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Transitional Year

At A Glance

Program Type: Military Medical Center

Location: Augusta, GA

Accredited: Accreditation Council for Graduate Medical Education (ACGME)

Program Length: 1 year

Required Pre-Requisite Training: Medical School graduation

Categorical Year in Specialty Required: No

Total Approved Complement: 10

Approved per Year (if applicable): Not applicable

Dedicated Research Year Offered: No

Medical Student Rotation Availability: No

Additional Degree Concurrent with Training (e.g. MPH): No

Program Description

The Dwight David Eisenhower Army Medical Center (DDEAMC) Transitional Year Internship trains interns in a broad range of clinical experiences which serve to qualify them for state medical licensure and to proceed to either further residency training or assignment as general medical officers in the U.S. Army. In addition to producing well-rounded interns, the program promotes military readiness and resilience. Our graduates must be ready to serve effectively as both military officers and physicians across the spectrum of clinical care in garrison and deployed.

A main focus of the program is medical readiness. As future physicians who graduate to general practice or myriad specialties, our graduates, through rotations in intensive care units, develop clinical knowledge and procedural competence with critically ill patients. Interns are educated in the challenges of running an inpatient service with polytrauma patients (at Wellstar/Augusta University Health) as they could experience in a contingency/deployed environment. General medical officers must care for diverse patient populations and be prepared for a broad range of patient complaints. We develop these skills through rotations in Gynecology, Pediatrics, Ambulatory Medicine, Inpatient Medicine wards, and General Surgery to name a few. Interns learn military-specific occupational medicine considerations in Army Troop Medicine clinics. As graduating interns assume leadership responsibility for the medical staff under their supervision and lead their patients through care decisions, they participate in a professionalism and military-unique curriculum throughout the internship year.

Finally, the program is primarily focused on delivering high-quality, patient-centered care. Through an emphasis on quality improvement and patient safety, interns are engaged in Problem Based Learning and Improvement and deliver a professional Morbidity and Mortality presentation to the class as part of an integrated quality and patient safety curriculum.

The Transitional Year is designed to fulfill the educational needs of medical school graduates who:

Have chosen a career specialty for which the categorical program in graduate medical education has, as a prerequisite, one year of fundamental clinical education (this education may also contain certain specific experiences for development of desired skills).
Desire a broad-based year to assist them in making a career choice or specialty selection decision.
Are planning to serve in public health organizations or on active duty in the military as general medical officers or primary flight/undersea medicine physicians.
Desire or need to acquire at least one year of fundamental clinical education before entering administrative medicine or non-clinical research.

Mission, Vision and Aims

Mission

The DDEAMC Transitional Year Program's mission is to provide the clinical experience, educational resources, and support that produces exceptional general medical officers and specialty residents who engage in the ethical and compassionate practice of medicine in military health care settings.

Vision

Across a variety of clinical experiences throughout the academic year, DDEAMC Transitional Year Residents hone their medical knowledge and practice to become competent and confident military healthcare system physicians who graduate to serve in general medical officer or categorical residency settings.

Aims

Develop general clinical knowledge and procedural competence with a wide range of patient acuity.
Produce competent physicians and military leaders capable of serving as a general medical officer or resident.
Provide the highest level of clinical care with a continuous focus on patient safety and quality improvement.
Generate an inclusive workplace where all members are respected and function as a team to achieve the mission.
Foster resilience through healthy work-life balance, self-reflection, and professional development that will guarantee the longevity of our mission into the future.

Curriculum and Schedules

The TY program has dedicated, protected program time for one afternoon each month, in which residents are excused from clinical duties to meet with their program leadership and have TY-specific education. The dates/times of these meetings will be provided at the beginning of the academic year. Each meeting will be comprised of a program meeting followed by didactics: medical, professional, and military topics. In addition, this is an opportunity to share experiences, troubleshoot issues, and learn from each other. TY residents are also expected to attend resident didactics provided in each rotation they complete, as well as institutional grand rounds.

