Internal Medicine Residency Program

The WBAMC Internal Medicine (IM) Residency is a three-year training program after which successfully graduated residents will be eligible for board certification in Internal Medicine.  Our program has an approved total complement of 33 trainees.  A typical residency class consists of 8 Active Duty residents and 3 Civilian residents sponsored by the Veteran's Administration (must be US citizen).
 
Program Director’s Message
The Internal Medicine training program at William Beaumont Army Medical Center is one of the best kept secrets in Army Medicine. We can promise you a great education because we have a lot to offer: breadth of pathology, ample volume, hands-on procedural training, diversity of patients and staff, and a cohesive community of residents and teaching faculty. 

Some examples of the numerous educational resources available to you at WBAMC include: a simulation center which is located within the hospital and available for use by trainees and educators at all hours; collaborative partnerships with local medical centers; point-of-care ultrasound training; and daily didactic conferences with a mixture of case-based learning, EBM education, and board preparation. 

Residents will train in a supportive, collegial environment with easy access to general medicine and sub-specialty staff.   The small size of our hospital allows for hands-on procedural experiences without the added challenge of competing fellows or other primary care trainees.  Our academic curriculum is anchored by a strong core of skilled teaching faculty who are enthusiastic about medical education.  By the end of their training, WBAMC residents are ready for independent practice with a skillset rooted in patient ownership, critical thinking, and evidence-based management.

Our program is especially unique in that we are a blended military and civilian training program.   We accept three civilian VA-sponsored residents per year.  These VA residents must be US citizens but incur no obligation to the military or to the VA.  This rare partnership with the El Paso VA health care system expands our team of invested teaching faculty and provides a wide breadth of complex and interesting patient pathology.  It also offers an ideal solution for dual physician couples in which one trainee is active-duty and the other is not.

The city of El Paso provides a perfect opportunity for work-life integration.  We have fantastic weather, affordable housing, numerous outdoor and cultural activities, and a low crime rate (consistently in the top ten safest large cities in the US).  Multiple national parks and forests are also an easy day-trip away!
As Program Director, I am whole-heartedly committed to the wellness and education of our residents.  It is an honor to have the opportunity to coach and mentor them each day in their growth as physicians.   I sincerely hope you find what you’re looking for in all that our program has to offer!
 
Please do not hesitate to contact us with any questions!
Program Director
Internal Medicine Residency
William Beaumont Army Medical Center
4th Floor East Clinic, Room # 4370
DOM/Internal Medicine Clinic
18511 Highlander Medics Street
Ft; Bliss, TX 79918
Phone (915) 742- 0399 FAX (915) 742-4902


 Academic Schedule Overview
The academic year is divided into 13 four-week blocks.  For a PGY1 resident, the year consists of approximately 70% inpatient and 30% outpatient care.  These numbers gradually shift in favor of more outpatient rotations as residents progress through their training.  By the PGY3 year, rotations are approximately 50% inpatient duties and 50% outpatient duties.   Continuity clinic in the Internal Medicine Clinic (IMC) is sprinkled in as half-days of clinic throughout these 13 blocks.  This is in addition to a dedicated IMC 4-week rotation each year.  The program has transitioned to an X+Y schedule for residents on 1 July 2023.

Program Curricula Overview

General Internal Medicine (Ambulatory and Hospital Medicine)

In the IMC, residents are will gain clinical knowledge in the management of acute, routine, and chronic medical conditions commonly encountered in ambulatory medicine.  Visits consist of new patient evaluations, acute care management, and health maintenance evaluations across a broad range of disciples including primary care, women’s health, musculoskeletal/sports medicine, procedural care, and preventive medicine.  This environment also stimulates the development of office-based technical skills, clinical decision-making, and systems-based problem-solving in the outpatient setting. Special emphasis is made on patient education, anticipatory guidance, and indications for referral to a consultant or sub-specialist. Each resident is expected to carry a cohort of continuity patients during their 3-year residency.  

