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Small Animal Internal Medicine Residency (CIP)

Program Description Summary for Internal Medicine Residency

The Internal Medicine Residency Program provides advanced clinical training in small animal internal medicine, which meets or exceeds the training requirements outlined by the ACVIM. The primary objectives of the program are to develop clinical proficiency in small animal internal medicine; gain experience in didactic and clinical teaching; and to complete one or more clinical research projects. The duration of the program is three years. Board Certification in the ACVIM is expected by the end of the third year.

The program is highly structured and training is achieved via supervised case responsibility (internal medicine and other specialties) and participation in daily case rounds, intern/resident rounds, and the House Officer Seminar Program. Attendance at other college rounds and seminars is encouraged, time permitting. The internal medicine resident functions as a primary attending clinician for general internal medicine cases, sub-specialty clinics (pulmonary and renal), daytime emergencies, and referrals. Responsibilities include the supervision and education of professional veterinary students, interns and other residents; patient care; progressive diagnostic and therapeutic patient management; consultations and communications with clients and referring veterinarians; and the efficient organization, operation and scheduling of the internal medicine service. Residents are expected to contribute to daily student rounds, clinician case discussion rounds, and provide internal medicine backup for the emergency service and after hours intern. While the residents are given full responsibility for their clinical activities, they are expected to seek the daily guidance and opinions of faculty to ensure a comprehensive educational experience.

During the residency a generous amount of time is allotted to independent research activity. This time should be utilized to research, initiate and complete a clinical project with at least one publication in press by the end of the residency program. Whenever possible, results of the project should be presented in abstract form at the annual Forum of the ACVIM.

Program Description Summary Clinician Investigator (CI) Program

The Internal Medicine Clinician Investigator Program provides clinical training in small animal internal medicine (as described above) and graduate research training toward the PhD degree. The residency portion of the program meets or exceeds the training requirements outlined by the ACVIM for candidates seeking Board Certification in small animal internal medicine. The primary objectives of the program are to develop clinical proficiency in veterinary internal medicine, gain experience in didactic and clinical teaching, and proficiency in basic and applied research. The duration of the program varies according to each student's ability to satisfy program requirements, but will be no less than five years.

The Clinician Investigator Program is highly structured, rigorous, and embodies a spirit of cooperation amongst clinical and basic science faculty. The program was designed to satisfy the needs of those individuals who are seeking a career in academic veterinary medicine, industry, or government, and many past participants of the CI program at NCSU have highly successful academic careers (see below). Successful completion of the program is dependent upon attracting candidates of the highest caliber who are capable of excelling in this demanding program. Because of the breadth and complexity of the program, the clinician investigator will participate in a diverse group of activities with increasing levels of responsibility. Clinical activity is most intensive in the first year of the program and clinical training is as described above for the Internal Medicine Residency Program. During the second and third years, both clinical and research activities are scheduled. The remaining years of the program are devoted primarily to research activities.

To apply to the Clinician Investigator program, click here (position # 101827). Interviews will be held on December 6 and December 13. To apply for an interview for the Internal Medicine or Clinician Investigator program please e-mail a letter of intent and CV to Jill Schmitter (Jill_Schmitter@ncsu.edu).

A Survey of Participants of the CI Program at NCSU

Name	Start	PhD	Boards	Current Position
Russell Greene	1984	Microbiology	Medicine	Reference Lab/Speciality Practice
Syl Price	1985	Pharmtoxicology	Medicine	Industry, Boston Scientific
			Oncology
Shelly Vaden	1986	Pharmtoxicology	Medicine	Professor, NC State University
Leah Cohn	1987	Morphology	Medicine	Associate Professor, University of Missouri
Heather Jans		N/A	Medicine	Specialty Practice
Rance Sellon	1988	Immunology	Medicine	Associate Professor, Washington State University
Cathy Baty	1989	Virology	Medicine	Faculty, University of Pittsburgh
Julie Levy	1990	Immunology	Medicine	Associate Professor, University of Florida
Kevin Monce	1991	N/A	Medicine	Specialty Practice
Karyl Hurley	1992	N/A	Medicine	Faculty, Bristol University (UK)
Karyn Harell	1993	N/A	Medicine	Clinical Assistant Professor, NC State University
*Paul Hess	1994	Immunology	Medicine	Assistant Professor, NC State University
Jody Gookin	1995	Physiology	Medicine	Assistant Professor, NC State University
Adam Birkenheuer	1996	Immunology	Medicine	Associate Professor, NC State University
Karine Savary	1997	N/A	Medicine	Faculty, Ghent University (Belgium)
Robin Hopwood	1998	Immunology	Medicine	Specialty Practice
Amanda Gaskin	1999	N/A	Medicine	Specialty Practice
Barrak Pressler	2000	Immunology	Medicine	Assistant Professor, Purdue University
Angela Mexas	2001	Immunology	Medicine	Research Assistant Professor, University of Pennsylvania
Jonathan Fogle	2002	Immunology	Medicine	Research Assistant Prof, NC State University
Michael Wood	2003	Comparative Biomedical Science	Medicine	Clinical Assistant Professor , NC State University
Dana LeVine	2005	Pending	Medicine	PhD in progress
Tracy Hill	2006	Pending	Medicine	PhD in progress
Katie Tolbert	2007	Pending	Medicine	PhD in progress

