Unparalleled Clinical Training
Across the board, Columbia residents are smart, dedicated, and most of all, not afraid to get their hands dirty. Learning here is dynamic, hands-on, and you'll be surprised at how fast you and your co-residents feel comfortable joining the fray and taking care of some of the most complex patients in the country.
Daniel Burack, PGY3
Columbia residents have long prided themselves on clinical autonomy, and we believe that by challenging our residents to think and act independently, we give them the greatest opportunities for growth. Adequate clinical supervision is provided in a graded manner, with trainees being given more autonomy as their skills and experience progress.
Adding to the opportunity for growth is the high acuity of our hospital. Patients admitted to our General Medicine and Cardiology services are extraordinarily sick, with complex pathology and high potential for clinical decompensation. In our ICUs and stepdown units, the level of illness is even greater. Managing these patients is extremely challenging, and also rewarding. After three years of training, Columbia graduates are comfortable and proficient in any clinical situation.
The Gen Med rotations comprise the core of our inpatient wards experience. Each of our three Gen Med services is composed of four resident teams, pairing either a junior or senior resident with an intern in a one-to-one resident-to-intern ratio. Gen Med has long operated on the two-attending system, whereby sister teams round together, allowing both attendings to provide feedback and guidance on case presentations. Generally, one of the two attendings is a hospitalist, and the other is a specialist drawn from a wide variety of disciplines (pulmonology, rheumatology, nephrology, gastroenterology, infectious disease, and endocrinology).
Interns spend an average of 12 weeks on Gen Med, with junior and senior residents doing an additional 12-18 weeks over the final two years of residency.
A critical part of residency training is the outpatient experience, which allows residents to care for a panel of continuity patients over the three years of residency. Residents learn to manage acute and chronic illnesses, take care of high-risk patients followed after discharge from the hospital and ED, and become skilled in preoperative evaluations, diabetes management, urgent care, and transitions of care from the hospital.
Over the course of a three-year residency, residents form close bonds with their patients and learn about the continuum of disease processes over time, as well as experiencing first-hand the impacts of the social determinants of health on our local community. Residents often comment that one of the hardest parts of finishing residency is saying goodbye to their panel of clinic patients.
On the cardiology ward service, residents care for patients with a wide range of diseases including heart failure, valvular disorders, acute myocardial infarction, and dysrhythmias. Resident teams round in the two-attending system, with attendings drawn from many areas within the field—general cardiologists, interventional cardiologists, electrophysiologists, heart failure specialists, and cardiac imaging specialists.
Columbia residents rotate through three intensive care units, the Milstein Medical ICU (MICU) and Cardiac Care Unit (CCU), and the Allen ICU (AICU).
The MICU is a twelve-bed unit that cares for the most critically ill and complex patients in the entire hospital system. Four junior residents and four interns work together under the supervision of a critical care attending and fellow. Rounds include nurses, pharmacists, respiratory therapists, and other key members of the care team. Interns perform invasive procedures, such as insertion of central venous catheters and arterial lines, under the supervision of the junior residents. House staff become proficient with the management of shock and respiratory failure, managing pressor-dependent and mechanically ventilated patients with acute respiratory distress syndrome (ARDS), septic shock, massive gastrointestinal bleeding, fulminant hepatic failure, and a host of other challenging conditions.
The CCU is a fourteen-bed unit, where four junior residents and four interns work together under the supervision of two attending physicians and a cardiology fellow. Residents and interns learn how to manage patients requiring intra-aortic balloon pumps (IABP), pulmonary artery catheters, extracorporeal membrane oxygenation (ECMO), ventricular assist devices (VADs), and other advanced mechanical and medical life-support measures. The on-call CCU resident is also the “code resident,” and is responsible for directing the management of all cardiac arrests that occur on the hospital campus.
The Allen ICU is a twelve-bed unit, where four interns are supervised by three senior residents and a critical care attending. Each day, one of the interns is the “board resident,” admitting new patients and directing rounds on those patients already in the ICU. The AICU offers interns an unprecedented level of responsibility and autonomy caring for critically ill patients. The senior residents on service operate in a fellow-like role, moderating discussions on rounds and advising the interns on management decisions. As a whole, we believe the Allen ICU experience is one of the most unique educational opportunities in our program.
On the solid oncology service, junior residents care for patients with solid-organ tumors and manage medical manifestations of either the tumor or its treatment and related complications, including neutropenic fever, spinal cord compression, malignant effusions, and more.
Elective and Selective
Elective blocks provide residents at all levels with several weeks (spread out over the course of the year) to pursue a clinical or research opportunity. Residents frequently use this time to write research articles, rotate through subspecialty or non-medicine services, pursue education projects, and much more.
The selective rotation in intern year allows interns to spend one week on a rheumatology rotation—working with the consult service and spending time in clinic—and a second week working in another subspecialty clinic of their choice.
Junior residents spend a total of four weeks working shifts in the Emergency Department, caring for patients with a full range of medical and surgical conditions. The rotation offers an opportunity to participate in the management of surgical, orthopedic, and gynecologic emergencies as well as medical conditions.
The Allen Hospital is a 196-bed community hospital located at the northern tip of Manhattan. Rotating on the Allen wards gives residents an opportunity to experience more “bread and butter” inpatient medicine. One senior resident oversees two interns, which gives the interns more autonomy and residents practice in a more attending-like role.
The inpatient night float team is responsible for new admissions and cross-coverage of patients under the care of the day teams. Interns and residents are responsible for addressing all acute issues overnight, and therefore gain experience with the workup and management of common clinical scenarios, such as shortness of breath, hypotension, delirium, and more. Residents generally find that the autonomy afforded during this rotation helps them rapidly mature into more sophisticated and confident clinicians. Admissions are presented by night interns and residents on attending rounds so that residents receive feedback on overnight management.
The four-week Geriatrics rotation at the Allen Pavilion provides interns with a comprehensive review of geriatric medicine, as well as the opportunity to see patients at home, in nursing homes, and in the inpatient and home hospice setting.
Teach is a PGY3 rotation designed to improve teaching skills in various settings and across various platforms, with the objective of preparing senior residents to be outstanding educators, regardless of subspecialty interest. The Teach Resident has the opportunity to lead Medicine Report, medical student teaching sessions, and interdisciplinary teaching sessions with neurology residents. In addition, Teach residents also participate in developing Learning Lab curricular activities and do hands-on simulation and line training with interns.
Medicine Consult/Preoperative Evaluation
Senior residents spend two weeks on the medicine consult service, performing inpatient consultations and pre-operative evaluations for the hospital’s many non-medicine services. Residents become the hospital’s medicine experts, guiding other physicians through the management of some of their most complicated patients.
Senior residents spend two weeks as the ICU triage resident, responsible for evaluating all patients potentially requiring admission to the medical ICU or stepdown unit. In this capacity, residents see the hospital’s sickest patients, perform rapid evaluations, provide initial recommendations, and determine whether transfer to one of the hospital’s MICU beds is warranted.