Critical Care Medicine

Residents will rotate on the MICU service multiple times throughout their three years of training with a combination of day and night schedules.  Learners will gain clinical experience with diagnosis and management of a wide variety of core critical care illnesses.  As we do not have fellowships at our institution, residents have first-pass at all MICU procedures including central venous access, arterial access, intubation, chest tubes, lumbar punctures, and others.  Our critical care staff are exceptional clinical educators who are committed to making MICU rounds fun and educational for all levels of learners. 

Allergy/Immunology

 Residents rotating on the Allergy/Immunology service will gain experience with diagnosis and management of a broad range of conditions, including but not limited to: Asthma, Immune deficiency, Food Allergy, Allergic and Non-Allergic Rhinitis, Chronic Urticaria, Angioedema and Anaphylaxis, Medication Reactions, and Sting Hypersensitivity. The rotation includes evaluation of both new and chronic patients.   Residents also have the opportunity to observe and interpret skin testing, pulmonary function testing, and delayed-type hypersensitivity skin testing.  Faculty routinely lead educational sessions to assist with board review.
 

Cardiology (Inpatient and Outpatient Services)

 
The Cardiology service provides comprehensive care of all adult patients with cardiovascular disease in the supervised environment of the Coronary Care Unit, inpatient cardiac ward, and outpatient clinic. The Cardiology service performs 750-900 heart catheterizations and about 120 PTCA/Stents each year. House staff on elective will be exposed to the diagnostic procedures and therapeutic interventions necessary in the care of cardiac patients.  Residents gain proficiency in EKG interpretation as well as evaluation of an adult cardiac patient in the outpatient setting.

Pulmonary

The Pulmonary rotation is a four-week, predominantly ambulatory sub-specialty clinic rotation.  Residents will have experience evaluating new and established patients with a wide-range of acute and chronic pulmonary conditions.  Additionally, residents will have the opportunity to participate in the Pulmonary Function Lab as well as the bronchoscopy suite.  Our Pulmonologists are passionate clinician educators and routinely integrate board-relevant teaching into their clinical practice with resident rotators.  Several of the staff are actively engaged in clinical research projects with multiple publications and residents may have the opportunity of being co-authors when time allows.  Residents will be responsible for inpatient pulmonary consults as well which adds to the learning experience.

Dermatology

Dermatology service offers a one month outpatient rotation for house officers and medical students. This is a high volume clinic, serving patients across the life span with skin disorders.  During the rotation, residents will become familiar with diagnosis and treatment of skin conditions including melanoma and non-melanoma skin cancers, infectious skin diseases, psoriasis, contact dermatitis, atopic dermatitis, autoimmune skin disease such as discoid lupus and sarcoidosis, lichen planus, acne, drug exanthema, and psuedofolliculitis barbae. They will also get hands-on experience with performing cryotherapy, laser treatments, phototherapy, biopsies, simple excisions, and suturing.

Endocrine Clinic

The Endocrinology Service offers a one month outpatient rotation for William Beaumont house officers and medical students. The patient mix consists of about 25% diabetes (of the diabetic patients roughly 1/3 are insulin pump users), 25% thyroid disorders (hypothyroidism, hyperthyroidism, nodular thyroid disease, and thyroid cancer), and 50% general endocrinology (pituitary disorders, parathyroid disorders, adrenal disorders, hypogonadism, metabolic bone disease, and unusual lipid abnormalities). The Clinic is active in research and publication.

Gastroenterology

The gastroenterology service provides inpatient and outpatient consultative services to the military population. The GI endoscopy suites are co-located with the clinics where diagnostic and therapeutic upper endoscopies and colonoscopies are performed. The residents are exposed to the full range of gastrointestinal and liver diseases. Residents rotate through the clinic where they see a broad range of chronic GI pathology, as well as on the inpatient GI consult service where they see high-acuity GI conditions including upper and lower GI bleeding, decompensated cirrhosis, and other acute biliary disorders.  We currently have one interventional endoscopist at WBAMC.