* CI Program receives official recognition

Faculty in Support of the Programs

Adam Birkenheuer, DVM, PhD, Associate Professor of Medicine

Edward Breitschwerdt, DVM, Professor of Medicine and Infectious Diseases (Clinician Investigator Program Coordinator)

Richard Ford DVM, Adjunctive Professor of Medicine

Jody Gookin DVM, PhD, Research Assistant Professor

Karyn Harrell DVM, Clinical Assistant Professor of Medicine

Eleanor Hawkins DVM, Professor of Medicine

Steve Marks BVSc, MS, Clinical Associate Professor of Medicine & Critical Care

Shelly Vaden DVM, PhD, Professor of Medicine

*All faculty are board certified by the American College of Veterinary Internal Medicine in the specialty of Small Animal Internal Medicine

Residency Program Goals

• To become board certified by the American College of Veterinary Internal Medicine, Specialty of Small Animal Internal Medicine. The resident will have their credentials accepted and sit for the general exam (Year 2) and certifying examinations (Year 3).

• To develop clinical expertise in client and referring veterinarian interactions, patient care, problem-oriented case management, and advanced diagnostic and therapeutic techniques.

• To develop teaching skills by leadership and participation in student and house-officer rounds, clinical ( on-floor ) training of students and interns, and student laboratories, and presentation of lectures to students, peers, and practicing veterinarians.

• To acquire experience in research and scientific writing through the publication requirement of the ACVIM and presentation of a research abstract at the ACVIM Forum (during Year 2 or 3), or other scientific meeting.

Specific Responsibilities

Requirements to be met during the residency:

1. Register with the ACVIM during the first month of your program. Contact the ACVIM and obtain the registration form and copy of the certification requirements (General Information Guide). The absolute deadline for receipt of the completed application form is October 1 of the first year of the residency program. This can be done by regular mail or via the internet (http://www.acvim.org/wwwfp/Candidate/cand%20regis/CandRegFm.rtf).
2. Write at least one first author publications in conjunction with a medicine faculty member. The publication should be peer-reviewed, and ideally original research (generally a retrospective study, case series, or short-duration prospective study). Plan clinical studies and at least one publication submission early in the program to satisfy the acceptance deadline for ACVIM credentials.
3. Maintain a case log and endoscopy log to allow you and your residency committee to determine if you are seeing an appropriate balance of case material (e.g., no polyarthritis cases, few endocrine cases). The ACVIM requires that records be retrievable.
4. You are assigned a residency advisor, who serves as ACVIM mentor, at the start of your program. In conjunction with your advisor, select the remaining two faculty members for your residency committee by January 1 of your first year.
5. Failure to meet these requirements may lead to the residency certificate being withheld from the resident.

Clinical responsibilities

Responsibilities to the patient and client

1. Admission: after the student has seen the case, discuss the case and plan with student, meet the owners, complete the history and physical examination, and discuss the plan and written cost estimate with the owners.
2. Diagnostic evaluation and therapeutic management: perform all hands on procedures with which you are comfortable, and become comfortable with any procedures that fall under the traditional bailiwick of small animal internal medicine clinicians. Specific training for use of rigid and flexible endoscopic equipment will be provided during the first two months of the residency program.
3. Owner communication: contact owners daily during hospitalization to relay the patient's condition, test results, plan, and current bill/update of estimate. Students perform this duty whenever possible, but you are responsible for the accuracy of the discussions and written records. All client communications MUST be recorded in the medical record.
4. Availability: all clinicians are expected to be available by beeper or phone any time they have a case in the hospital (24 hours/day, 7 days/week). If you must be absent, another resident or an intern must be responsible for your hospitalized cases.
5. Unfinished business: keep an on ongoing record of loose ends, such as pending laboratory tests and necropsy reports. Do not rely on the appearance of lab reports to remind you of these responsibilities.
6. Independent Study Time (IST): a generous amount of time will be scheduled for release from clinical responsibilities (see Approximate Rotation Schedule). We expect you to maintain the continuity of the management of your patients. This includes answering related phone calls and managing brief recheck visits (these can be arranged through our technicians) If follow-up will require overnight hospitalization, transfer the case to another clinician.
7. Medicine back-up: internal medicine residents take turns serving as the designated after-hours resident, available for emergency case management discussion with the emergency service and after hours intern, and emergency endoscopy procedures.

