At the heart of the residency program at Harlem Hospital are the 13 months spent on the general medicine ward service. The three 30-bed wards are staffed by 5 teams. Each team composing of 2 interns, 1 junior resident and 1 attending physician. Interns and junior resident are on call every fourth day and are responsible for the initial management of all admissions with supervision of faculty. A night float relieves residents on call of added responsibility after 9:00 PM. All new admissions are presented to the ward attending, who interviews and examines each patient the following day.
In this setting, key elements of the history, pertinent physical findings and laboratory data are incorporated into the development of a complete differential diagnosis. Basic pathophysiology is reviewed and a rational and cost-effective treatment plan is devised. Work rounds are held six days a week. Each patient is briefly presented by the intern in charge. The patient's problems are discussed and a management plan is determined by the team.
Residency training in Internal Medicine at Harlem Hospital Center is based on practical experience. The Primary Care rotations add to the training experience and provide a way for residents to prepare in a very practical way for the practice of Primary Care Internal Medicine. The patient population includes people of all ages with a wide variety of acute and chronic illness. This offers a tremendous opportunity to learn about the evaluation and treatment of complex problems and to apply the principles of preventive medicine and health promotion in a community that stands to benefit from this more than many others. The resident who trains at Harlem Hospital is making a significant contribution to this effort.
The Primary Care rotation offers a concentrated experience in ambulatory care in a continuity setting, as well as special emphasis on physician-patient communications, psychosocial problems, epidemiology and community health. During this rotation residents also receive special instruction in the evaluation and treatment of common problems in ophthalmology, otolaryngology, dermatology, gynecology and orthopedics.
The ICU rotation is designed to give house staff experience in the management of patients with a constellation of acute problems. Residents learn to handle "multi-system" disease through a systematic approach, using the latest available technology under the guidance of the appropriate specialists.
Critically ill patients are cared for in the 12-bed Intensive Care Unit (ICU). Every bed is equipped with facilities for invasive monitoring and mechanical ventilation. Comprehensive nursing care is provided around the clock. A 32-bed ICU is planned as part of the ongoing hospital renovation project.
First year residents gain hands-on experience in all of the procedures of critical care medicine, while learning the day-to-day management of cardiovascular and respiratory parameters, fluids and electrolyte balance, and metabolic support of critically ill patients. Junior residents function as teachers and co-leaders of the ICU team. Senior residents are responsible for evaluating patients for admission to the ICU and, in conjunction with the attending staff, for all major patient management decisions. A Pulmonary Medicine Fellow supervises work-rounds. Rounds with the Medical Director of the Intensive Care Unit or an attending physician for the pulmonary/critical care division are made every day.
The Coronary Care Unit provides interns and residents intensive experience in managing patients with a variety of critical cardiac disorders. Each of the 6 CCU beds is equipped with facilities for Swan-Ganz and intra-arterial pressure monitoring. The cardiac catheterization suite, the echocardiography, exercise testing laboratories, and the cardiology conference rooms are adjacent to the CCU.
Attending rounds are held six mornings a week. Housestaff members are given ample opportunity to master the technique of Swan-Ganz catheter and intra-arterial line placement and interpretation. They may also participate in other procedures, such as pericardiocentesis and pacemaker placement.
On the neurology services, interns and residents work with Board Certified Neurologists caring for patients with a wide spectrum of acute and chronic neurologic problems. Weekly conferences include neuroradiology, neurosurgery, EEG, EMG review, and neuropathology.
Harlem Hospital Center is a designated New York City Cardiac Care, Trauma and Burn Center, with over 100,000 patient visits per year, the recently renovated Emergency Room of Harlem Hospital Center is one of the busiest in the country. Attending physicians certified in medicine, surgery or emergency medicine, provide 24-hour on-site teaching and supervision, and subspecialty consultations are readily available for unusually complex medical problems.
When assigned to the Emergency Room, medical residents work one shift a day with two days off per week. Residents are encouraged to see a variety of patients, including surgical and OB/GYN cases, with appropriately qualified attending support. Physician's Assistants, registered nurses and paramedics work closely with medical and surgical residents in a team approach to patient care. Decisions regarding the admission or referral of patients are made by residents in the Emergency Room with the agreement of the attending physicians.