Hematology/Oncology

The WBAMC Hematology/Oncology Service prepares house staff to evaluate and manage patients with cancer and hematologic abnormalities. The setting spans the entire range of inpatient and outpatient hospital and clinic care at the home of terminally ill cancer patients. Skills are honed with characteristic presentations of common cancers and strengthened with a challenging mix of unusual presentations of common malignancies and less commonly seen cancers.  A wealth of diverse opportunities allows for the gaining of additional expertise. Medical and Surgical inpatient consults, outpatient follow-up of cancer patients or evaluation of common hematological abnormalities, pain management, management of cancer complications and end-of-life issues and terminal cancer patient care are vital areas of expertise that the practicing Internist of today must possess.

Infectious Disease

During a one-month rotation with the Infectious Disease Clinic, residents will gain an understanding of the diagnostic approach to infectious disease problems, the treatment of recognized infections, and empirical therapy for presumed infectious processes. Particular attention is directed towards the following common ID problem/topics:  Antibacterial, Antiviral, and Anti-fungal therapy Principals Interpretation of the Gram's Stain, AFB stains, Fungal preparations, Pneumonias, Upper Respiratory Infections, Skin and Soft Tissue infections, Urinary Tract Infections, Intraabdominal Infections, Menigitis, Encephalitis, Brain Abscess, Endocardits, Vascular infections, Diarrheal Diseases, Hepatitis, Diabetic Foot infections, Infections in the HIV-positive patient, HIV infection, Infections in Transplant Recipients, Antibiotic Prohylaxis Fever of Unknown Origin, Travel Medicine Immunization Recommendations, Nosocomial Infections and Principals of Infection Control.
Residents will learn to integrate medical history, physical examination, radiographic studies, and laboratory tests to evaluate and treat infectious diseases. Principals of regular re-examination and/or more detailed and directed history-taking are emphasized.

Residents will learn:

1. Proper collection and handling of clinical microbiological specimens
2. Proper procedure for Gram's Stain performance
3. How Acid-Fast, Giemsa, Silver, and other stains are performed.
4. Various methods for detection of fungi.

Nephrology

The Nephrology service offers an inpatient and outpatient clinical rotation for medical trainees. Rotating trainees are responsible for evaluating patients under the supervision of a staff nephrologist. Educational goals are to provide experience in the evaluation, diagnosis, and treatment of patients with kidney disorders. Didactic lectures and clinical exposure are provided to cover major nephrology topics.

Neurology

Our Neurology curriculum consists of a 4-week rotation at University Medical Center (UMC), one of our partnering affiliate academic institutions in El Paso.  As UMC is a stroke center, residents will gain extensive, hands-on experience with diagnosis and management of high-acuity, critically ill stroke patients, along with other important Neurologic pathologies.  WBAMC also offers an in-house Neurology rotation that is a blend of outpatient Neurology (headache, movement disorders, cognitive diseases, epilepsy, etc…) and inpatient consults.

Rheumatology

The Rheumatology Service provides a 4-week rotation for house officers and medical students. During this time period, rotators will participate in the supervised evaluation of outpatients and hospitalized patients with rheumatic disease. Rotators will gain familiarity with rheumatic ailments including rheumatoid arthrithis, systemic lupus erythematosus and other connective tissue diseases, crystalline arthropathy, the vasculitides, the seronegative spondyloarthropathies, and osteoarthritis. In addition, rotators will be instructed in diagnostic arthrocentesis and therapeutic injection for various rheumatic diseases. House officers will attend noon report and didactic lectures. Rheumatology-specific rotation teaching will be comprised of short didactic lectures, patient encounter specific teaching, case-based questions, radiology rounds, and joint simulator instruction. House officers are encouraged to engage in an aggressive reading program and will complete a pre and post rotation quiz to assess incoming knowledge, guide didactic teaching while on the rotation, and assess knowledge acquisition.

