Chief Resident's Message

Hello and welcome!

We are thrilled by your interest in our Internal Medicine Residency Program at Salem Hospital! This is a truly special program that is part of a closely connected community where the residents and faculty are like family. At the same time, we are also part of a much bigger interconnected community at Mass General Brigham, which allows for a vast number of unique opportunities within our organization.

While at Salem Hospital, you will quickly get to know everyone by first name and spend time together both in and out of the hospital. Our program is proud to have a diverse group of residents and faculty from all over the world, bringing a variety of experiences and talents that enrich our community.

We train with excellent faculty who are experts in their fields and who are committed to fostering a supportive learning environment to help each individual grow to their fullest potential. The size of our program allows for adaptability and mutual growth, with a goal of continuous improvement together.

Our graduates go on to pursue successful careers in hospital medicine, primary care and a wide variety of fellowships, with many choosing to stay at Salem Hospital or remain in the area. I hope this helps highlight what makes our program at Salem Hospital a special place to train for residency.

Clinical Experience

As an internal medicine resident at Salem Hospital, you will care for a diverse patient population with a wide variety of presentations and pathologies. Whether on the medical floors or in the ICU, you will work amongst a multidisciplinary residency team comprised of nurses, pharmacists, case managers, and social workers, while providing care under the guidance of your attending physician. You will also have many amazing resources to consult for additional care, from physical therapy, respiratory therapy, and nutritional services. This allows for a well-rounded learning experience, while also providing excellent patient care.

During residency you will also have the opportunity to work in multiple different specialties, including but not limited to pulmonary and critical care, cardiology, radiology, neurology, geriatrics, emergency medicine, and urgent care, to name a few. Our neurology and medicine consult rotations can be completed at Massachusetts General Hospital in Boston.

Additionally, many residents will have the opportunity to pursue subspecialty or research rotations at larger tertiary hospitals in Boston where they can work with world-renowned experts and researchers. This allows for a well-rounded clinical learning experience and develops a strong foundation in internal medicine. In addition, we have a robust addiction medicine curriculum which provides our residents with the skills to help care for patients suffering from substance use disorders, emphasizing harm-reduction strategies.

X+Y format

Our schedule follows an "X+Y" format over 5 weeks periods. This is broken down into four "X-weeks" (core inpatient rotations & electives) and one "Y-week" (clinic, workshops, wellness and flex days). During the X-weeks, residents will work on inpatient rotations (ICU/ Wards) or electives (inpatient or ambulatory) in specialties of gastroenterology, infectious disease, pulmonology and palliative care, to name a few.

• Our first-year curriculum emphasizes experiential teaching through various clinical settings, testing facilities, specialty services, and outpatient practices. We also integrate education about the complexities of the US healthcare system. In this way our first-year residents can better understand and utilize the healthcare resources available to them.
• The second-year curriculum includes more time for career development, with an increased number of electives which allows the residents opportunities to solidify their knowledge, prepare for fellowship or work toward a specific career path.
• The third-year curriculum includes rotations designed to cover the majority of core internal medicine specialties, such as addiction medicine, oncology, cardiology, geriatrics, and internal medicine consults. It also offers electives to help the residents improve medical knowledge gaps before entering fellowships or independent practice.

We have also made program enhancements by decreasing the number of weeks spent on inpatient services (ICU/wards) and offering new scheduled ambulatory rotations. Additionally, we have improved expectations on inpatient rotations, and lowered encounter caps to enhance the educational experience while simultaneously addressing concerns around workload and physician burnout.

Y-week breakdown

Continuity Clinic (Categorical Residents)

Our amazing outpatient continuity clinic experience has improved even more after switching to the "X+Y" format. Every fifth week throughout the year, the categorical residents will attend their continuity clinics and build their patient panels under the guidance of faculty at one of the North Shore Physicians Group outpatient sites. Residents will care for patients with both common and rare conditions, providing them with an excellent outpatient experience to develop their skills in managing a diverse set of pathologies. The clinics help care for our local patient population and are located within 10-15 minutes from the 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, nutrition, IV therapy, microbiology, or the STAT RN team, to expand their knowledge about how these resources. They can use this time for personal development, e.g. medical board preparation or research projects.

