Transitional Year - Internship Program
Newton-Wellesley Hospital Transitional Year Program Overview
Newton-Wellesley Hospital (NWH) is a 200-bed community hospital that is part of the Partners HealthCare System. Partners’ hospitals include Massachusetts General Hospital (MGH), Brigham and Women’s Hospital (BWH), Spaulding Rehabilitation Hospital, and Faulkner Hospital. NWH is located in the suburb of Newton about 8 miles west of Boston and is a quick drive from downtown via the Mass Pike or an easy subway ride on the MBTA (Green “D” line at Woodland Station). The Hospital offers most specialties on site but there are often some patients we refer downtown to MGH or BWH for such things as urgent cardiac catheterization or transplant surgery
NWH has over 400 residents who spend some part of their training, if not all of their internship at NWH. We have our own Transitional Year internship program. MGH Categorical Anesthesia residents spend their internship at NWH before going on to their 2nd year at MGH. MGH/McLean Psychiatry interns spend 6 months of their internship doing medicine at NWH. A new partnership with the Harvard Longwood Psychiatry Residency Training Program (BWH/BIDMC/MMHC) started July 2011 and trainees spend 4 months of their internship at NWH. In addition, residents from the MGH in medicine, surgery, and pediatrics spend 1-2 months per year at NWH to gain some exposure to a community hospital. Tufts/NEMC orthopedic residents also rotate at NWH. Tufts medical students in their 3rd and 4th years come to NWH for clerkships, electives and sub-internships. And finally, PA students from the Massachusetts College of Pharmacy and Health Sciences rotate at NWH on many services.
Our transitional year program typically seeks 5-7 interns per year. This number is flexible based on the number of MGH Categorical Residents that match. The number of interns from the two programs totals 13 per year. There are 10 MGH/McLean psychiatry interns that spend 6 months of their internship at NWH, thus there are 5 MGH psychiatry interns at NWH at any given time. Finally, there are 6 BWH psychiatry interns that each spend 4 months of their internship at NWH, thus there are 2 BWH interns here each block. So, despite NWH’s transitional year program being small, the addition of the other programs gives NWH 20 interns here on a monthly basis. The atmosphere is more collegial and more interesting given the different backgrounds and interests the mix of interns brings to NWH. The four different interns are hence referred to as NWH-based interns.
We do not have fellows at NWH, so contact is directly between attendings and residents. Given we are a small community hospital; the environment at NWH is welcoming and quite collegial. We have the distinction of being just outside Boston and affiliated with the larger academic centers in downtown Boston, allowing NWH to have an academic feel; yet, without the pressure or rigor of a downtown hospital. NWH based interns are held to the same standards that the rotating residents from MGH are, so our interns are expected to work hard along side their MGH colleagues.
The typical Transitional Year intern schedule is divided into 13 four-week blocks. The other NWH interns do some modified schedule based on their specific program requirements. Each TY intern is able to take up to 3 weeks paid vacation per year. However, due to scheduling constraints vacation can only be taken one week at a time and not in 2 or 3 consecutive weeks. Also, there is no terminal vacation at the end of the academic year in June. We offer free parking or a paid monthly subway pass. There is a gym on site (with free membership for residents) as well as a daycare center. A noon lecture series with lunch is scheduled on weekdays. Meal cards, to be used at one of our 3 onsite restaurants, are provided for breakfast and dinner for admitting shifts.
||Proposed Number of Blocks
for TY Interns
|Medicine Ward Service
There are 4 medicine teams that comprise our medical teaching service. The teams are comprised of:
- MGH senior medicine resident
- MGH medicine intern
- NWH-based intern
- Tufts MSIII student
- PA Students
Each medicine intern accepts new patients every other day. Formal pass-off of night medicine admissions to the day teams occurs each morning. New admissions are accepted by the admitting interns until 6:00 pm. Non-admitting (swing) days are typically much shorter and interns can sign out by 4:00 pm. Admitting interns typically end their days by 8:00-9:00 pm.
