A Curriculum-Based Residency

The scope of modern medicine is extraordinarily broad.  The faculty and the residency program in Internal Medicine are dedicated to educating and training physicians who will be superior practitioners in General Internal Medicine and the medical subspecialties, and who will be well prepared for their roles in the rapidly changing environment of clinical practice.  Our philosophy is to provide all residents in the program with a solid foundation in all areas of internal medicine through a core curriculum that spans all three years of training and provides substantial depth and breadth.  In addition, each resident is then equipped with the necessary tools and career counseling to utilize our track structure and elective rotations to allow for a highly personalized and self-directed experience.  All residents develop skill in approaching complex as well as common problems that present to the generalist via clinical experiences and didactic sessions on health maintenance, preventive medicine issues, psychosocial medicine and problems confronting the adolescent or geriatric patient.

• Week
• Conferences
• Electives
• Meetings & Events
• Research

Conferences

Morning Report

Monday through Thursday, 7:45-9:00am.; Friday, 9:00-10:00am. Case-based conference for all residents facilitated by the chief residents and attended by the Program Director, Department Chair, or selected faculty.

Classics In Medicine

Monthly, 7:45-9:00am.  Residents review classic and seminal papers in the medical literature.  Past talks have included the 1918 influenza pandemic, the history of mechanical ventilation, the history of drug regulation, and small pox.  
 

Interns' Report

Friday, 12:00-1:00pm. Case-based conference for interns during which time residents hold intern’s pager; facilitated by the chief residents and attended by the Program Director or Department Chair.
 

Medical Grand Rounds

Friday, 8:00-9:00am. General Medicine or subspecialty-related lecture given by University of Vermont faculty or visiting speakers.

Morbidity and Mortality

Monthly on Fridays, 8:00-9:00am. A case presentation from the Medicine service and discussion with a panel to review teaching points about diagnosis and management.
 

Core Curriculum Didactic Conference

Monday, Wednesday, 2nd Tuesday, 12:30-1:30pm. A three-year rotating curriculum covering topics in general internal medicine and the subspecialties.
 

Journal Club

3rd Thursday each month, 1:00-2:00pm. Resident-led discussion of a timely and clinically-relevant journal article with attention to developing appropriate skills in the use of the medical literature.

Medicine Housestaff Meeting

1st Thursday each month. An opportunity to discuss important program or hospital-related issues with all residents, the chief residents, the Program Director and Program Administrator.
 

Teaching Attending Rounds

Mon and Thurs 11-12:00pm, Tues and Wed 10:30-12:00.  Each Medicine wards team meets with a subspecialty or General Internal Medicine attending. On Wednesdays all four Medicine teams meet to share expertise and participate in innovative educational ventures, including medical ethics discussions, Medical Jeopardy, and intern or resident presentations that answer focused clinical questions pertaining to their patients using an evidence-based approach.

Pre-clinic Conference

On your continuity clinic day, 1:30-2:00pm. Residents receive structured readings, literature weblinks, and case questions in advance. Faculty preceptors lead discussions on these ambulatory general medicine topics and reinforce the salient concepts through case problem solving.  A comprehensive GIM curriculum is delivered over the course of residency. 

Outside Electives

Over the past few years, several residents have chosen to pursue medical electives in other parts of the world.  Some recent resident adventures include:

Swaziland

"In the winter of 2005, I spent five weeks in the Southern African country of Swaziland.  During the first four weeks I saw patients in an outpatient clinic in Siteki, a town near the border with Mozambique.  I spent the fifth week touring Swaziland and South Africa.  In the clinic, I saw 40-50 patients each day, the majority of whom had HIV/AIDS.  Typical problems included tuberculosis, esophageal candidiasis, AIDS wasting syndrome, and pelvic inflammatory disease.  I lived at the hospital with an American medical student.  I enjoyed my rotation and the Swazi hospitality, and since my visit, two University of Vermont medical students have scheduled month-long rotations at the same hospital." 

-Erik Rufa, MD

Columbia

"In December, 2004, I did an elective rotation in Medellin and Leticia, Colombia.  I spent the first two weeks in an Infectious Diseases lab doing basic research on malaria, helminth infections, tuberculosis, and leishmaniasis.  I spent the second two weeks working in a village health post in a small town on the Amazon River, bordering Peru and Brazil.  We treated villagers and people from the surrounding community, up to 100-200 km away by boat.  Most of the patients we saw were indigenous Colombians.  It was a fantastic experience, even though I had to muddle through with my less than passable Spanish."

