hsr gme folder 2011

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For more information, visit our website srhs.org

Resident Education

at the Hospital of Saint Raphael

Shaping tomorrow’s physicians today

Experience. The difference.

About Saint Raphael’s

Our Mission Statement The mission of the Saint Raphael Healthcare System, sponsored by the Sisters of Charity of Saint Elizabeth, is to care for and improve the health of our patients, with compassion and with a special concern for the underserved, poor and elderly.

Some of our mission-focused programs and services include:• the award-winning Project

MotherCare prenatal and primary care program and Smiles-to-Go mobile dental clinic

• eight community-based clinics dedicated to treating the poor and elderly

• two school-based clinics in Saint Raphael’s inner city neighborhood that offer preventive and basic health care to students.

Welcome

Dear Resident Candidate:

Thank you for your interest in resident education at the Hospital of Saint Raphael. Saint Raphael’s, in affiliation with Yale University School of Medicine, has sponsored graduate medical education for more than 100 years. Resident education and service to our community are the heart and soul of our hospital’s caring mission. We look for every opportunity to improve the quality of residents’ educational and life experiences. We are extremely proud of the results, which are reflected in the allegiance of our graduates – many Saint Raphael faculty and attending physicians were once Saint Raphael residents themselves.

Our resident education program is overseen by a Graduate Medical Education Committee comprised of faculty, administrators and residents. This group regularly conducts detailed reviews of each residency and fellowship. We examine the educational experience, its organization and delivery, the performance of faculty and trainees, and the camaraderie and job opportunities offered to our graduates. We scrutinize the institution’s resources, considering everything from remuneration and benefits to library services and computer access. We have recruited faculty who not just enjoy medical education, but excel in it.

We are fully committed to the success of each trainee. Residents are given the chance to completely realize their potential, with broad clinical experiences and opportunities to present papers and research findings at national meetings. Residents are not given responsibilities beyond those that contribute to their training and are never asked to do work that does not require a physician or contribute to their growth.

As a Saint Raphael resident, you will be an important part of our patient-centered care team. Your opinions will be valued, and your input encouraged. I invite you to apply and become part of our great tradition. We will give your application very personal consideration. If you match with Saint Raphael’s through the National Resident Matching Program, you will enjoy one of the finest educational experiences available in one of America’s finest hospitals.

Caren M. Genovese, MPS Designated Institutional Official Director of Academic Affairs

Caren M. Genovese, MPSDesignated Institutional Official Director of Academic Affairs

GME Brochure 2011.indd 1 8/23/11 1:00 PM

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Who we are .................................................................................. 4

Residency programs Diagnostic Radiology ......................................................................... 6

General Surgery ............................................................................... 12

Internal Medicine ............................................................................ 18

Oral and Maxillofacial Surgery ..........................................................24

Transitional Year ................................................................................28

Yale-integrated programs ....................................................... 32 Orthopedics

Otolaryngology

Pediatrics

Plastic Surgery

Podiatric Surgery

Clinical resources .................................................................... 34 Anesthesiology

Emergency Medicine

Pathology

Psychiatry

Radiation Oncology

Fellowships ................................................................................ 36

Cardiovascular Disease .......................................................................37

Geriatrics ...........................................................................................38

Nephrology ........................................................................................40

Yale fellows ........................................................................................42

Gastroenterology

Hematology Oncology

Infectious Diseases

Pulmonary and Critical Care Medicine

Around Connecticut .................................................................. 44

How to apply .............................................................................. 46

Directions ................................................................................... 48

Back pocket Salaries and benefits

Faculty bios

Visa information

Table of Contents


Standing (left to right)Joni Hansson, M.D., Nephrology FellowshipErnest Moritz, M.D., Transitional YearGerard Kerins, M.D., Geriatric FellowshipGeoffrey Nadzam, M.D., General SurgeryJohn Kelly, M.D., D.M.D., Oral and Maxillofacial Surgery

Seated (left to right)Robert Nardino, M.D., Internal MedicineAndre Ghantous, M.D., Cardiovascular DiseasePhilip Dinauer, M.D., Diagnostic Radiology

P r o g r a m D i r e c t o r s


T he 511-bed Hospital of Saint Raphael, a community teaching hospital affiliated with Yale University School of Medicine, is renowned for excellence in patient care and medical education.

With beautiful and comfortable facilities, some of the region’s top healthcare professionals, and sophisticated programs and services, Saint Raphael’s combines quality

medicine and medical education with a commitment to the dignity and better health of each patient.

For more than 100 years, Saint Raphael’s has offered the Greater New Haven community state-of-the-art technology, top experts and the compassionate care that is our hallmark. Well-recognized on the regional, state and national level, we are listed in the top 5 percent of hospitals nationwide for clinical quality performance and women’s health excellence by HealthGrades, a leading healthcare ratings organization. In 2011, U.S. News & World Report ranked the Hospital of Saint Raphael as one of the top hospitals in the region, with nine medical specialties cited as “high performing”: • Cardiology and heart surgery

• Diabetes and endocrinology

• Ear, nose and throat

• Gastroenterology

• Geriatrics

• Gynecology

• Nephrology

• Orthopedics

• Pulmonology

The American College of Radiology has also designated Saint Raphael’s a Breast Imaging Center of Excellence, and Press Ganey has honored Saint Raphael’s Emergency Department as a top improver in 2010. In addition, the Hospital of Saint Raphael has been designated as a Bariatric

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Who we are

How will Saint Raphael’s help you succeed?

