Internal Medicine

At A Glance

Program Type: Military Medical Center

Location: Fayetteville, NC

Accredited: Accreditation Council for Graduate Medical Education (ACGME)

Program Length: 3 years

Required Pre-Requisite Training: If prior completed preliminary IM PGY1, may start at PGY2 level with program director approval; If prior completed Transitional Year, may receive partial credit; all others start at PGY1

Categorical Year in Specialty Required: No

Total Approved Complement: 9

Approved per Year (if applicable): Not applicable

Dedicated Research Year Offered: No

Medical Student Rotation Availability: 4th Year

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

Program Description

This is Womack Army Medical Center, located in Fort Liberty, North Carolina—One of the busiest military complexes worldwide. Fort Liberty is home to the legendary 82nd Airborne Division, the XVIII Airborne Corps, the U.S. Army Special Operations Command, the U.S. Army Forces Command, the U.S. Army Reserve Command and the U.S. Army Parachute Team, the Golden Knights. By population, Fort Liberty is the largest Army installation in the world, home to 10 percent of the Army's active component forces…yes, really – 1 in 10 of all Army Service Members are stationed here. Womack Army Medical Center is the main hospital for all of these amazing Soldiers and Retirees, their families, and an adjunct hospital to the Veterans Administration (VA) beneficiaries. We can tell you about how we are a “state of the art facility, providing a rich training experience,” but this is what that really means: we are a great hospital with pathology rivaling that of the major centers – and YOU will be in the middle of all the action. We don’t have any subspecialty fellows to put in that central line or intubate that patient or have that goals-of-care discussion with that cancer patient. This will be YOU. Also, more than any other residency, you will see firsthand what it is to be an Army doctor. You will have more contact and interaction with more INTERNISTS who have deployed or been assigned to Army units. We have subspecialists who are very passionate about their fields and about teaching who have no fellows to train who can’t wait to train you. We can help you design your career path and a curriculum that fits YOU, no matter what your passion in Internal Medicine.

This program is going to watch you grow – academically, emotionally, and physically. We are moving towards fully integrating competency-based milestones where we will expect you to meet milestones to progress to the next level. As you progress, you will be given more and more responsibility and eventually, independence. What about research? We have the best clinical investigations department I’ve ever worked with. What does that mean? I have been places where I was just “the little guy” trying to make my way through the forest of institutional review board (IRB) regulations and no one seemed to want to help me. Here, one quick email to and you'll be set you on the path to your publication. I have NEVER had support for research like this in any of the five Army hospitals I’ve worked at.

This residency is 36 months long. You will primarily train here, at Womack Army Medical Center (known as the “sponsoring institution”). We also have two participating sites: the University of North Carolina in Chapel Hill, where you will rotate through their large cardiac care unit (CCU) and intensive care unit (ICU), and the Fayetteville VA, where you will do your geriatrics and palliative care rotation. The requirements have changed since most of your staff were in residency (effective 2021), and now our accrediting body has transitioned to a more career-focused design. This means fewer inpatient months and more electives. What about the electives? Well, the selection of those depends on your in-training-exam (ITE) scores (you take that in September). Those subjects that you’re weaker on, we’ll give you more elective time to learn. Don’t worry – we’ll give you tons of resources, a dedicated faculty, a lot of passion, and the support you need to make this residency the best training for you.

Mission, Vision and Aims

Mission

Our residents will learn how to provide the highest quality health care and gain the skills necessary to maximize the deployability of our soldiers and care for their families as well as those who retire in this area.

Vision

Become the model residency for training Army Internists, gaining not only the medical skills but also the professional skills to care for complex patients both at home and abroad in austere environments.

Aims

To train medical school graduates in all the procedures and competencies they need to independently care for adult patients with complex medical problems in the inpatient and outpatient settings.
To provide training on the unique procedural, clinical, and professional skills necessary to care for Soldiers in an austere environment with limited resources.
To train scholars in the academic and professional principles of internal medicine to meet American Board of Internal Medicine standards and to become well-rounded, respected clinicians.

Curriculum and Schedules

Our program academic schedule includes:

Tuesdays: 12:15 - 1 p.m. Case Conference
Wednesdays: 7:30 - 8:15 a.m. Case Conference, 12 p.m. Journal Club or Morbidity and Mortality (monthly)
Thursdays: 7:45 - 8 a.m. Mini report
Fridays: 12:30 - 4:30 p.m. Academic 1/2 day including:
- 1 - 2 p.m. Grand Rounds 1st Friday of each month
- 2 p.m. All staff meeting with program updates 1st Friday of each month

Morning Report

Morning Report is on Tuesday and Wednesday mornings from 7:30 - 8:15 a.m. It Provides residents with the opportunity to present cases from their practice followed by a case-based discussion which is led by a faculty moderator with interactive participation of the medical students, residents, and faculty present. This conference is required for all residents during rotations at WAMC. On Thursdays there is a “mini report” with quick imaging cases, pictures, and quizzes.