We have an extensive hospitalist service and one private physician who admit to the medicine teaching service. The communities where a majority of our patients come from are quite affluent. Our patient population is often elderly, educated, and compliant with medications and follow-up. There are certainly exceptions to this and we can admit patients with de novo presentations of common and less common diseases. Patients will come in with a variety of illnesses including coronary artery disease, cardiac arrhythmias, congestive heart failure, valvular heart disease, chronic obstructive pulmonary disease, asthma, diabetes and its complications, renal failure, stroke, seizure disorders, a variety of neoplastic diseases including lymphoma and multiple myeloma, gastrointestinal bleeding, pancreatitis, pneumonia, pyelonephritis, and bacterial endocarditis.
There are many didactic sessions scheduled on the medicine service. Morning report, teaching attending rounds and noon lectures with lunch served are scheduled daily. On a weekly basis, journal club, intern report and grand rounds are held.
There is one large surgery team that includes:
- MGH senior level surgery resident
- MGH junior level surgery resident
- MGH intern surgery resident
- NWH-based interns (4)
- Tufts MSIII students (4-5)
- PA students
Given the team has few senior members, interns are often first assist in one of our many operating rooms. So if you like the operating room, you will have plenty of time to hone your skills in surgeries such as laparoscopic and open cholecystectomies, large and small bowel resections, hernia repairs, vascular bypass and endarterectomies, breast biopsies, breast lumpectomies and modified radical mastectomies. Due to the new work hour requirements we follow a nightfloat type system where each intern on the team will take turns working the overnight shift for a week at a time. We have the largest gastric bypass department in the state and there will often be patients on the surgery service status post gastric bypass. There are weekly didactic lectures by the Chair of Surgery.
Intensive Care Unit (ICU)
The ICU is a closed unit of 12 beds comprised of surgical, cardiac and medical patients. The surgery service covers the surgery patients in the ICU. The cardiac and medical patients are covered by the ICU resident team, which is comprised of:
- MGH senior medical resident
- MGH junior residents (2)
- NWH-based interns (2)
The ICU follows a night float system. The ICU is staffed by critical care attending physicians during the day and moonlighter attending level physicians or senior medical residents at night. Patients suffer from a variety of syndromes requiring intensive care unit treatment including sepsis, respiratory failure, toxic overdoses, acute myocardial infarction, unstable angina, congestive heart failure, and gastrointestinal bleeding. There are daily teaching sessions and the ICU is a most enjoyed rotation due to the team structure and excellent teaching.
Each NWH intern will spend 4 weeks rotating in our new Emergency Department. We are not a trauma center but do see a variety of emergency situations such as myocardial infarction and drug overdoses. The interns have first contact with a variety of patients and can often do procedures such as suturing and intubation if desired. The 10 hour shifts are scheduled from 9:00 am - 7:00 pm. In addition, the ED interns are scheduled to be the night medicine interns 4 nights out of the block.
The Transitional Year Review Committee requires a minimum of 140 hours be spent in an ambulatory setting. We schedule the rotation to include some time in an offsite local Urgent Care center and some time in a primary care practice at NWH. The interns have first contact with patients and work along side 1-2 attendings so teaching is a daily occurrence. This requirement is for the TY interns only but the other NWH interns have occasionally chosen this as their elective given the popularity of the rotation especially at the Urgent Care Center.
Each NWH intern spends approximately 8 weeks being a night medicine intern for the same medicine megateam (2 geographically assigned medicine teams organized as above). There are 2 night medicine interns each night covering 2 different “regions” of the hospital and 2 medicine teams. The nightfloat interns will cross cover the service and admit 3 patients to that region. The night medicine interns work 6 nights in a row and additional coverage on Wednesday or Thursday nights is done by interns in the ED. Typically, a night medicine intern works only 12 nights total out the 28 day block. The remaining 16 days/nights are scheduled as vacation and as “backup” for the other NWH interns.
There are a variety of elective choices at NWH. We are very flexible on what electives interns choose and support research opportunities if appropriate.
Over the past 8+years, our matched applicants have graduated from US medical schools within the past 2 years and go on to residencies in such things as anesthesia, radiology, ophthalmology, and other various programs.
For additional information on our trainee contract, benefits, and other policies please refer to: http://www.partners.org/Graduate-Medical-Education/Residency-And-Fellowship-Programs/Default.aspx
If you have any questions or are interested in our program, please contact us.
Janet (Jodi) C. Larson, MD, Program Director
Marie Williams, Graduate Medical Education Coordinator