Internal Medicine Residency Program

The WBAMC Internal Medicine (IM) Residency is a three-year training program leading to eligibility for board certification in Internal Medicine. A typical residency class consists of 6-8 Army residents and 2-3 civilian (US citizen) residents sponsored by the Veteran's Administration for a total of 25-30 total residents training during any given training year. First year residents are often referred to as PGY-1s. Alternatively residents may be referred to by their year of training. Post Graduate Year 1 (PGY-1), Post-Graduate Year 2 (PGY-2), and Post-Graduate Year 3 (PGY-3). To confuse things further, sometimes the residents are also referred to as R1, R2, or R3 to again designate their years of training and a fully trained physician in Internal medicine is called an internist.

Program Director's Message

The internal medicine training program at WBAMC is one of the best kept secrets in Army Medicine. We can promise you a great education because we have a lot to offer: pathology, procedures, volume, small size, and a diverse ethnic population.

We have no competing fellowships or primary care programs so residents and students gain tremendous hands on experience. You will have unparalleled access to both general and sub-specialty staff. As one of the smaller medicine residencies, we promise that you will not get lost in the crowd. Our residents have much input into the curriculum and structure of the residency program. As a result, the program's culture is close-knit, our residents own their program experience, and graduate ready for independent practice. Roughly half of our graduating residents proceed to fellowship training on a yearly basis.

A unique aspect of our program is our relationship with the El Paso VA health care system. We provide primary hospital services for El Paso's veterans with a catchment area encompassing a several hundred mile radius. We accept three civilian VA-sponsored residents a year. The VA residents must be US citizens but incur no obligation to the military or to the VA. This relationship is extremely rewarding in that it expands our pool of invested staff and consistently provides a large volume of patients with complex and interesting pathology. It also offers an ideal solution for dual physician couples where one is military and the other is not.

Vital to a high Quality GME program are faculty who are well versed in not only medicine but also in teaching techniques. At WBAMC we offer faculty development, improving your experience and education. We are passionate about the quality of teaching for our residents and the competency and confidence of our graduates. We strive every day to promote and develop a great program.

El Paso offers residents a perfect work-life, balance, fantastic weather, affordable housing, minimal traffic, and a low-crime rate (consistently in the top 3 of safest large cities in the US), plus all of the entertainment and amenities you might expect in a large city (metropolitan area with population ~2,000,000). New Mexico is minutes away and multiple national parks and forests are an easy day trip away. Come check out the Sun City.

I am a proud of graduate of WBAMC IM Residency, a former Chief Resident, and fellowship trained--and I chose to come back because I believe in the quality of the program and the residents who train here. If you are interested in joining a residency where hard work, learning, curiosity and scholarly pursuits are balanced with a strong sense of Esprit de Corps and comradery, then please contact us.

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 is a senior WBAMC Internist. He is appointed by the Surgeon General of the U.S. Army for a minimum of four years and is responsible for the day-to-day administrative management of the training program. RRC-IM criteria for the Program Director include 50% professional-time dedicated to the program. The Program Director chairs the monthly Resident Education Committee. The program director is board certified in Internal Medicine, Psychiatry and Psychosomatic Medicine, and Critical Care Medicine.
3. The Associate Program Director is a WBAMC Internist 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 and enhances his/her knowledge of medical education through attendance at special courses and through special educational readings. The Associate Program Director chairs the Curriculum Committee and Clinical Competency Committee (CCC). Per RRC-IM guidelines the Associate Program Director must devote at least 20 hours per week toward program related functions.
4. The Chief Medical Resident is a member of the Department of Medicine staff. He/she acts as the direct liaison between the housestaff and the other medical staff. He/she is responsible for the academic and administrative management directly related to the housestaff to include coordinating/implementing the department's academic curriculum and scheduling rotations for house officers. The Chief Resident's primary duties are teaching and mentorship. All efforts will be made by the Program Director to minimize non-program related duties.
5. 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 prepares an annual report of all resident research activity.
6. The Education Technician supports the administrative needs of the residents, Chief Resident and the Program Director.
7. The Director of Medical Education (DME), provides institutional oversight to all the residency programs at WBAMC. The DME chairs the monthly Graduate Medical Education Committee. The Program Director, Chief Medical Resident (CMR), Chief of Medicine, and an Internal Medicine resident represent the Internal Medicine Residency program. All are voting members except the CMR. The DME also oversees the other training programs at WBAMC to include General Surgery, Orthopedic Surgery, and the Transitional Internship.
8. The ombudsman is a designated non-biased institutional representative who is available to also serve as a resident advocate.

