Mission

The mission of the Tripler Army Medical Center internal medicine residency is to educate and develop the next generation of physicians in clinical care excellence, scholarship, leadership, and resiliency so that each graduate is competent and compassionate, thus preparing trainees to meet tomorrow’s challenges in military and civilian healthcare.

Vision

The internal medicine residency provides a supportive and inclusive environment, setting the conditions for individual growth both personally and professionally, so that each resident can achieve their full potential as physicians and individuals.

Aims

Each graduating resident is:

• Capable of practicing in a wide variety of clinical settings from a remote, austere location to an academic center
• Possessing the knowledge, skills, and attributes to conduct and lead clinical research and process improvement
• Committed to a lifetime of service for their patients and communities

The residency conducts a daily noon conference and a weekly academic half day. 40% of daily noon conferences consist of case-based presentation focusing on clinical reasoning, diagnosis, and treatment. 20% of daily noon conferences focus on morbidity and mortality, process improvement, research, journal club, or DEI topics. The academic half day is structured around the American Board of Internal Medicine’s internal medicine certification blueprint ensuring that 97% of topics are addressed within an 18-month period. Therefore, by graduation each resident will receive instruction on each topic of the ABIM certification exam at least twice during their residency.

The academic year is divided into 13 blocks.

PGY-1

Each resident completes five inpatient medicine rotations* including one nocturnist rotation, two medical / surgical intensive care rotations, rotations in geriatrics, emergency medicine, military medicine (military residents only), two electives, and one research block.

• *One inpatient medicine rotation is at Queen's Medical Center
• Civilian residents will complete a rural medicine rotation at VA in lieu of military medicine rotation

PGY-2

Each resident completes three inpatient medicine rotations including one nocturnist rotation and rotations in the medical / surgical intensive care, neurology, dermatology, inpatient cardiology* / coronary care unit, three electives, and three research blocks.

• Inpatient cardiology is at Queen's Medical Center

PGY-3

Each resident completes one inpatient medicine rotation, one medical / surgical intensive care rotation, one medical intensive care rotation*, and rotations in internal medicine consultation / procedures and as a senior teaching resident, six elective rotations, one research block, and one transition to practice block. The geriatric rotation is conducted at our on-sight VA community living center.

• Medical Intensive Care is at Queen's Medical Center

Tripler Army Medical Center’s Department of Medicine

• Allergy/Immunology
• Cardiology
• Endocrinology
• Gastroenterology
• Hematology/Oncology
• Infectious Diseases
• Nephrology
• Palliative Medicine
• Pulmonary Medicine
• Rheumatology
• Sleep Medicine

Tripler Army Medical Center Outside of the Department of Medicine

• Radiology
• Radiation oncology
• Ophthalmology
• Physical Medicine and Rehabilitation
• Sports medicine.

Queen’s Medical Center

• Gastroenterology
• Medical Oncology
• Nephrology
• Pain Medicine
• Neurologic Intensive Care
• Palliative Medicine

• The duty day for the inpatient medicine rotation and the medical / surgical ICU begins at 6:00 a.m. and ends at 6 p.m.
• A nocturnist team consisting of a PGY-1 and PGY-2 resident take admissions for the inpatient medicine teams from 6 p.m. to 6 a.m.
• A resident team consisting of a PGY-1 and a PGY-2 or PGY-3 take medical / surgical ICU admissions from 6 p.m. to 6 a.m. with in-house intensivist coverage available.
• There are three inpatient medicine teams.
• The call schedule follows a call, post-call, pre-call schedule over a three-day period.
• Each team is on-call every third day, and each team typically admits between six and 10 patients per call day.
• The medical / surgical ICU is on-call daily and typically admits between one and four patients per day.

The military unique curriculum for Tripler Army Medical Center’s internal medicine residency is longitudinal.

Civilian residents

Are not required to participate in the military unique curriculum.

Military residents

PGY-1

The Basic Officer Leader Course (BOLC) is a prerequisite and residents must complete this prior to beginning their residency. Each military PGY-1 resident will rotate at the Desmond Doss Health Clinic at Schofield Barracks. During this block, they may accompany one of the 25th infantry battalions during field training exercises if schedules permit.

PGY-2

Each military PGY-2 resident attends the Tactical Combat Casualty Care course at Fort Sam Houston, TX during their PGY-2 year unless they completed an equivalent course prior to residency.

PGY-3

Each military PGY-3 resident completes a trauma capstone held at the Medical Simulation Training Center at Schofield Barracks and qualifies with the M-17 pistol prior to graduation. Hospital-wide monthly leader professional development classes are available for residents. Military residents can complete electives in jungle warfare, air assault, airborne, and flight surgery during training, and are encouraged to participate in the Expert Field Medical Badge (EFMB) lanes held annually each April.

All Residents

All residents have access to an in-hospital gym, 24/7 physical fitness facilities at Fort Shafter, and physical fitness facility on the campus of Tripler Army Medical Center.