 

Responsibility to the referring veterinarian

1. Call the referring veterinarian and record the content of your conversation in the medical record when:
• The diagnostic evaluation and/or initial treatment plan is completed. Usually this occurs near the time of discharge. For animals hospitalized for more than 3 days, call the rDVM with a progress report.
• The day that the patient is admitted to ICU, dies or is euthanized.
• Results of laboratory tests pending at the time of discharge are available, or if treatment plans are changed.
• DVM calls regarding a previously referred patient.
• Send a printed copy of the discharge or case summary to the DVM when: a hospitalized patient is discharged.
• These must be as complete as possible, including a list of all pending tests, all prescribed drugs and dosages, and short and long-term plans for follow-up
• a patient dies or is euthanized. If possible, a copy of the preliminary necropsy report.
• In general, faculty will be responsible for returning consultation calls. At times, you will also participate in these communications.


Teaching in clinics

 

1. Interns: Be available to the medicine intern(s) to provide consultation, assistance with procedures and advice regarding patient care. The internal medicine "backup" resident must be immediately available to the intern on emergency duty during evenings and weekends.
2. Students: Encourage the students to “take charge” of their cases as much as possible, with you as their guide rather than the student acting as your CT. Every student should present to you their findings, 3 major differential diagnoses, and diagnostic and treatment plans for each case.
3. You are responsible for supervising all procedures and providing suggestions and guidance to students. Encourage students to perform procedures that are consistent with their abilities and that do not compromise the patient.
4. Students do not need to be involved in the management of every case. If the students are overwhelmed with patient responsibilities, clinicians may see cases (especially recheck appointments) without students.
5. We expect interns and residents on clinic duty to attend student rounds (except on Wednesdays and some Thursdays: see General clinic schedule). We also expect the residents to facilitate and lead student rounds on Mondays and Tuesdays; this is a requirement of your program specified by the ACVIM.


• Records
1. Check ICU orders - at least twice daily to assure accuracy and to note new observations or problems. Review ICU orders with the students before 8:00 a.m. rounds begin. SIGN the daily Clinician Order Forms (COF’s) & ICU orders by 8.00 a.m.
2. Review medical records daily. Edit student SOAPs thoughtfully to assist the student in problem-oriented thinking and sign the SOAPs daily
3. Encourage the students to write complete and concise discharges in a language the clients can understand. Refer to the rDVM by name and list all the diagnostic tests performed on this document. The working diagnoses or problems, therapeutic and follow-up plans should ALWAYS be included.
4. Complete medical records as soon as possible after patient discharge. Under no circumstances should records remain incomplete for longer than 30 days. After 60 days your hospital privileges will be suspended.
5. Record all client and rDVM conversations (in person or by phone).


• Case material

We expect you to be a "gunner"; be aggressive about receiving new cases. Publishable case reports, best learning experiences, and stimulus for reading and research all come from your own case material. It is to your advantage to be involved with the management of as many cases as possible.

• General clinic schedule

i. Morning schedule

The medicine service consists of 2 faculty members, 3-5 residents and 1-2 interns. By 7:30 a.m. every weekday morning, the resident and interns pick up cases admitted the previous evening or weekend It is primarily the responsibility of the most senior on-duty resident or the resident on call to assess and delegate who takes these cases. Morning teaching rounds will end at 9:00 am, at which time on-duty faculty, residents, and interns will meet with the CTs for organizational and case discussion rounds.

Referral and recheck appointments are seen predominantly on Mondays until 1.30 p.m. according to a team A/B schedule. Receiving has the highest priority on these days. Only essential procedures required for stabilization of critical patients are scheduled for these days. Other procedures are postponed until the non-receiving days. A limited numbers of procedures are scheduled for Friday in an attempt to try to keep this day free for emergencies and to catch up on the week’s paperwork and phone calls.

Emergency appointments and in-house consultations are handled as needed every day of the week.

• Rounds and seminars

You are required to attend the following rounds and seminars:

Student rounds: Monday, Tuesdays, and Thursdays (unless attending the House Officer Seminar). (8:00 - 9:00)

Internal Medicine House Officer (HO) rounds: Wednesday (8:00 - 9:15)

House Officer Seminar Series: Thursday (8:00 - 9:00)

Cardiology/Critical Care Rounds: Friday (8:00 - 9:00)

Daily Clinician & CT rounds: Monday-Friday (9:05-10:00 or until finished, 9:15 start on Wednesdays).