Geriatrics

During the PGY2 or PGY3 year, residents will rotate at the Texas Tech Permian Basin, Odessa, TX for a Geriatrics rotation. The primary purpose is to educate the residents on the art of caring for the elderly, disabled, and terminally ill patients.  The educational goals of the rotation include: demonstrate an understanding of the diagnosis and treatment of Geriatrics related problems;  demonstrate an understanding for the normal aging physiology, pharmacology, and sociology of the elderly patients; recognize the common diseases of the elderly and when special geriatrics consultation is indicated; assessment of functional performance from both a physiological and sociomedical perspective; resident will provide competent, respectful and compassionate care of the elderly patients in all health care settings. Residents will be exposed to inpatient hospice care, home based primary care, dedicated geriatrics lectures, and supervision by board-certified geriatricians.

Other Electives

The WBAMC IM Residency Program offers a number of other inpatient and/or outpatient electives (both at WBAMC and/or at outside affiliate institutions including:

• Sleep Medicine
• Sports Medicine
• Critical Care Medicine (additional)
• Inpatient Cardiology/CCU (additional)
• Endocrinology

Residents will have the opportunity to learn more about these and other components of our curriculum during their application interview.

Organization Structure

1. The Chief of the Department of Medicine is ultimately responsible for all patient care, teaching, and administrative functions throughout the department.
2. The Program Director (PD) is a senior WBAMC Internist.  She is appointed by the Surgeon General of the U.S. Army for a minimum of four years and is a mentor, administrator, educator, advisor, recruiter, and consummate manager of all vital functions in the residency program.  RRC-IM criteria for the Program Director requires that no less than 50% of her professional effort  be dedicated to educational and administrative activities of the program. The Program Director chairs the Department of Medicine Education Committee (DOMEC) meetings.  She is board certified in Internal Medicine.
3. The Associate Program Director(s) (APD) is a WBAMC Internal Medicine Faculty member appointed by the Chief of the Department of Medicine and the Program Director who assists in the day-to-day management of the residency program. The APD(s) serves as Chair of the Clinical Competency Committee and conducts semi-annual resident feedback sessions.  He/she is responsible for developing and overseeing the mentoring and research programs, along with a variety of academic curricula (simulation, humanities, wellness).  The APD(s) plays an active role in residency recruitment.  Per RRC-IM guidelines, the APD must devote at least 20 hours per week toward program-related efforts (this time commitment may be divided if there is more than one APD).
4. The Chief of Medical Residents (CMR) is a member of the Department of Medicine and is a Core Faculty member for the residency program. He/she acts as the direct liaison between the house staff and the other medical staff. He/she is responsible for the academic and administrative management directly related to the house staff to include coordinating/implementing the department's academic curriculum and scheduling rotations for house officers. The primary duties of the CMR are education and mentorship of the residents. All efforts will be made by the Program Director to minimize non-program related duties.
5.  The Program Administrator (PA) is responsible for the day-to-day administration of the residency program and reports directly to the PD.  The PA functions as a liason among the PD, the training site administration personnel, and the Designated Institutional Official (DIO)/Director of Medical Education (DME), as well as other department, division, resident, medical student, and outside agency personnel (American Board of Internal Medicine [ABIM], ACGME, Electronic Residency Application Service [ERAS], National Residency Match Program [NRMP]).    
6. The Resident Research Coordinator(s) is/are staff members with research expertise, dedicated to coordinating and optimizing research output by the Internal Medicine residents. He or she provides expertise and mentorship in project concept, design, statistical analysis, presentation, and publications. The coordinator helps in preparation of abstracts and presentations for the Army American College of Physicians (ACP), Far West Texas ACP Clinical Vignette competition, Texas ACP, and WBAMC Research Day. He or she also promotes publications to include the El Paso Physician, Military Medicine, and other peer-reviewed journals. Finally, he/she is responsible for tracking resident research activity.
7. The Designated Institutional Official (DIO)/Director of Medical Education (DME) provides institutional oversight to all the residency programs at WBAMC. The DME chairs the monthly Graduate Medical Education Committee meeting which is attended by the Internal Medicine PD, CMR, Chief of Department of Medicine, PA, and a medicine resident representative.
8. The Ombudsman is a designated non-biased institutional representative who is available to serve as a resident advocate.