-Lucas Ryback, MD

Nepal

"I performed research in high altitude medicine looking at the changes in airflow in response to a deep breath at high altitude.  This research was performed at Mt. Everest Base Camp, where I also served as the base camp physician for the Mountain Madness Everest expedition.  There I treated patients with high altitude cerebral edema, high altitude pulmonary edema and general altitude illness."

-Jason Fought, MD

Meetings and Events

Retreats

Day long retreats are held annually for each class in a casual environment outside the hospital.  This day offers an opportunity for the class to develop as a team and discuss issues specific to their level of training.  Topics include how to teach and mentor medical students, the evaluation and feedback process, case presentation skills, successful work and teaching attending rounds, and managing a team.  Career planning and the changing environment of medical care are also discussed. 

ACP

Residents are encouraged to participate in the annual, Vermont ACP chapter meeting each fall as well as the national ACP meeting in the spring.  Over the past several years, our residents have presented novel case vignettes and innovative research projects that have earned them the opportunity to present at the national level.  We have also had several resident winners at the national ACP abstract competition in recent years.  Some of our winners include:

2005: Diane Hakey, MD - Sarcoidosis and Calciphylaxis with Interferon Therapy

2004: Patricia Kao, MD - Intestinal Ischemia Secondary to Idiopathic Myointimal Hyperplasia of Mesenteric Veins: Case Report and Review of the Literature

2003: Robert Dubin, MD - Silo-Filler’s Disease Treated with Inhaled Nitric Oxide:  The Double-Edged Sword of Nitric Oxide Species

Resident Research, Presentations and Scholarly Activities

Cardiology

Nicholas Hodgman MD, Nathaniel Madsen MD, Maruf Haider MD, Brenda Dole RN, Daniel Lustgarten MD PhD, Peter VanBuren MD.   Departments of Medicine and Cardiology

Title: Impedance Data in Heart Failure Patients 

Pierre Znojkiewicz, MD, Peter Spector MD  Departments of Medicine and Electrophysiology

Title:  Complex Fractionated Atrial Electrogram (CFAE) Stability Over Time and Space in the Human Left Atrium. 

Pierre Znojkiewicz, MD, Peter Spector MD Departments of Medicine and Electrophysiology

Title: Assessment of Lesion Depth during Radiofrequency Ablation Using Concentric Surface Electrodes 

Joachim Mueller, M.D. (Mentors, Drs. Shruti Sharma, Arshia M. Noori, Gagan Mirchandani, and Peter S. Spector)

Title:  Assessment of Atrial Electrophysiology and Effects of Autonomic Blockade on Human Atrial Fibrillation.

Bruch C, Grude M, Mueller, Joachim, Breithardt G, Wichter T. 

Title: Usefulness of tissue Doppler imaging for estimation of left ventricular filling pressures in patients with systolic and diastolic heart failure.  Am J. Cardiol  2005;95:892-5

Xu L, Renaud L, Mueller, Joachim, Baicu CF, Bonnema DD, Zhou H, Kappler CS, Kubalak SW, Zile MR, Conway SJ, Menick DR. 

Title: Regulation of NCXI expression: Identification of regulatory elements mediating cardiac specific expression and upregulation.  J Biol Chem  2006;281(45):34430-40. 

Dauerman HL, Sobel BE, Gauthier E, Kelley Michael, Dauerman K. 

Title:  Outcomes of a regional approach to ST elevation acute myocardial infarction using pharmacoinvasive therapy. (not yet completed)

Eric Gauthier, M.D. (Mentor, Peter Van Buren, M.D)

Title: Modulation of FKBP12.6 (FK506) and Ryanodine Receptor Isoform Expression in Failing Human Atrial and Ventricular Myocardium: Implications in Failure and Remodeling after LVAD Implantation

Research Award Winner, ACP Regional Meeting, October 2004

Presented at the ACP Annual Session, San Francisco, April 2005

Title: RT-PCR of Cardiac Specific M-RNA's for the Detection of Acute Myocardial Infarction

Presented at the ACP Regional Meeting, October 2003

Research Award Winner, ACP Regional Meeting, October 2003 

Caroline Lyon, M.D., MPH 

Title: Not Your Typical Myocardial Infarction: A Case of Takotsubo Cardiomyopathy

Clinical Vignette Award Winner, ACP Regional Meeting, October 2004

Presented at the ACP Annual Session, San Francisco, April 2005

Title:  Aerobic Capacity in Patients Entering Cardiac Rehabilitation

Submitted to Circulation, 2006 

Nathaniel Madsen, M.D.