• Faculty members responsibilities on clinics

Each week, 1 faculty member is assigned to be with the students and 1 is with the HO’s. The clinician with the students oversees student rounds, is available for the students (& HO’s) during the day, and answers phone consultations from veterinarians and clients. The faculty member with the HO’s is responsible for overseeing all the cases on the medicine service that week.

1. Publication(s)

Within the first 6 months of your program, work with your advisor, residency committee members and other medicine faculty to select material and projects for the ACVIM required publication.

2. Seminars, presentations, and didactic teaching

You will present 1 HO seminar on a Thursday morning during the second and third year of your residency with primarily HO’s and faculty as the audience. These seminars are often based upon areas of research or publication interest.

You will present cases for discussion in Medicine HO Rounds on Wednesday mornings according to the schedule prepared by the rising third year resident. You will receive more detailed information about how to prepare for these case discussions after you arrive. In general, select cases that will invoke good discussion. Be familiar with the pathophysiology and current veterinary and human literature relating to your case. HO Rounds should facilitate brief topical reviews that can assist your preparation for board examinations.

Plan to have a research abstract prepared for presentation at the ACVIM meeting during the second or third year of your program.

During the year you will be asked to participate in a limited number of laboratories for veterinary students.

3. Continuing education

Attend the annual ACVIM Forum in May of the second and third years of your program. Funds from your departmental account can be used to help defray your expenses.

4. Resident reviews

Your residency committee will work with you to help you achieve the goals of your program. Meet with your advisor during the first month of your program. Schedule a meeting with your residency committee each December and April during your program.

Clinician Investigators

The Graduate Program

Visit the Student Services Office during your first year to obtain current information regarding requirements for the PhD program. The Director of Post Graduate Programs, would be the best resource for this information. Early in your second year, give considerable thought to what area or discipline you would like to pursue in the PhD segment of the Clinician Investigator Program. It's never too soon to start talking about graduate work with faculty or other graduate students in your interest areas. Application for your graduate stipend as a PhD student is made mid-way through Year 2; a letter from your advisor on your behalf is required in the Student Services Office by December 15 th. It is imperative that your major professor (graduate advisor) be identified by this time.

Five of the 6 months of Independent Study Time is set aside in both Years 2 and 3 for you to spend in your potential major professor's laboratory gaining some experience or otherwise getting a jump start on your PhD work. Additionally, attending seminars in the different interest areas or working in a lab during your second year may aid you in identifying the subject of your PhD thesis. We expect you to use it this way.

Strengths

The Small Animal Internal Medicine Clinician Investigator Program is unique among North American Colleges of Veterinary Medicine. The program has been very successful in identifying well-qualified candidates and supporting these candidates through both the internal medicine residency and the combined Ph.D. program. Seven individuals completing this program now hold faculty positions at other Colleges or Universities. Our goal is to maintain the program with support for three residents each year.

Approximate Rotation Schedule




Traditional	Clinical Investigator Program
Year 1 6 months Internal Medicine 1 month Triage service 2.5-3 months/year sub-specialty rotations among: 1 month Oncology 1 month Medical Intensive Care 1 month Neurology 1 month Cardiology 2 weeks Clinical Pathology 2 weeks Radiology 2 months IST* Register with the ACVIM by October 1	Year 1 8 months Internal Medicine 2 months sub-specialty rotations (Cardiology, Medical Intensive Care, Neurology, Oncology) 2 months IST Register with the ACVIM by October 1
Year 2 7 months Internal Medicine 2.5-3 months/year sub-specialty rotations among: 1 month Oncology 1 month Medical Intensive Care 1 month Neurology 1 month Cardiology 2 weeks Clinical Pathology 2 weeks Radiology 3 months IST General exam credentials due October1 Develop resident clinical & HO Rounds schedules and insure that they meet everyone's approval by June 1; see below	Year 2 4 months Internal Medicine 2 months sub-specialty rotations (Cardiology, Medical Intensive Care, Neurology, Oncology) 6 months IST: 5 months Graduate Program 1 month Board Preparation General exam credentials due October 1 Develop resident clinical & HO Rounds schedules and insure that they meet everyone's approval by June 1; see below
Year 3 6-7 months Internal Medicine 1-2 months IM Chief of Service 1 month External or Optional rotation 3 months IST Certifying exam credentials due October 1, including one publication	Year 3 3-4 months Internal Medicine 1-2 months IM Chief of Service 1 month External or Optional rotation 6 months IST: 5 months Graduate Program 1 month Board Preparation Certifying exam credentials due October 1, including one publication

*IST= Independent Study Time (includes 2 weeks vacation)

NCSU Libraries provides access to ACVIM Examination Reading List materials in addition to many other relevant resources.