Transitional Year Schedule

The typical Transitional Year intern schedule is divided into 13 four-week blocks. Each TY intern is scheduled to take four weeks of paid vacation per year. However, due to scheduling constraints vacation can only be taken one week at a time (not two or three consecutive weeks). The typical distribution of rotations is as follows:

• Medicine Ward Service: 1–2 blocks
• Surgery Service: 1–2 blocks
• Intensive Care Unit: 1 block
• Night Medicine: 2 blocks
• Pediatric Ward Service  1 block (opt-in)
• Ambulatory Care: 1 block
• Emergency Medicine: 1 block
• Elective: 3 blocks including a Quality Improvement elective

Medicine Service

There are four medicine teams that comprise our medical teaching service. Each team is comprised of:

• MGH or Tufts senior medicine resident
• MGH or Tufts medicine intern
• NWH-based intern
• Tufts MSIII student
• MCPHS PA student
• NWH Hospitalist

Each medicine intern accepts new patients every other day. Formal pass-off of night medicine admissions to the day teams occurs each morning during Morning Report, which is led by the MGH Chief Resident. New admissions are accepted by the admitting interns until 5:00 pm. Non-admitting (swing) days are typically shorter, and interns often can sign out by 4 p.m. Admitting interns typically end their days by 8 p.m.

Each team is supported by a dedicated Hospitalist attending, and there are no private attendings involved in the inpatient medicine services.

Patients present 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 such as lymphoma and multiple myeloma, gastrointestinal bleeding, pancreatitis, pneumonia, pyelonephritis, and bacterial endocarditis. Given the communities from which NWH draws, the patient population is typically older, well-educated, and compliant with medications and follow-up, although there are certainly exceptions.

There are many didactic sessions scheduled on the medicine service. Morning Report and noon conference lectures with lunch are scheduled daily. On a weekly basis, intern report, simulation training, and Grand Rounds are held. The MGH Chief Resident based at NWH leads many of these didactic sessions.

Surgery Service

There is one large surgery team that includes:

• MGH upper level surgery resident(s): (4-5)
• MGH surgery interns (1-2)
• NWH-based interns (4)
• Tufts MSIII students (4)
• Physician Assistants
• PA students (8–10)

Care of the surgical patients at NWH is team-based, and interns will have the opportunity to spend time on the Acute Care Surgery team as well as the Subspecialty Surgery team. If you enjoy 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. NWH has the largest gastric bypass department in the Commonwealth, and there will often be patients on the surgery service status post gastric bypass.

Due to the resident work hour requirements, we follow a night float system in which each intern on the team will take turns working the overnight shift for four to six nights at a time. There is always an upper-level surgery resident in-house, day and night, to provide supervision and assist in patient care. Weekly didactic lectures and simulation center trainings are led by a surgical attending or the surgical senior resident.

Intensive Care Unit (ICU)

The ICU is a closed unit of 12 beds comprised of surgical, cardiac, and medical patients. The surgery service remains the primary team for 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 medical resident
• Tufts junior medical resident
• NWH-based interns (4)

The ICU is staffed by critical care attending physicians during the day and moonlighter attending-level physicians at night. The ICU follows a night float system, and each intern works five to seven night shifts over the block. Patients present with 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. The ICU is one of the most enjoyed rotations due to the team structure and excellent teaching.

Emergency Medicine

Each NWH intern will spend one four-week block rotating in our Emergency Department, one of the busiest EDs in the Commonwealth. Although NWH is not a trauma center, we do see a variety of emergency situations such as myocardial infarction, sepsis, congestive heart failure, GI bleed, acute stroke, 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 typically scheduled from 7:30 am to
5:30 p.m., or noon to 10 p.m. There are weekly lectures on core emergency medicine topics given by an Emergency Department attending.

Ambulatory Care

The Transitional Year Review Committee requires that a minimum of 140 hours be spent in an ambulatory setting. During this rotation interns spend their time offsite at an NWH affiliated Urgent Care center. Interns have first contact with patients and work alongside one to two attendings, leading to optimal supervision and education. Interns will gain proficiency in performing outpatient procedures such as suturing and I&D.

Night Medicine

Each NWH intern spends two blocks on the night medicine team. There are three night medicine interns covering different “regions” of the hospital for the four medicine teams. The night medicine interns cross-cover the service and admit patients to their “region.” The night medicine interns work up to six nights in a row. Typically, a night medicine intern works 12 nights total out the 28-day block. The remaining 16 days/nights of the four-week block are scheduled as vacation and/or as “backup.”

Electives

There are a variety of elective choices at NWH, and transitional year interns have three blocks reserved for electives. There is a four-week quality improvement elective that is offered to each TY intern. Other electives that residents commonly choose include anesthesiology, cardiology, dermatology, ophthalmology, pulmonology, radiology, pathology, and palliative care. We are very flexible on what electives interns choose, and many interns choose to pursue research opportunities during an elective block as well.

Pediatrics

Interns are given the opportunity to rotate on our inpatient pediatric service in lieu of a block of medicine or surgery. NWH interns work with the pediatric team comprised of a pediatric hospitalist, MGH pediatric junior resident, MGH pediatric intern, Tufts sub-Is and medical students, and MCPHS PA students. This four-week block is divided into two weeks of daytime shifts and two weeks of evening (4:00 pm–11:00 pm) admitting shifts. In addition to the variety of pediatric ailments encountered on-service, education on this service is supplemented by numerous didactics, journal club, radiology rounds, and grand rounds.