Title: A Curious Myocardial Infarction and Brussels Sprouts

Clinical Vignette Winner at the ACP Regional Meeting, October 2005 

Nathaniel J. Madsen, MD, Chris E. Holmes, MD, PhD, Feliciano A. Serrano, MD, Burton E. Sobel, MD, and David J. Schneider, MD Departments of Medicine and Cardiology

Title: Influence of Preparative Procedures on Assay of Platelet Function and Apparent Effects of Antiplatelet Agents Am J Cardiol 2007; 100: 722–727 

Endocrinology

Suzanne Schermerhorn MD,  Muriel Nathan MD  Departments of Medicine and Endocrinology

Title: Implementation of an Insulin Infusion for CABG Patients: A Quality Assurance Project   

Kristen Pierce, M.D. (Mentors, Benjamin Littenberg, M.D., Charles MacLean, M.D. and Richard Pinckney, M.D.)

Title:  Goal Setting and Improvements in Diabetic Control

Peter Ward, M.D.

Title: Hemodynamic Collapse After Beta-Blocker Therapy in a Young Man with Thyrotoxicosis and Low-Output Cardiac Failure

Presented at the ACP Regional Meeting, October 2005

Gastroenterology

Maruf Haider, M.D.

Title: Hepatic Sarcoid Presenting With Portal Hypertension 

ACP Poster Presentation 

Nicholas Petrick, PhD Maruf Haider,MD Ronald M. Summers, MD, PhD Srinath C. Yeshwant, BS Linda Brown,MD Edward M. Iuliano, DO Adeline Louie,MD, ScD Perry J. Pickhardt,MD

Title: CT Colonography with Computer-aided Detection as a Second Reader: Observer  Performance Study    Radiology: Volume 246: Number 1 - Jan 2008

Paul Crainich MD, Richard Zubarik MD  Departments of Medicine and Gastroenterology. 

Title: Examination of Current Colorectal Cancer Screening Practices: Are We Adherent to National Guidelines?   Abstract accepted to DDW (Digestive Disease Week)

Chan P, Kelley Michael, Zubarik R. 

Title: Oriental cholangiohepatitis in Rural Vermont, case report, ACP poster

Dennie Trevor, M.D. 

Title: Prolonged fever and hepatosplenic disease in an adult patient with B.henselae infection.

Price Nathaniel, Cook VL, Froeliger EH, Winn WC. 

Title: Multisystem organ failure and death with E.Coli-O157-H7 bloody diarrhea: How PulseNet can determine if case if part of an outbreak.   

Clinical Vignette Winner at the Vermont Chapter ACP Meeting, October 2006

Clinical Vignette Winner at the National ACP Meeting, April 2007 

Adam Chodosh, M.D. (Mentors, Rocco LaSala, M.D. and James Vecchio, M.D., and Hagan Blaszyk, M.D.)

Title: Seasonal Pattern of Onset in Lymphocytic Colitis

Presented at the ACP Regional Meeting, October 2004

Published in Journal of Clinical Gastroenterology. 2005. 39 (10):891-3. 

Michael Kelley, M.D. (Mentor, Richard Zubarik, M.D.)

Title: Oriental Cholangiohepatitis in Rural Vermont

Presented at the ACP Regional Meeting, October 2005

General Internal Medicine

Coates A, Kelley M, Landry F, Schwarzenberger K.   

Questionnaire to Assess Provider’s Skills in Motivational Interviewing Techniques. 

Dean H. Stephens, M.D. (Mentor: Anthony Tomassoni, M.D.)

Title: A Rare Cause of Acute and Prolonged Delirium: Ethyl Chloride Inhalation.

Presented at the National ACP Meeting (Clinical Vignette Poster Finalist),  Philadelphia, PA   2006

Clinical Vignette Presentation at the Vermont – New Hampshire ACP Meeting,

October 2005 

Hematology / Oncology

Trevor Dennie, M.D. 

Title:  Proteomics for the Screening and Diagnosis of Pancreatic Cancer.