Military residents must maintain service-specific physical fitness standards throughout their residency. Additionally, each resident receives instruction from master fitness trainers from the Medical Readiness Battalion – Hawaii and from nutritionists at Tripler Army Medical Center. The program offers certification in the Society of Critical Care Medicine’s fundamentals of critical care support (FCCS) and fundamentals of critical care support – resource limited (FCCS-RL) courses. Certification as combative instructors (hand to hand combat) and as master fitness trainers (analogous to personal trainers) are also available to military residents. Civilian residents are not required to participate in the military unique curriculum, but some opportunities are available to them such as the physical fitness resources, FCCS, and FCCS-RL.

Each resident must maintain certification in basic life support (BLS) and advanced life support (ALS). By the end of their second year, each military resident must have certification in advanced trauma life support (ATLS).

The institution has a simulation center that allows for residents to learn procedures and to practice clinical scenarios using a high-fidelity simulation mannequin.

The leadership curriculum aligns with the military unique curriculum above. Additionally, all residents are encouraged to pursue program, department, and hospital-wide committee assignments.

Each resident is expected to complete scholarly activity over the course of their residency. Opportunities typically include case reports, retrospective analysis, or meta-analysis. There are on-going IRB-approved research protocols within the Department of Medicine that residents can join. Some residents choose to liaison with the institution’s Department of Clinical Investigations and participate in field research. Historic locations for this research include Indonesia, the Philippines, and Australia.

Each resident is highly encouraged to attend conferences and academic meetings. There is yearly meeting of the Hawaii chapter of the American College of Physicians that all residents are expected to attend if not otherwise on duty. The residency supports maximum attendance at the TriService ACPs annual meeting. Historically, residents have presented at other conferences such as the American College of Gastroenterology, CHEST, and the American Thoracic Society.

Each resident is expected to complete one process improvement project over the course of their residency. The institution’s Quality Services Division assists residents with this. Often, residents will cooperate with other residents on long-term projects. Residents are encouraged to present their process improvement projects at yearly conferences.

Professional development opportunities align with the military unique curriculum and the program’s didactic schedule. The program provides formal instruction in creation and maintenance of each resident’s curriculum vitae, fellowship application, academic appointment, and military / academic promotion.

All participating sites are primarily located on the island of Oahu. Additionally, the VA Pacific Islands Healthcare System has clinic locations on the islands of Guam, American Samoa, Saipan, Kauai, Molokai, Lana’i, Maui, and Hawai’i. These participating sites include:

• Tripler Army Medical Center
• VA Pacific Islands Healthcare System
• Queen’s Medical Center

Medical students interested in rotation at Tripler Army Medical Center are encouraged to apply. Uniformed Services University students may rotate during their internal medicine clerkship or during sub-specialty selective rotations. These rotations are split between outpatient and inpatient experiences. Health Professional Scholarship Program students may rotate during their active-duty time rotations. These rotations are exclusively inpatient experiences.

Interviews for Army applicants occur between July and September. Interviews for civilian applicants occur between October and January. Interviews for Army applicants are either in-person or virtual. Interviews for civilian applicants are exclusively virtual. Interviews are conducted with a panel of faculty and consist of structured questions to determine an applicant’s academic potential, motivation, emotional intelligence, and overall fit for the program. Military applications are made via the Medical Operational Data System (MODS). Civilian applications are made via the Electronic Residency Application Service (ERAS), and the program participates in the National Residency Match Program (NRMP) for civilian applicants.

Graduates take the American Board of Internal Medicine’s (ABIM) certification exam in internal medicine. To be eligible for this exam, graduates must complete all pre-requisites required by the ABIM by July. The exam is offered annually in August. ABIM requires successful completion of an internal medicine residency and an unrestricted state license prior to certification. Specifics can be found on the ABIM Site. 

Residents teach medical students during all rotations. During the PGY-3 year, residents complete a senior teaching resident rotation that is structured to provide further didactic instruction to medical students. The noon didactics are structured so that residents lead case presentations, M&Ms, and journal clubs under the supervision and guidance of program faculty. Residents may participate in USU faculty development during their PGY-3 year.

Each resident can become an ALS instructor. Residents can apply to become USU teaching fellows. Annually, the program accepts one graduating military resident and one civilian resident into chief resident positions for the following academic year.

The program has board-certified faculty in:

• Allergy/Immunology
• Cardiology
• Critical Care
• Dermatology
• Endocrinology
• Gastroenterology
• General Internal Medicine
• Geriatrics
• Hematology/Oncology
• Infectious Diseases
• Nephrology
• Neurology
• Palliative medicine
• Pulmonary medicine
• Rheumatology
• Sleep medicine

Additionally, the program has faculty trained in: interventional cardiology and gastroenterology.

Each resident is encouraged to establish mentor-mentee relationships.

• The program has a formal resident well-being subcommittee and conducts wellness activities at the end of every block. These activities range from beach days to museum tours to ice skating.
• Physical fitness is highly encouraged. The program hosts a resident running club, and these residents complete and compete in marathons, half-marathons, and iron man races within the state.
• Honolulu is a robust metropolis of over one million people within in the surrounding community featuring excellent dining and night life opportunities.
• Hawaii offers numerous activities such as world-class hiking, mountain biking, trail running, golf, surfing, scuba, free-diving, and sailing. It is not unheard of for residents to go to the beach or surf after their work is complete.