The Transitional Year Program consists of 12 months of training divided into 13 rotation blocks which each last four weeks. The immediate below list comprise the core seven rotations for all TY interns:

Medical Intensive Care Unit (1 block): Caring for critically ill hospitalized patients.
Cardiac Intensive Care Unit (1 block): Caring for critically ill cardiac patients.
Medicine Ward (1 or 2 blocks): Caring for hospitalized adult patients.
General Surgery (1 or 2 blocks): Care of adult inpatients with surgical disease.
Emergency Medicine (1 or 2 blocks): Ambulatory care of patients presenting to the emergency department with a required minimum of 140 hours of emergency experience.
Pediatric Outpatient Clinic (1 block): Ambulatory care of sick/well children.
Family Medicine or Ambulatory Medicine Outpatient (1 block): Ambulatory care of patients of all ages and minor procedure training.
Trauma Service (1 block): Acute and follow-on inpatient care for patients presenting to a Level 1 trauma center.
Gynecology (1 block): Ambulatory care for adult patients seeking routine and advanced gynecologic care.

Transitional Year Residents also complete additional elective rotations. See elective list below for opportunities,

Allergy and Immunology
Anesthesiology
Burn Intensive Care Unit (Burn ICU)
Cardiology
Dermatology
Endocrinology
ENT/Otolaryngology
Gastroenterology
Hematology/Oncology
Infectious Disease
Interventional Radiology
Nephrology
Neurology
Obstetrics and Gynecology
Orthopedics
Ophthalmology
Pain Clinic
Pathology
Plastic Surgery
Physical Medicine/Rehabilitation
Psychiatry
Pulmonary
Radiology
Rheumatology
Surgical Specialties (Vascular, Cardiothoracic, Bariatrics, Colo/Rectal)
Soldier Medicine Clinics
Urology

Transitional Year interns follow the typical call schedule for categorical interns on each rotation. There is little to no overnight call for interns at DDEAMC. However, TY interns do participate in a “night float” rotation during the Trauma rotation at Wellstar/MCG and there are scheduled night shifts during the Emergency Medicine rotation.

Transitional Year interns are trained in a broad range of clinical experiences which serve to qualify them for licensure and proceed to either further specialty residency training or assignment as general medical officers. These unique experiences expose them to a wide range of patient demographics representative of the active duty population as well as the dependents of active duty members. They are exposed to a wide variety of trauma cases at initial presentation and following stabilization as inpatients, which prepare them for the deployed environment. They are also exposed to pre and post deployment evaluations during outpatient rotations at the Troop Medical Clinic. Experiences in Ambulatory Medicine, Ophthalmology Clinic, Gynecology Clinic, and Troop Medicine Clinics provide robust outpatient preparation for general medical officers’ future clinical experience. The MUC is woven into academics as well through the professionalism curriculum, journal club, and sessions led by physicians with personal experience in military-unique environments. Lastly, all interns are required to complete the U.S. Army Combat Casualty Care Course at JBSA-Camp Bullis prior to graduation.

All TY residents complete the American Red Cross Basic and Advanced Life Support certifications. Additionally, Wellstar MCG requires certification in sterile procedure as well as central line placement certification prior to rotating at that site.

All TY residents participate in clinical procedures throughout the year and are heavily involved with our hospital simulation center. Residents participate in team response and individual tasks on their respective rotations (Trauma, ICU, General Surgery, and Emergency Medicine) when these are part of the schedule.

There are opportunities for interns to take on leadership roles within the program and hospital. At the beginning of the year, interns are elected by their peers to serve as primary and alternate representatives in the positions of Residency Council representative and TY Program Evaluation Committee representative.

Scholarly and Professional Development Opportunities

Interns will complete a single project sufficient to meet the DDEAMC TY graduation requirement for research. This is a formal podium presentation that is presented at the annual Transitional Year Residency Research Symposium each Spring and judged by a panel of faculty across a broad range of specialties. Research topics range from case reports, informatics, quality/patient safety, and basic research. Opportunity is abundant as Fort Eisenhower also houses the Department of Clinical Investigation which maintains multiple actively ongoing grant-supported research protocols. The winner of the Research Symposium is recognized at the end of the year during the Completion of Residencies Graduation Ceremony for all GME programs.