Title: An unexpected life-threatening reaction to a commonly used drug (case report, abstract)

Repp A, Madsen Nathaniel, Kelley Michael.  
Title: Creating evidence based medicine orders (quality improvement project)
 
James Peros, M.D. (Mentor, Richard Pinckney, M.D.)
Title:  Inpatient Medication Reconciliation and Quality Outcomes: A Systematic Review and Synthesis
 
Russo, Elizabeth, M.D. (Mentor, Claudio Nigg, M.D.)
Title:  Relation of Behavioral State of Change and Ethnic Identity on Fruit and Vegetable Consumption among Hawaiians
 
Tehrani, Tara, M.D. (Mentor, Dr. Robert Macauley)
Title:  Violence Against Physician
 
Jane Weinman, M.D. (Mentors, Drs. Mark Levine and Richard Pinckney) 
Title:  Motivational Weight Loss Planning
 
Klevis Kadiqi, M.D. (Mentor, Richard Pinckney, M.D.)

Title:  The Development and Validation of a Knowledge, Attitude and Behavior

Erik Rufa, M.D. and Peter Ward, M.D. (Mentor, Chris Holmes, M.D.)

Title:  The Effect of Moderate Consumption of Purple Grape Juice on Platelet

Activation in Healthy Volunteers.  

Erik P. Rufa, M.D.

Title: Is It the Pill or the Shot?: Skin Necrosis During Anticoagulation

Presented at the ACP Regional Meeting, October 2005 

Teresa Fama, M.D. (Mentors, Marie Wood, M.D. and Hyman Muss, M.D.)

Title: Patient Preferences for the Adjuvant Treatment of Breast Cancer 

Julian Sprague, M.D. (Mentor: Marie Wood, M.D.)

Title: Validation of Cancer Family History Questionnaire 

Infectious Diseases

Jaina Clough MD   W. Kemper Alston M.D., Daniel Daltry and Scott Laney PhD   Department of Medicine and VT Dept of Health.

Title:  An Outbreak of Syphilis in Vermont: How the Internet Facilitates Disease Transmission and Intervention  

Danyon Wagner, M.D. (Mentors: Beth Kirkpatrick, M.D., Chris Huston, M.D., and Kemper Alston, M.D.)

Title:  Serum Mannose-binding Lectin Deficiency is Associated with Cryptosporidiosis in Young Haitian Children. 

Lucas Ryback, M.D. (Mentor: Christopher Huston, M.D.)

Title:  Successful Treatment of Disseminated Trichosporon Asahii Infection in a Neutropenic Male Using Voriconazol 

Robert Cochrane, M.D. (Mentor: Christopher Huston, M.D.)

Title:  A Transgenic Approach to Identifying Potential Therapeutic Targets Against Cryptosporidiosis.

Matthew Arentz, M.D. (Mentor, Beth Kirkpatrick, M.D.)

Title: Superior Mesenteric Artery Syndrome in a Patient with AIDS: A Case Report

Regan Holdridge, M.D. (Mentor, Beth Kirkpatrick, M.D.)

Title: The Novel Oral Typhoid Vaccine M01ZH09 is Well-Tolerated and Immunogenic in Two Vaccine Presentations 

Adam Mack, M.D. (Mentor, W. Kemper Alston, M.D.)

Title: Catastrophic Outcomes Associated with Clostridium Difficile Colitis 

Trevor Dennie, M.D.

Title: Fever, Elevated Transaminases and Splenomegaly in an Adult Patient with Bartonella Infection

Presented at the ACP Regional Meeting, October 2005

Medical Education

Michael Mindrum, M.D. (Mentor, Burton Sobel, M.D.)

Title:  Time for a Revolution?  The Flexnor Report in Historic Context, Reflections on Our Profession. Published in:  Coronary Artery Disease  2006, Vol 17, No 5, 477-481 

Albert Rielly, M.D. (Mentor, Anna Noonan, Vice President for Quality

Title:  Promoting ACGME Resident Competencies in System-Based Practice     And Practice-Based Learning 

Nephrology

Enkhtuyaa Mueller, M.D. (Mentor: Richard Solomon, M.D.)

Title:  Hypokalemic Nephropathy as a Cause of ESRD

Clinical Vignette Presentation at the Vermont ACP Meeting, October 2006 

Taraneh Tehrani, M.D. (Mentors. Drs. Tobin Hoppes and Richard Solomon)

Title:  Acute Bacterial Pyelonephritis resulting in renal failure – a complication of chronic NSAID use?

Diane Hakey, M.D.

Title: Sarcoidosis and Calciphylaxis with Interferon Therapy

Clinical Vignette Paper Winner,  ACP Annual Session, San Francisco, CA  April 2005 

Carina Cartelli, M.D. (Mentor: Chris Holmes, M.D.)

