting of residents in outpatient clinic. In some cases, a single faculty member may serve all these roles for a fellow. Fellows meet with the Program leadership early in the first year to discuss who the primary mentor will be. Choice of research mentor and clinical mentor will then depend on specific projects and clinical precepting site. Mentors will help the fellow develop a portfolio of research, clinical, teaching, and leadership activities and develop a timeline for completion of tasks. Fellows also participate in the ICRE ˝-day workshop Mentoring Matters during the first summer.

Internal Funding Opportunities for Fellows

GIM Fellows have the opportunity to apply for internal funding support for their projects. The CRHC Data Center Fellow and Faculty Research Awards will provide up to $2,500 per year for statistical and data management support. Details on the application process for this data support grant can be obtained from Dr. Doris Rubio, Director of the CRHC Data Center, at 412-692-4873 or rubiodm@upmc.edu, and from www.crhc.pitt.edu/datacenter.

The Competitive Research Fund of UPMC Shadyside Hospital and Shadyside Hospital Foundation is another potential source of funding for fellows’ medical education and research projects. It provides up to $10,000 of support for single projects. The project must be conducted at least partly at UPMC Shadyside Hospital and be relevant to Shadyside Hospital’s mission. The funds may be used for materials supplies, participant payments, software, statistical support, travel, and other items. The application deadline is generally in late November and funding decisions are made shortly after. Contact Dr. Michael Elnicki at elnickim@upmc.edu for more information.

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