Grand Rounds

Grand Rounds is a recurring monthly activity sponsored by the hospital in conjunction with GME. The topics vary monthly and often include guest lecturers. Attendance is required by residents.

Other Monthly Conferences

Journal Club
Morbidity & Mortality Conference
Board Review

We operate on a 4+1 block schedule meaning that you spend four weeks on a given rotation with one week of continuity clinic.

1st Year	2nd Year	3rd Year
Inpatient Wards - 4 months Night Float - 4 weeks (1 week per ward month) Inpatient Cardiology at UNC - 1 month Outpatient Cardiology Procedure Rotation Intensive Care Unit at UNC - 1 month Internal Medicine Consult - 1 month Elective - 1 month Combat Casualty Care Course - 1 week	Inpatient Wards - 3 months Night Float - 2 weeks Inpatient Cardiac Critical Care at UNC - 1 month ICU at UNC - 1 month Research - 1 month Elective - 4 months	Inpatient Wards - 2 months Night Float - 2 weeks Neurology - 1 month Geriatrics/Palliative Care - 1 month Operational Medicine - 2 to 4 weeks Elective - 3 to 4 months

UNC = University of North Carolina Chapel Hill, where we put provide resident lodging while on temporary duty orders.
Procedure Rotation = Otolaryngology, Ortho, Gynecology and other subspecialties
Electives are decided based on preference, but also on in-training exam scores (taken every August) and distributed based on areas of needed focus (lower scoring areas)
Residents are allowed up to 4 weeks of vacation time per year and these may be taken on any elective or research block but not during inpatient blocks or clinic weeks.

Allergy Immunology / Clinic
Cardiology / Clinic
Dermatology / Clinic
Endocrinology Clinic
Gastroenterology / Clinic
Hematology-Oncology / Clinic
Infectious Diseases / Clinic
Nephrology / Clinic
Neurology / Clinic
Pulmonary / Clinic
Rheumatology Clinic
Ward Medicine

The program no longer utilizes 24-hour call schedules. All inpatient rotations are organized into day and night shifts. During 4-week inpatient blocks, you will be allowed one day off per seven days worked, which are preferred to be taken one per week. On elective outpatient rotations and on outpatient clinic weeks, the work schedule is Monday through Friday with Federal Holidays off as well.

Residents in our training program are preparing to become not only general internists but also military medical officers, in a time where the latter skills will undoubtedly be required and tested in any staff position that they fill after their training. Our graduating residents have been increasingly tasked to serve in vital military roles, ranging from battalion and flight surgeon positions to intensivists in combat support hospitals. Military unique training opportunities provided through a variety of educational programs provide our trainees with the medical knowledge, patient care skills, and systems-based practice understanding to be successful military medical officers.

Many Army internists serve in operational medical roles after graduation, providing care to soldiers both at home and deployed. The variety of practice environments in which these individuals find themselves, both equipped and austere, present a unique set of challenges and skills an effective military physician and officer must embrace and develop. The current operational tempo frequently places military internists in practice situations where they must also be fully capable of performing initial trauma resuscitations, including basic and advanced trauma life support. Internal medicine physicians are essential members of the military health care team due to their expert recognition and management of so-called “disease non- battle injuries” due to medical illness or infectious diseases in foreign environments. Military medical personnel must also be competent in the area of disaster medicine, because of the potential to care for patients during mass casualty events in future duty assignments. As terrorism remains a real threat in the United States and the rest of the world, an understanding of the manifestations and management for casualties of chemical, biological, and nuclear attacks remain a real and important additional responsibility for a military physician.

All interns are required to complete the Combat Casualty Care Course (C4) during their PGY-1 year. In addition to the educational opportunities detailed above and offered as part of the residency curriculum at Womack, residents have the opportunity to pursue a variety of additional external military training opportunities that can be selected during program electives. These education opportunities are strongly encouraged but cannot exceed 3 months total over the 3 years of resident training. Courses that have been selected by our residents in the past are described in detail below. As the course structure, educational resources, goals and objectives, and methods of evaluation are specific and unique to each individual course. Additional details are provided below:

Combat Casualty Care Course (C4)

This is a required course held in Fort Sam Houston, San Antonio, Texas during PGY-1. This course is required if not already completed during medical school (USUHS graduates, Bushmaster). C4 is a basic 8-day tri-service continuing medical education program designed to enhance the operational medical readiness skills of physicians, nurses, physician assistants, dentists, and other specialty healthcare providers.

