Department of Medicine
Theodore E. Woodward Professor and Chair
Frank M. Calia, MD, MACP
Faculty in the Department of Medicine teach the body of medical knowledge necessary to diagnose and treat the illnesses of adults. Most interests often care for patients over the long term, establishing a therapeutic relationship in a continuity practice.
The internal medicine practitioner is called an internist and can be a generalist, subspecialist or hospitalist. General internists deal with the broad and comprehensive illnesses that affect adults. They are recognized as experts in diagnosis, in treatment of chronic illness, and in health promotion and disease prevention. Hospitalists are general internists who care for primarily inpatients. Internal medicine subspecialists are expert in the diagnosis and management of a specific system or type of disease. An internist may be a cardiologist, an endocrinologist, a gastroenterologist, a rheumatologist or a practitioner in one of the dozen or so specialties of internal medicine. But the internist always remains the physician (or the diagnostician as internists were called in former times) whose special competence is solving difficult diagnostic problems and personally applying or obtaining from a colleague the best treatment available.
The term internal medicine, which derives from the German Innere Medizin, was first used during the nineteenth century when many American physicians traveled to Germany and Austria for training in what were then the leading clinics and medical laboratories. According to one medical historian, “Within a decade or so after 1880, internal medicine was differentiated from ordinary clinical medicine, the simple natural history of disease, by emphasizing that it was based on experimental work in physiology and physiochemistry.” Internists have always required special training to acquire their knowledge and skills and have continuously shown a particular interest in the scientific basis of clinical work.
Educating medical practitioners for the state and the nation is the principal training responsibility of the faculty of the Department of Medicine, but they also seek to develop in some students a desire to make useful discoveries through basic science or clinical research. Internists have often made fundamental advances in the causes and treatment of disease. For example, the work on cholesterol metabolism which in 1985 brought the Nobel Prize in Medicine and Physiology to two internists, one a gastroenterologist and the other a geneticist. In keeping with this traditional devotion to the value of research, the Department of Medicine provides many opportunities for students to participate in research and strongly encourages all who may have an interest to experience laboratory work with investigators.
First and Second Years
The Department of Medicine faculty teach in the first-year Cell and Molecular Biology, Neurosciences and Functional Systems blocks, and in the second-year Pathophysiology and Therapeutics, Host Defenses, Infectious Disease and Epidemiology and Preventive Medicine blocks. In addition, faculty serve as preceptors for Introduction to Clinical Medicine.
History and Physical Examination
Eliciting an accurate story of the patient’s complaints (the history) and detecting abnormal findings by physical examination constitute the fundamental skills of every physician. To acquire these abilities, students attend introductory lectures from members of the faculty. Afterwards, groups of two students meet weekly with instructors in one of the University of Maryland’s teaching hospitals. The students interview and examine patients with a wide variety of illnesses and then discuss the findings with their teacher who correlates the observations with pathophysiological abnormalities being studied in basic science courses. The course also includes small group sessions with instructors from neurology, pediatrics and psychiatry. This will be incorporated into the Introduction to Clinical Practice block given longitudinally in the sophomore year.
This is the fundamental course in internal medicine for medical students. The clerkship lasts 12 weeks with eight weeks of inpatient internal medicine and four weeks of ambulatory internal medicine. For eight weeks, the students work with the medical teams caring for inpatients at two of the department’s three primary teaching hospitals: University of Maryland, Baltimore Veterans Affairs and Mercy Medical Centers. Students may also have a one-month inpatient rotation at one of our Med Star community affiliates, Union Memorial Hospital or Franklin Square Hospital. Students join the interns, residents, and nurses for work rounds at 7:00 a.m., attend Morning Report at 8:15 a.m., and participate in daily teaching rounds with their faculty attending at 9:00 a.m. Conferences are held daily; some are case-based sessions facilitated by members of the faculty and are designed to teach problem solving ability. During other sessions, students join the residents and faculty at medical grand rounds, morbidity and mortality, ambulatory conference and journal club. During the afternoons and evenings, clerks participate in the care of the team’s patients. Students obtain histories, perform physical examinations, obtain and evaluate other aspects of the patient’s database, and develop a differential diagnosis and treatment plan with the residents and faculty. During the four weeks of ambulatory medicine, students are assigned to one of several university-based or community sites where they are introduced to the basic concepts of ambulatory medicine. These include problem focused assessments, decisions about urgent care issues and principles of access and continuity of care. Students may spend time in acute walk-in clinics, general medicine clinics, as well as selected subspecialty clinics.
Student Internship (Subinternship in Medicine). The 4-week student internship in internal medicine, all of which must be spent on the medical services at the University of Maryland, Baltimore Veterans Affairs or Mercy Medical Centers. These inpatient services include general medicine teams, subspecialty services, such as infectious diseases and oncology, and intensive care units, such as the Coronary Care Unit and Medical Intensive Care Unit. Student interns function in the capacity of graduate physicians under the close supervision of the resident and attending physician. Subinterns are on-call in the hospital with their resident physicians one out of four nights. The amount of responsibility delegated to subinterns depends upon the extent of each student’s knowledge, dedication and maturity. Successful completion of a subinternship in medicine provides superb preparation for residency training in any field.
Electives in Internal Medicine
The Department of Medicine also offers senior students a broad range of electives in the inpatient and outpatient settings. Students may participate in general medicine clinics, subspecialty rotations, and the combined medicine elective, which offers condensed rotations to allow the student exposure to multiple specialties. Students participate as active members of the consultative teams and receive intensive instruction on the diagnosis and management of individual organ systems, such as the heart, kidney and lung.
Laboratory and Clinical Research Electives. The faculty of the Department of Medicine strongly encourages all students to join them on a full-time or part-time basis to participate in research projects being conducted in the department. This experience may be scheduled at most times of the year. Students with an interest in investigation should talk with members of the faculty or the chair about the many opportunities available in the Department of Medicine.
Training in internal medicine continues after graduation from medical school in the Department’s residency program. Approximately 50 graduates from leading medical schools are appointed to first year residency positions on a competitive basis. Residents receive their training at University of Maryland and the Baltimore Veterans Affairs and Mercy Medical Centers in addition to numerous ambulatory sites. Most first year residents continue their training in internal medicine for an additional two years, thus becoming eligible for certification as diplomats of the American Board of Internal Medicine. A four-year medicine-pediatrics track is available to individuals interested in certification in both internal medicine and pediatrics. Also, a five-year track in internal medicine-emergency medicine is available. All residents receive intense clinical training in primary care and the medical subspecialties in a variety of ambulatory and inpatient settings under close guidance of the department’s faculty. While completing the broad core curriculum, residents have the opportunity to explore clinical and basic science research areas or engage in individualized electives. Residents are expected to develop their leadership, teaching and professional skills while gaining expertise in the vast expanse of internal medicine. Residents completing the training program are very successful at securing subspecialty fellowship, primary care or hospitalist positions of their choice throughout the country. Several of the graduates continue in academic positions both at the University of Maryland and other institutions.
Subspecialty Fellowship Training
Residents interested in subspecialty training may compete for any of the 13 subspecialty fellowships offered in the Department of Medicine. Depending on the subspecialty, training continues for one to four years. Fellows receive extensive clinical training and opportunities for clinical and basic science research.