Title: Thrombocytopenia and Continuous Renal Replacement Therapy (CRRT): A Retrospective Chart Review 

Ron Levy, M.D.

Title: Effect of Glomerular Filtration Rate on Survival in Patients Treated with Implantable Cardioverter Defibrillators

Presented at the ACP Regional Meeting, October 2005

Pulmonary / Critical Care

Marinshine Gentler MD  Chris Hampson, MD, Anne Dixon, MD  Departments of Medicine and Radiology

Title: Variation in Intrathoracic Large Airway Size in Obese and Non-Obese Women    

Jenny Martino MD  Wesley D. McMillian, Louis B. Polish, Anne E. Dixon, Departments of Medicine, Infectious Disease and Pulmonary/Critical Care   

Title: Community-acquired Methicillin-resistant Staphylococcus Aureus Pneumonia    Respir Med. 2008 Jun;102(6):932-4. Epub 2008 Apr 18.

David Gruenberg, M.D.   Shelton W, Rose SL, et al.

Title  An Analysis of Factors Influencing ICU Length of Stay.    Am J Crit Care 2006;15:502-09

David Gruenberg MD  Anne Dixon, M.D. Department of Medicine and Pulmonary and Critical Care Medicine

Title:  Obesity is Associated with an Increased Prevalence of Asthma in Patients Presenting to a Primary Care Clinic 

Paul Slavik, M.D. (Mentor, Brian Marden and Theodore Marcy, M.D.)

Title:  Recombinant Human Activated Protein C in the MICU at Fletcher Allen Health Care – MCHV Campus: Overuse?  Misuse? 

Slavik Paul, Gilman A. 

Title: Room air vs high flow oxygen in a mouse model of acute lung injury (preliminary data) 

Kelley Michael, Chan P, Jones C. 

Title: Anti-synthetase syndrome masquerading as Bird Fancier’s Lung (case report, ACP poster) 

Ron Anafi, M.D. 

Title:  The Effect of Muscle Shortening Speed on the Heterogeneity of Bronchoconstriction – A Computational Study. 

Dean Stephens, M.D. (Mentor, Anthony Tomassoni, M.D.) 

Title:  A Rare Cause of Acute and Prolonged Delirium: Ethyl Chloride Inhalation     

Krishnendu Bhadra, M.D. (Mentor, J. Thompson-Figueroa, R. Norton, C.G. Irvin, J.H. Bates and L.K.A. Lundblad) 

Title:  Oxygen Induces Airways Closure in Inflamed Airways    

Presented at the Vermont Chapter ACP Meeting, October 2006

Krishnendu Bhadra, M.D. (Mentors: John Thompson-Figueroa, MS, RyanNorton, BSc and Lennart Lundblad, PhD

Title:  An Analysis of Lung Mechanics and CT Images

Winner of the Award for Research Presentation at the Vermont ACP Meeting, October 2006 

Krishnendu Bhadra, M.D.

Title:  Not One of the Usual Suspects.

Clinical Vignette Presentation at the Vermont ACP Meeting, October 2006 

Krishnendu  Bhadra, M.D. (Mentor, Scott Wagers, M.D.)

Title: High Fractional Inspired Oxygen in Airway Hyperresponsiveness: Oxygen Worsens Asthma!

Research Award Winner, ACP Regional Meeting, October 2005  

Alisa Johnson, M.D. (Mentor: Karin Weidenhammer, M.D.)

Title:  Myasthenia Gravis Unmasked by Therapeutic Misadventures

Clinical Vignette Presentation at the Vermont ACP Meeting, October 2006 

Nicole Belanger, M.D. (Mentor, Theodore Marcy, M.D.)

Title: Has the Vermont Comprehensive Tobacco Control Program Improved Physician Adherence to the Tobacco Use and Dependence Guidelines? 

Todd Whitman, M.D. (Mentor, David Kaminsky, M.D.)

Title: Do We Really Need to Correct for Lung Volume When Interpreting the Diffusing Capacity?

Rheumatology
 

Michael Kelley, M.D. (Mentor: Christine Jones, M.D.)

Title:  Anti-Synthestase Syndrome Masquerading as Bird Fancier's Lung

Clinical Vignette Presentation at the Vermont - New Hampshire ACP Meeting, October 2005

Toxicology

Dean Stephens, M.D. (Mentor: Anthony Tomassoni, M.D., M.S.)

Title: A Rare Cause of Acute and Prolonged Delirium: Ethyl Chloride Inhalation

Presented at the ACP Regional Meeting, October 2005