The Creighton View on GME
By Jaya Raj, MD, FACP, Program Director & Vice Chair of Education Internal Medicine at Creighton University, School of Medine
From Print Issue - Spring 2023
In 2017, an alliance was formed to strengthen and expand graduate medical education in Arizona. Creighton University, Dignity Health St. Joseph’s Hospital and Medical Center, Valleywise Health and District Medical Group joined together in the Creighton University Arizona Health Education Alliance. The Alliance provides learners with essential patient-care experience in prominent mission-focused Phoenix facilities. Together, we are training the next generation of physicians and health care providers. With hands-on experience and a commitment to caring for a diverse community, we’re increasing the number of compassionate health care professionals in the region. As we move forward, we’re guided by a spirit of service learning and a commitment to community.
Size and Shape
There are more than 320 residents and fellows currently training at member institutions. We have 16 residencies and fellowship programs. Residency programs include emergency medicine, family medicine, internal medicine, obstetrics and gynecology, podiatry, psychiatry, radiology-diagnostic, and surgery. Fellowship programs include child and adolescent psychiatry, emergency medicine ultrasound, gastroenterology, global women’s health, healthcare disparities, hospice and palliative medicine, surgical critical care and burn, and women’s imaging.
Creighton University has a strong commitment to increasing the diversity of the healthcare workforce, promoting an equitable and inclusive environment, and fostering a sense of belonging among all its residents, students, and faculty. The Internal Medicine program has made it a top priority to recruit students with diverse backgrounds, experiences, cultures, and perspectives. Our residents and faculty come from all over the country and from many different areas of the world. We place a heavy emphasis on recruiting residents from groups which are traditionally underrepresented in medicine in order to better meet the needs of our diverse patient population. Currently, 46% of our categorical Internal Medicine residents identify as women and 27% identify as Black or African American, Hispanic/ LatinX, or Native American.
GME Team
There are multiple supporting resources the Creighton Alliance provides. These include academic support (e.g., interviews and board exam prep), scholarly activity and research, faculty development for our physician and healthcare faculty, wellness, and the GME program.
Breadth and Depth of Training
Internal Medicine (IM) is a broad medical specialty which encompasses Ambulatory Internal Medicine, Hospital Medicine, and a wide array of subspecialties. Our residency is 36 months in length, during which residents spend at least 12 months on the general inpatient wards, 3-6 months in the medical intensive care unit, and 10 months in the ambulatory setting. They also rotate through all the subspecialties of Internal Medicine, including Cardiology, Pulmonology, Hematology and Oncology, Gastroenterology, Infectious Disease, Endocrinology, Nephrology, Allergy, Addiction Medicine, Geriatrics, and Rheumatology. At the completion of residency, trainees are eligible for board certification in Internal Medicine. Physicians who wish to subspecialize must complete anywhere from 1-6 additional years in fellowship training.
Uniqueness
Our IM Residency Program has a total of 85 residents in the program: 26 categorical residents per year plus 7 preliminary interns. Residents rotate at both St. Joseph’s Hospital and Valleywise Health Medical Center, thus gaining a broad exposure to a diverse patient population with a wide range of pathology. They also rotate to the St. Vincent de Paul Clinic, which provides free medical care to uninsured patients. Thus, our residents care for a large portion of the medically underserved population in Phoenix in at least three different settings and healthcare systems. This is a core value of Creighton, a Jesuit institution, which is dedicated to the care of the whole person and service to others.
What Makes IM Residents Successful
Excellent interpersonal and communication skills are essential. The ability to relate to and communicate effectively, respectfully, and collaboratively with people who have different viewpoints, backgrounds, and areas of expertise is essential. The most successful residents are great team players. They are also self-reflective and are constantly striving to improve their knowledge and skills.
Incorporating Med Tech
Medical technology is changing rapidly. Point of care ultrasound (POCUS) is one of the most exciting and useful technical advances in medicine. Our residents receive hands-on training in bedside POCUS to aid in more rapid, accurate diagnosis of common acute conditions such as pneumothorax, heart failure, and deep venous thrombosis.
Obstacles for Attending Physicians
Physicians work long hours, cope with stressful situations, and juggle many responsibilities. Teaching faculty have additional roles and responsibilities on top of their clinical duties. They must be knowledgeable about adult learning theory and pedagogy. They must strike a balance between experiential and didactic teaching and provide residents with supervision while granting them autonomy. These are skills which are not necessarily taught in medical school. They are acquired with time and dedicated practice.
Physicians who teach residents and students find it incredibly rewarding. It is a pleasure and a privilege to watch them grow into compassionate and clinically outstanding physicians who will shape the future of U.S. healthcare.
Where They Go Next
Over the past 3 years, roughly 575 of our residents become hospitalists, 6% choose a career in Primary Care, and 37% subspecialize. Our residents have matched into highly competitive fellowships in Cardiology, Pulmonary and Critical Care Medicine, Gastroenterology, Hematology and Oncology, and Rheumatology, to name just a few. Approximately 43% of our internal medicine graduates stay and practice in Arizona. Many have stayed and joined our faculty at Creighton.
IM residency programs feed into all the subspecialties mentioned above. The Internal Medicine program at the Creighton Alliance has its own IM fellowships in Gastroenterology, Hospice & Palliative Care, and a newly approved program in Cardiology.
What the Future Holds
The landscape of medicine and healthcare is constantly changing, and medical education must evolve to meet the needs of our patients and our community. In addition to educating residents about new diagnostic tests, treatment strategies, and technologies, we need to educate them about medical ethics, the business of medicine, the science of healthcare delivery systems, social determinants of health and healthcare disparities, social justice and public policy. We must teach them to be clinicians, scientists, healers, advocates, teachers, and leaders.
About the Author:
Jaya Raj, MD, is the Program Director of the Internal Medicine Residency program at Dignity Health - St. Joseph's Hospital and Medical Center. She also serves as the Vice Chair of Education Internal Medicine at Creighton University School of Medicine - Phoenix. Dr. Raj has more than fifteen years of experience in teaching residents and medical students, including 10 years as a residency program director. She is board certified by the American Board of Internal Medicine. Dr. Raj obtained her medical degree from Columbia University College of Physicians & Surgeons. She can be reached by calling (602) 406-7564.