DDEAMC integrates a broad quality curriculum as it pertains to patient safety during the TY year. All TY interns are required to present a “My Mistake” paper of a patient safety event (near-miss, etc.) that occurred during their training to that point and construct a root cause analysis for that event which is presented to the group at the monthly meeting. Additionally, this is tied into an instructional series provided by the DDEAMC patient safety office on methodologies and best-practices to mitigate patient safety events in the future.

TY Interns at DDEAMC are required to complete the U.S. Army Combat Casualty Care Course offered at JBSA-Camp Bullis which includes Advanced Trauma Life Support certification. They are also required to complete a research project as graduation requirement with multiple opportunities for bench research at the Department of Clinical Investigation as well as clinical/informatics research within the hospital.

Participating Sites

All TY rotations occur at Fort Eisenhower, Georgia, or with the affiliated Wellstar/Medical College of Georgia health care system which includes:

Hospital and Clinics within Dwight D. Eisenhower Army Medical Center
Pediatric, Trauma, Cardiac ICU, Emergency Medicine at Wellstar/MCG
Connelly Health Clinic
Huber Troop Medical Clinic

Applicant Information, Rotation and Interview Opportunities

There are no medical student rotation opportunities as TY is not a clinical department. Medical students who are only applying to the Transitional Year (PGY-1 only) program are encouraged to meet in person or virtually with the Transitional Year Program Director to discuss the program.

Rotation opportunities and scheduling during the first months of the TY program will be individualized for each intern’s career goals.

Medical students who apply to categorical residency programs (i.e., Ophthalmology, Diagnostic Radiology, Aerospace Medicine) should apply through those programs and request placement in the Transitional Year internship.

Residents who intend to proceed as general medical officers or are undecided about a specialty are encouraged to apply for a PGY1 position with the Transitional Year Residency. Contact the PD directly (email preferred) to arrange an interview if you are applying to TY as your only residency.

There is no specialty board examination for the Transitional Year Internship. Transitional Year residents must have a passing score on United States Medical Licensing Exam (USMLE) Step 3/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 3 to graduate from the program.

Teaching Opportunities

Interns rotating with medical students are expected to teach in that role. Each intern teaches the program during their Morbidity & Mortality (M&M) presentations, Journal Club presentations, and their original research at the Transitional Year Research Symposium held annually each Spring. Interns may also participate in extracurricular teaching, if they are inclined, in root cause analysis in conjunction with our Patient Safety Services, and life support training (Advanced Cardiac Life Support and Basic Life Support).

Can be discussed with the Program Director on an individual basis.

Faculty and Mentorship

The current TY leadership team is comprised of physicians with training in Otolaryngology and Ophthalmology.

Core Faculty for the Transitional Year include physicians trained in General Surgery/Trauma, Internal Medicine, Urology, Radiology, Ophthalmology, Pediatrics, Family Medicine, Orthopedic Surgery, and Emergency Medicine.

Each intern prior to arriving at DDEAMC is assigned a TY program resident to assist with mentorship and sponsorship as they transition out of medical school and into clinical practice as new physicians. After arrival, each intern is assigned a TY leadership faculty member as an advisor who follows them throughout the academic year. Additionally, the Program Director will make any requested introductions between an interested intern and another Program Director or program of their choice.

Well-Being

At monthly didactics the residents and program leadership have purposeful time for camaraderie and open-ended question and answer sessions with program leadership to discuss any ongoing concerns that affect wellness and well-being. Questions can be professional or personal in nature. In addition, the program hosts a potluck near the end of program orientation for newly incoming and soon-to-be departing residents and their family members to promote early connections between residents and families. The TY program holds several informal off-site events throughout the year to include group kayaking trips, attending minor league baseball games, and multiple social gatherings. This serves to foster wellness and spirit de corps within the program.