Back to the Bedside initiative 

Over the past several decades bedside teaching and learning have declined. Core bedside skills of history taking, and physical examination are taught and assessed in the first two years of medical school. These skills should be further cultivated during the clinical years of medical school and residency. The American Board of Internal Medicine removed the clinical examination requirement in 1972. Since then, several generations of internists have been trained without formal assessment of their clinical skills. Additionally, escalating constraints of time, rapid turnover of patients, and the need for documentation compete with time spent on bedside teaching. Direct observation is the key to the development of competence. As matters stand, assessment of residents’ clinical skills often appears to be based on little more than the general impression of attending physicians, whose own clinical skills were never directly observed.  

To improve the bedside skills of our residents and faculty, we have conducted faculty development programs, Objective Structured Clinical Examinations (OSCEs), and mini-CEXs over the past 25 years. More recently, we have introduced a robust longitudinal clinical skills curriculum which runs weekly for the first-year class. In 2015 we took a delegation to the Royal College of Physicians Edinburgh (RCPE) to witness and study the PACES (Practical Assessment of Clinical Examination Skills) examination. In 2016 we signed a memorandum of understanding with the RCPE to conduct a PACES type examination for our residents. Since then senior faculty from the RCPE visit Saint Peter’s University Hospital every six months and conduct the clinical examination for our residents. Our faculty partner with the RCPE faculty and learn the finer points of clinical examination and assessment. 

To prepare the residents to navigate through this examination, Saint Peter’s University Hospital has built an Institute for Bedside Medicine (IBM). The IBM has 10 fully furnished examination rooms and has recruited a capable staff of nurses and advance practice nurses with core faculty from the department of medicine. Approximately 100 real patients with real physical findings have been recruited to teach physical examination skills. In addition, we have recruited 100 standardized patients to act out clinical scenarios in history taking and communication skills. 

As part of our commitment to clinical skills, our residency has added the requirement that the class of 2022 will pass the clinical examination under the RCPE-run examination for graduation. Such an examination will be offered during the 30^th month of their training. It is expected that this self-imposed standard will accelerate the learning and teaching of the most fundamental skills for internists. 
 

Research 

Research is the life blood of any scientific organization. All residents are expected to perform meaningful research during the residency. Basic lectures on research methodology are given.  The research project begins when the resident joins the program. All residents are assigned a research mentor and protected time is given to conduct the research.  
Since the inception of the program in 2005, more than 700 abstracts have been submitted to the American college of Physicians (ACP) New Jersey chapter annual scientific meetings. In addition, the program conducts an annual Research Day when all residents present their work. 

Personal Professional Portfolio 

All residents are required to create and maintain a portfolio of their work. Residents log all patients they encounter during electives and provide learning points with references on every fourth patient they see. They also log all procedures, any PowerPoint presentations, abstracts, papers, book chapters in their portfolios. Other entries may include letters of praise from patients, special recognition by faculty or peers, and awards. Over time the portfolio represents resident’s effort, imagination, learning, and actual work.  
We have found that a well-maintained portfolio is the single most important tool in obtaining a fellowship or job placement. 

Residents as Teachers 

The word doctor means a teacher. Teaching is an integral part of being a doctor. All residents are expected to teach fellow residents, medical students, and other healthcare professionals. The department of medicine offers a faculty development program throughout the year. Well known educators visit Saint Peter’s University Hospital and conduct lectures and workshops for our faculty to enhance their teaching skills. For this purpose, residents are considered faculty and are expected to participate in these programs. 

Career Development 

The program measures its success by its ability to produce leaders in medicine. To this end residents regularly receive advice and encouragement to set high goals for their professional development. Our residents obtain excellent fellowships in prestigious institutions. We have our own two fellowships (GI and Pulmonary medicine). 50 percent of our fellows did residency in our program. 

We encourage our residents to settle in this area. 70 of our residents are practicing within 15 miles of Saint Peter’s University Hospital. Almost every year one or two residents join our full-time faculty. 

Alumni Fellowship Placement 2010 to present 

Cardiology	Icahn School of Medicine  SUNY Downstate  University of Chicago  University of Arkansas  Newark Beth Israel Medical Center  University of Kansas  St. Luke’s University Hospital  Montefiore Medical Center  Hofstra North Shore – LIH  Creighton University  Rush University	2020, 2017  2019, 2010  2019  2017  2017  2017  2016, 2014  2016  2015  2015  2012
Critical Care	Cooper University Hospital  University of Pittsburgh Medical Center	2012  2010
Endocrinology	University of Miami  Henry Ford Hospital  Allegheny General Hospital  University of Texas  National Institute of Health  University of Cincinnati Medical Center  Case Western Reserve University  Emory School of Medicine  University of Michigan  Dartmouth Hitchcock Medical Center	2020  2020  2020  2019  2018  2018   2015  2015  2011  2010
Gastroenterology	Saint Peter’s University Hospital (2)	2018
Geriatrics	UCLA Medical Center  Beaumont Hospital, Royal Oak  Hackensack University Medical Center  Icahn School of Medicine – Mt. Sinai  University of Hawaii  Mayo Clinic  Rush University  Indiana University SOM  Massachusetts General Hospital  Johns Hopkins Hospital  New York Hospital Queens  New York Presbyterian Hospital	2020  2019  2019   2018   2017, 2016  2017  2017  2016  2013  2012  2011  2010
Hematology/Oncology	Cook County Health  University of Kentucky  Jackson Memorial Hospital  Hofstra Northwell School of Medicine  Texas A&M	2020  2020  2016  2014  2014
Hospice and Palliative Care	Cleveland Clinic	2011
Infectious Diseases	University of Cincinnati Medical Center  University of South Florida  UT Southwestern Medical Center  Memorial Sloan Kettering  Cooper University Hospital  Washington Hospital Center, DC	2018   2018  2017, 2015  2016  2016  2014
Infectious Diseases/Critical Care	Allegheny General Hospital	2019
Nephrology	Stanford University  Temple University  University of Pittsburgh Medical Center  Indiana University  University of South Florida  University of Iowa	2020, 2018  2019  2018   2017  2017, 2013  2011
Neurology	University of Maryland	2013
Pulmonary	Eisenhower Medical Center  Saint Peter’s University Hospital	2020  2018
Pulmonary/Critical Care	SUNY HSC Brooklyn  Cooper University Hospital  St. Louis University	2020  2014  2010
Rheumatology	University of Connecticut  UT Southwestern Medical Center  University of Michigan  Montefiore Medical Center  Temple University  University of Tennessee	2017  2016  2014  2014  2013  2010
Sleep Medicine	Cleveland Clinic	2019