Our preliminary residents also participate in the Y-week through a variety of different experiences similar to the flex day, where they will partake in the above-mentioned experiences, in addition to a variety of experiences that can be tailored to their interests, to help make them well-rounded candidates after they complete their preliminary year.

Academic Workshops

We have also 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.

Wellness

At the heart of our program's values is a strong sense of wellness and work-life balance. We have implemented a wellness committee, which helps to organize events amongst the residents. We incorporate events from bowling to pickle-ball, wellness lunches with boardgames and dinners out to help improve the wellbeing of all the residents. We have also incorporated a wellness half-day into each Y-week, which provides an opportunity for residents to schedule personal appointments or attend to responsibilities outside the hospital.

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

Alongside our culture of constant growth and improvement, we have a Y-week half-day dedicated to a longitudinal quality improvement (QI) curriculum. During this session residents work together in a team, to develop a quality improvement initiative, and to developing tools to enhance the practice of medicine and healthcare policy. Our Quality Improvement projects are sponsored by the Albright Read Institute for Quality Improvement. Residents are encouraged to generate their own project ideas in an area of interest. There projects are carried out longitudinally and can expand to span all three years of training. Previous projects have successfully decreased the use of unnecessary telemetry monitoring, improved central line access, and facilitated difficult end-of-life discussions. Resident-initiated QI projects have recently been accepted for presentation at local and national society meetings, including the American College of Physicians and the Society of Hospital Medicine.

Daily Learning

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

• Daily morning reports presented by attendings or residents under the supervision of an attending from either hospital medicine or subspecialties.
• Daily 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.
• As well as Department of Medicine Grand Rounds on Friday mornings.

We have also revamped our simulation lab experience, which occurs approximately on a weekly basis. This allows residents' the opportunity work as a team and hone their skills in critical situations. The SIM-lab offers the ability to tailor a wide assortment of critical cases, which are created to mimic real-life scenarios that may be encountered on the wards or in the ICU. The cases are meant to represent an authentic experience to help prepare and improve the residents' skills. After each SIM experience they meet in a debrief session with the attending and the chief medical resident to go over their performances, identifying key areas for improvement.

Monthly M&M

A monthly Morbidity and Mortality Conference invites multidisciplinary specialties to discuss treatment options, prevention strategies, and improvements in medical care. Residents also have access to the MGB Grand Rounds series on internal medicine and subspecialties, tailored to their specific clinical interests.

Resident Life

As residents of Salem Hospital, we are a diverse group that includes both domestic and international medical graduates, together we represent multiple continents and nations from around the world. As mentioned, the residents and faculty here are like one big family, many residents have developed very close friendships and Salem has become their home away from home.

Salem is a beautiful town that is both locally and nationally renowned for its rich history including the famous Halloween-time experiences. The surrounding towns of the Northshore and proximity to the Greater-Boston Area offer a wealth of experiences outside of the hospital. There are plenty of local coffee shops, restaurants, bars, and boutiques, as well as many local beaches within a short drive including the beautiful historic fishing towns of Gloucester, Marblehead and Newburyport.

Also, with Boston so close by, there are exceptional venues and sporting events with teams and fans like nowhere else in the world. With so many championships between over the past few decades, many consider this the City of Champions. Not to mention some of the best food, nightlife, and historic culture that New England has to offer.

A slightly longer drive will bring you to my home state of New Hampshire, also to Maine and Vermont where you can experience the beautiful New England coastlines, as well as both the Green (VT) and White Mountains (NH, ME). I highly recommend visiting these locations at least once to see their natural beauty and have an outdoor experience like-no-other, during any time of year. I grew up in New England and completed my medical training in these wonderful states, if there's something you need, I'm happy to help.

Thank you again for considering the Salem Hospital Internal Medicine Residency Program for your training, I am honored to be the Chief Medical Resident for the 2024-25 academic year. Please do not hesitate to reach out!

Best wishes,

Brian Hurley, DO
Chief Medical Resident