CAPSTONE

This is a course that all 3rd years will take at the very end of their residency (usually May-June of the PGY3 year) here at Fort Liberty. This will be coordinated by GME and will also have built in “transition to practice” sessions. This is mandatory.

Operational Medicine Elective

This elective is a mandatory 2-week elective in the PGY3 year with an optional 2-week extension. The aim of this curriculum is to ensure that graduates of the Womack Army Medical Center Internal Medicine Residency are prepared to function as a unit-level provider, both academically as a doctor and professionally as an Officer in the U.S. Army. PGY3’s will work with embedded medical units outside of the hospital, learning the balance between the medics, medical service corps officers, brigade/battalion-level leadership, and the brigade/battalion surgeons. Residents will see patients in a sick call type environment, attend meetings with the medical providers and leadership, gain experience writing medical profiles and tracking unit health, and understand when to refer Soldiers for a Medical Evaluation Board. See the curriculum for more information.

Jump School / Airborne School

Note that these ARE NOT MEDICAL AND THEREFORE WILL COUNT AS “PROGRAM TIME OFF” against your 105 days total. These are not recommended during residency; however, exceptions can be made, understanding that this will count as program time away in the same way that caregiver leave does (not as charged military leave, but as American Board of Internal Medicine days off).

Medical Management of Chemical and Biological Casualties Course (MCBC)

This course is intermittently presented at Womack in conjunction with the U.S. Army Medical Research Institute of Chemical Defense and the U.S. Army Medical Research Institute of Infectious Diseases over three days in our local auditorium. The course is open to all Services, provides graduate-level classroom instruction with hands-on and field exercises. Attendance at this course meets the chemical/biological training requirements under AR 525-27.

Fundamentals of Critical Care

Taught on site by our staff and faculty in your first month with us.

All residents are required to maintain Basic Life Support (BLS) and Advance Life Support (ALS) certification throughout residency.

We have a robust simulation center within the hospital with numerous resources including code blue simulations, trauma simulations of both humans and Army working dogs, procedure trainers (central lines, lumbar punctures, paracentesis, thoracentesis, arthrocentesis and more), point of care ultrasound trainers, breast exams for cancer. We will soon be incorporating virtual reality training to put you in the deployed environment.

From the moment you arrive, we train you as a leader. We are a small program at a large base with hundreds of thousands of soldiers – most of whom will see you as their senior. Within our small program, you will quickly be tasked with responsibilities within our program perhaps as our social coordinator, or representative to the residency committee. We value resident input to make things better and we work as a small team to make necessary changes. We are dedicated to providing you the skills you need to be both a successful doctor and Army officer. Examples include:

Lectures entitled “The Do’s and Do Not’s of the U.S. Army,” “Do you know your Ranks? (Tri-Service),” and “How to Read your Leave and Earnings Statement.”
Requirements to participate on hospital committees and bring committee updates back to the department.
Unending quality improvement initiatives implementing hospital change.

Scholarly and Professional Development Opportunities

We have a structured curriculum for our research electives. The aim of this curriculum is to ensure that graduates of the Womack Army Medical Center Internal Medicine Residency not only meet all accrediting body graduation requirements for scholarly activity and performance improvement, but also graduate from residency with an understanding of the research process that will allow them to independently build a competitive scholarly activity profile.

Research Presentation Opportunities that our residents have been sent to:

Tri-Service American College of Physicians Meeting (In Washington, D.C. or in San Antonio, Texas)
Cape Fear Valley Research Symposium (local)
Specialty Conferences (CHEST, Gastroenterology)
National American College of Physicians Meeting

Residents are required to participate in at least one quality improvement initiative. This may be something simple such as recognizing a gap in their own patient care and setting a plan to improve it. This may also include sitting on a root cause analysis board for the hospital or submitting a patient safety event. For one example, a few of our residents created a “procedure notification system” in order for staff to let residents know when a procedure was being performed in order to increase resident involvement.