Outpatient Clinics

Internal Medicine Clinic

Resident continuity clinics in our new Internal Medicine Resident clinic provide for comprehensive quality care for patients in a supervised environment. Residents are expected to gain clinical knowledge in the management of acute, routine, and chronic medical conditions commonly encountered in ambulatory medicine. This environment also stimulates the development of office-based technical skills, decision making, and 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. All house staff are usually assigned one half-day/week clinics in the morning or afternoon. In each year of the program there are month-long rotations in the Outpatient Internal Medicine Clinic doing a specially designed Ambulatory Care Rotation aimed at enhancing skills in new patient evaluations, acute care management, and health maintenance evaluations for bone density, women's health, men's health as well as cancer screening.

Cardiology

Pulmonary Clinic

The Pulmonary Clinic at WBAMC operates out of the Pulmonary clinic, and Pulmonary Functions Lab. There are 4 full time board certified pulmonary sub specialists. Approximately 350-550 patient contacts are made in the clinic each month. A wide spectrum of pulmonary diseases are encountered.

About 10-20 fiberoptic bronchoscopy procedures are done each month. In addition, the lab performs 400-500 pulmonary function studies each month to include bronchial challenge testing with methacholine and exercise. There are more than 150 arterial punctures/month performed for ABG [Arterial Blood Gas] analysis. Also located in the clinic area is a fully equipped state of the art exercise physiology lab where cardiopulmonary exercise testing is performed when clinically indicated and for research purposes.

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. This is an excellent rotation for improving outpatient diagnosis and management of common pulmonary diseases. Also, residents are responsible for inpatient 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 including outpatient skin surgeries.

During their rotation a rotator will become familiar diagnosis and treatment of skin conditions including melanoma and non-melanoma skin cancers, infectious skin diseases, psoriasis, contact dermatitis, atopic dermatitis, autoimmune skin dz 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 to include hepatitis C. Residents rotate through the clinic where they are exposed to the full range of gastrointestinal diseases. 

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.

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

The Neurology Service engages rotating medical students and WBAMC house officers in a patient-focused didactic program. Despite the setting within a military hospital, the patient population mirrors that of a civilian neurological practice in that the majority of patients (approximately 55-60%) are retirees. Upon completion of the rotation, the diligent student will be knowledgeable in the management of a variety of headache disorders, seizure disorders, and stroke. The rotator will also become adroit in the performance and interpretation of the mental status and neurological examinations. The rotator will receive an extensive collection of up-to-date review articles on the various common neurological disorders, as well as exposure to outpatient neurology and inpatient consultative neurology. In addition, the Neurology Service (including a pediatric neurologist) works closely with the Neurosurgery and Physical Medicine Services. 

Rheumatology

The Rheumatology Service provides a 4-week rotation for William Beaumont 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 morning 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 R2 and or R3 year, resident 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.

Educational goals are:

1. Demonstrate an understanding of the diagnosis and treatment of Geriatrics related problems.
2. Demonstrate an understanding for the normal aging physiology, pharmacology, and sociology of the elderly patients.
3. Recognize the common diseases of the elderly and when special geriatrics consultation is indicated.
4. Assessment of functional performance from both a physiological and sociomedical perspective.
5. 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.