Chief Resident's Message

Dear Applicants,

Welcome to the Salem Hospital Internal Medicine Residency Program. I am delighted about your interest in our program. I hope the following information gives you a sense of what makes our hospital a truly special place to pursue your residency training. The residency program and our faculty are committed to excellence in resident training while fostering a supportive environment emphasizing continuous improvement and preparation for independent practice. One of our most treasured traits is that we are a tight-knit group of 27 residents. You will come to learn everyone by their first name and will likely work with each resident at least once during the year.

Our graduates go on to develop successful careers in primary care, hospital medicine, and various subspecialties around the country. Many of our residents choose to stay in or return to Salem Hospital for their clinical practice after graduation.

Clinical Experience

The internal medicine residents at Salem Hospital care for a diverse patient population on the medical floors and the ICU. They work with a multi-disciplinary team consisting of attending physicians, nurses, pharmacists, respiratory therapists, case managers, and social workers. They also work very closely with Physical Therapy, Occupational Therapy, Speech Therapy, and the Nutrition Services teams. This allows for a well-rounded learning experience and seamless patient care for our patients.

Over the three years of training, all residents rotate through multiple specialties, including general internal medicine, critical care, cardiology, emergency medicine and urgent care, neurology, geriatrics, and other subspecialties. Our neurology and medicine consult rotations are done at Massachusetts General Hospital in Boston.

This combination of rotations, including dedicated rotations at the larger tertiary hospitals in Boston, comprises a well-rounded and hands-on clinical experience to help develop a strong foundation in internal medicine for our residents. In addition, we have developed an Addiction Medicine curriculum with an emphasis on teaching and providing our residents with tools to help them care for and manage patients suffering from substance use disorders, emphasizing harm-reduction strategies and medical therapies.

X+Y format

Our schedule follows an “X+Y” format. This means that for 4 weeks (the “X”), residents will work in inpatient care units (ICU/ Wards) or rotate on elective rotations, which could be ambulatory or inpatient, as well (e.g., Gastroenterology, Infectious Diseases, Pulmonology, Palliative Care, etc.).

• The Intern Year contains curriculum that teaches about the complex American healthcare system. Through exposure to different clinical settings, testing facilities, and clinical practices, interns can better understand, utilize healthcare system resources, and select a medical career.

• The Second Year now includes more time for career development, with an increased number of electives allowing the trainees to solifidy knowledge on selected career paths and prepare for fellowship.

• The Third Year of training includes rotations designed to cover the majority of core internal medicine specialties (e.g., Addiction Medicine, Oncology, Cardiology, Geriatrics, and Internal Medicine Consult). It also offers electives to help trainees close medical knowledge gaps before entering fellowships or independent practice.

We were able to make these enhancements to the program by decreasing the number of weeks spent on inpatient service (ICU and Ward) and offering new ambulatory schedule rotations. By better regulating the expectations for inpatient rotations with a new lower set of encounter caps, we are both improving the educational experience while also addressing concerns around workload and burnout.

Y week breakdown

• Continuity Clinic (Categorical Residents)

Our outpatient continuity clinic experience is fantastic and has improved after switching to our X+Y format. Every fifth week of the year, categorical residents will attend their continuity clinics and build their patient panels under the guidance of faculty at a North Shore Physicians Group outpatient site. Residents will care for patients with both common and rare conditions and gain excellent outpatient exposure to managing a diverse set of pathologies. Clinic sites are within a 10-15-minute drive from our main hospital.

• Interdisciplinary Exposure Day (Flex day)

During the Y week, each resident has a Flex Day where they can either work alongside another department or specialty (such as Physical Therapy, Echocardiography, Pulmonary Function Testing Lab, IV Therapy, Nutrition, etc.) to expand their knowledge about how these departments function, or they can use this time for personal development (Studying MKSAP, working on research projects)

• Wellness

To increase resident satisfaction and provide an opportunity for residents to accomplish personal appointments or responsibilities, categorical residents have a dedicated Wellness half day during their Y week that may be used as pleased.  

• Quality Improvement training through the Clinical Process Improvement Program (CPIP)

In line with constant growth and improvement culture, there is a dedicated half-day session for our quality improvement (QI) curriculum where interns, juniors and seniors work together as a team. This focuses on learning about tools that aid in improving the practice of medicine and health care policy. Our Quality Improvement projects are sponsored by the Albright Read Institute for Quality Improvement. Residents are encouraged to initiate their own projects which are carried out longitudinally throughout the year and may be expanded to span all three years of training. Past projects have decreased the use of unnecessary telemetry monitoring; improved central line access; and help with difficult end-of-life discussions.Resident-initiated QI projects have recently been accepted for presentation at local and national society meetings such as the American College of Physicians in MA and the Society of Hospital Medicine.

• Academic Workshops

We have initiated different workshops as a part of Y-week that focus on training the residents regarding patient safety, ICU procedures, multidisciplinary communication and High-Value Care.

Sample schedule

Daily Learning

Well established didactics are integrated all throughout the three years of training at Salem Hospital. Learning occurs in various forms including:

• Morning reports presented by residents under the supervision of attendings from either hospital medicine or subspecialties.
• Noon conferences with topics selected based on residents’ request and presented by subspecialists both from Salem Hospital as well as Massachusetts General Hospital and BWH/Dana Farber Cancer Institute.
• Department of Medicine Grand Rounds on Friday mornings
• Bimonthly Simulation Lab where residents practice and hone their abilities to stabilize patients with direct observed feedback
• Monthly Journal Club
• Monthly Morbidity and Mortality Conference where multidisciplinary specialties are invited to discuss options to treat, prevent and improve medical care.
• Access to MGB Grand Rounds series on internal medicine and subspecialities, based on specific resident clinical interests.

Resident Life

As residents of Salem Hospital, we are fortunate to spend time with each other. both inside and outside the hospital. We are a mixture of both AMGs and IMGs from multiple continents and nations, including North America, South America, Africa, Asia and Europe. During residency, we have developed very close friendships with each other and we truly consider the people at Salem our family away from home. In addition, Salem and Massachusetts have lots to offer when it comes to life outside of work.

Salem is a bustling town with plenty of coffee shops, restaurants, bars and boutiques. We are also a short drive away from several sandy beaches, including Nahant, Lynn and Dead Horse Beach. A short drive north of Salem will take you to the beautiful quaint fishing towns of Rockport, Gloucester and Newburyport, whereas a slightly longer drive will take you to Maine, Vermont and New Hampshire.

The hospital’s proximity to Boston affords the residents the opportunity to enjoy some of the best food, culture, sporting events and night life in New England.

Thank you again for considering Salem Hospital Internal Medicine residency program as your training program in the US. I could not be happier to have spent three years as a resident here and I am honored to be the 2023– 2024 Chief Medical Resident

Please do not hesitate to contact me with any additional questions.

Best wishes,

Muhammad Akash, MD
Chief Medical Resident