Participating Sites

Womack Army Medical Center, Fort Liberty, North Carolina
University of North Carolina, Chapel Hill, North Carolina
Fayetteville Veteran's Affairs, Fayetteville, North Carolina
The United States Special Operations Command, Fort Liberty, North Carolina

Applicant Information, Rotation and Interview Opportunities

We offer 4th year medical student rotation opportunities to those thinking about Internal Medicine. Rotations are typically 4 weeks long, though we are flexible based on your interests and medical school time constraints. Rotations for medical students include:

Ward Medicine
Hematology/Oncology consult service and outpatient clinic
Pulmonary consult service and outpatient clinic
Gastroenterology consult service and outpatient clinic
Cardiology consult service and outpatient clinic
Infectious Diseases consult service and outpatient clinic
Nephrology consult service and outpatient clinic

Our interview season starts in May and ends in October every year. We offer both in-person and virtual interviews. Please contact us at dha.liberty.womack-amc.mbx.gme-int-med-residency@health.mil to schedule an interview.

Program graduates take the American Board of Internal Medicine (ABIM) Certifying Examination. This exam is offered annually in August. All Internal Medicine physicians who have met the standards for Board Certification in general internal medicine are considered Board Eligible for a period of seven years. During this period of board eligibility, the candidate may apply for the certifying examination in internal medicine. To be eligible to take this exam, graduates must complete all pre-requisites required by the American Board of Internal Medicine by August 31st.

Teaching Opportunities

In a small program, teaching opportunities are a DAILY occurrence. These include:

Presenting cases at our case conferences
Teaching medical students, physician assistant students and occasionally nurse practitioner students, pharmacy students, and Army medics on wards and in the outpatient setting
Leading SIM scenarios (PGY2’s and 3’s)
Leading Board Reviews (PGY3’s)

Faculty and Mentorship

Faculty supporting the Internal Medicine Residency program have a wide range of subspecialty representation, including: Hematology/Oncology; Pulmonary; Gastroenterology; Cardiology; Infectious Diseases; Nephrology; Rheumatology; Endocrinology; Allergy Immunology; Dermatology; and Neurology.

We have a formalized mentorship program. Residents in the WAMC Internal Medicine Program are assigned a “Personal and Professional” faculty mentor by the program director based on the resident’s preference service affiliation and specialty interest. Residents are free to choose additional mentors on their own. Assigned faculty mentors meet with their resident mentees twice per year. The goals of this program are to help the mentee address their personal, military, and professional (clinical) goals including a review of relevant career pathways within the military, the trainee’s curriculum vitae, and individualized learning plan.

Mentorship of internal medicine residents at Womack Army Medical Center will follow a multifaceted approach. There will be research mentorship as well as personal and professional (P&P) mentorship which may or may not be with the same staff member.

Mentorship Program Aims

Provide a first line mentor the resident may consult for questions regarding personal and professional development and to act as a trainee advocate.
Act as a secondary learning environment for one-on-one discussions of essential educational topics such as diversity, equity, and inclusion, and healthcare disparities in medicine

Mentorship Mentors

P&P mentors will be selected from the academic internal medicine faculty. These mentors will have at least 1 year of staff experience and agree to provide at least 2 hours per month to the mentorship program.

Responsibilities

Program director: will assign initial resident-mentor pairings based on personality, request, mutual interests. The program director will also direct monthly discussion topics and collect feedback from the monthly meetings on MyTipReport.
Staff mentor: will coordinate with the resident to set a mutually agreed upon meeting time and direct discussions and one on one education and act as a role model of professionalism at all times.
Resident: will complete all assigned tasks and participate in discussions

Well-Being

Womack Army Medical Center is dedicated to resident wellness, and the IM Program has a formal program to address this. We have an ombudsman to act as a neutral go-between for residents who have issues with the program leadership, on-site mental health professionals, and time in our curriculum to address well-being. Curriculum time includes:

Processing Experiences in Residency Training (PERT) Meetings

These meetings aim to meet once a month is a group consisting of the IM residents and a faculty moderator. This meeting is meant to allow the opportunity for residents to share common stressors, fears, difficulties in their training to show them that they are not alone.

Program Director (PD) Time

1-2 lecture days per block are reserved for “PD time” where the PD will arrange lectures aimed at educating residents (and staff) on some of the things that often stress us out about life such as understanding your Leave and Earnings Statement (LES), financial planning and investment in your retirement account, how to calculate your commitment to the Army, panel discussions from our colleagues who are currently acting as brigade/battalion surgeons or any topic requested by residents! (It is YOUR residency – let the faculty know what you need)

A ½ Day of Wellness

The program dedicates ½ a day to wellness once every 5-week academic block that does not contain a Friday holiday. It will begin with the PERT meeting and then include one or two short “PD time” topics and early dismissal no later than 2:30 p.m. from all clinical/academic duties to allow residents time to attend personal health or home/vehicle maintenance appointments or to go to the gym or even extra time to hang out with family. If there is a pre-existing training holiday during the block, this will likely count as that block’s wellness day given that in civilian programs, outpatient clinics are not closed for training holidays.

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