• outstanding faculty• hands-on experience with the

latest technology• one-on-one mentoring• clinical continuity• balanced work schedule• diverse curriculum• innovative learning

methods• outstanding benefits• shared Yale University School

of Medicine services• outstanding clinical and

research resources• continually expanding

programs• friendly atmosphere• a commitment to you


Surgery Center of Excellence® by the American Society for Metabolic and Bariatric Surgery.

We lead the state in bilateral joint replacement and we are regional leaders in weight-loss surgery and single joint replacements. We rank third in the state and second in our region for the number of procedures we perform in vascular surgery, thoracic surgery and spine surgery. Saint Raphael’s also stays at the forefront of clinical advances and leading technology, offering:

• CyberKnife® radiosurgery system

• DaVinci® surgical robotic system

• Cutting-edge vascular operating room

• The latest in spine surgery, including lateral interbody fusion

• Chemoembolization with drug-eluting beads

• Computer-assisted, minimally invasive orthopedic surgery

• Minimally invasive chest and esophageal procedures

• Minimally invasive radiofrequency and microwave ablation of liver tumors; minimally invasive resections of the liver and pancreas

• Catheter ablation for atrial fibrillation

• Radial artery approach to cardiac catheterization

• Multidisciplinary Women’s Center for Breast Health, supported by patient navigators.

Our innovative programs, combined with our commitment to technology and vision for the future, position Saint Raphael’s as one of New England’s

premier hospitals and sources of medical education. And residency training is deeply ingrained in the hospital’s tradition and purpose. The teaching environment at Saint Raphael’s, with its wide range of both ambulatory and acute care settings, provides the basis for a fine residency experience. Our faculty members are outstanding teachers committed to helping you reach your full potential, and residents at the Hospital of Saint Raphael are considered important members of the medical team. Indeed, our residents play an essential role in providing care to the more than 24,000 inpatients and 175,000 outpatients who each year visit our Emergency Department, ambulatory/surgical departments and outpatient clinics. As a resident, you will receive invaluable practical experience that will help you become both a highly skilled and compassionate clinician.

Founded by the Sisters of Charity of Saint Elizabeth in 1907, Saint Raphael’s is the only Catholic hospital in Greater New Haven. It’s named after the archangel Raphael, patron saint of the sick and healing. Over the past century, Saint Raphael’s has grown from a 12-room hospital into the Saint Raphael Healthcare System – a nationally respected, integrated delivery system that offers a comprehensive array of services dedicated to the health and well-being of Greater New Haven residents.

A comprehensive list of Saint Raphael programs and services can be viewed on our website at srhs.org.

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Who we are

The Hospital of Saint Raphael unveiled its newly renovated Dr. Romeo A. and Lena B. Vidone Birth Center in January 2011, with a ribbon-cutting and blessing. The Center, a $2.2 million project, was constructed with state-of-the-art technology and a “family-centered” design utilizing soothing colors and lighting.


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Diagnostic“All program graduates in the last five years have achieved ABR certification, and the first-time written and oral board pass rates have been at or above the national average.”

– Philip Dinauer, M.D., program director of the Diagnostic

Radiology Residency Program


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When researching Radiology residency programs, Patrick Duffy, M.D., knew what he wanted. He was looking for a community-based program with a small number of Radiology residents and no Radiology fellows – a program that allowed for continuous one-on-one training.

“I looked at programs throughout the Northeast and on the East Coast and there were about 25 programs that I had researched and 12 that I seriously considered,” said Dr. Duffy, who earned his medical degree at George Washington University. “Having grown up in the area, I knew about Saint Raphael’s and its traditions and values. Generations of families have come to this hospital for a reason.”

Once he came to Saint Raphael’s to meet with the program faculty, Dr. Duffy said that was the deal clincher for him. “I interviewed at 12 schools,” he said. “At the end of the day, it was a pretty easy decision. It’s a great program. The most valuable part is the one-on-one training.”

Dr. Duffy began his residency training at Saint Raphael’s in 2009 and said he would like to stay in the area following completion of his program in 2013. “Coming here is one of the best decisions I’ve made,” Dr. Duffy said. “I’ve been trained very well, and I’ve learned a lot.”

Four-year residency trainingThe Department of Radiology at the Hospital of Saint Raphael offers a four-year residency-training program

for 16 total residents. Through the National Resident Matching Program, we accept the best-qualified medical students from a pool of more than 400 applicants each year. Our residents develop and refine their diagnostic and interventional skills by being exposed to a broad range of diseases in a diverse patient population, and by working closely with more than 20 subspecialized, fellowship-trained radiology faculty in a collegial, stimulating atmosphere. All program graduates in the last five years have achieved ABR certification, and more than 80 percent of recent graduates have entered fellowship training at excellent programs scattered throughout the country. Saint Raphael’s Radiology residents have historically achieved professional success for several reasons. After completing a one-year internship approved by the Accreditation Council for Graduate Medical Education (ACGME), residents enter a four-year program that grounds them in basic radiologic sciences and extensive clinical training in nuclear medicine, ultrasound, CT scanning, MRI, neuroradiology, and vascular and interventional radiology. Within the department, educational conferences are typically held twice a day, one at 7:45 a.m. and another at noon. Radiology faculty members teach residents key diagnostic imaging concepts on a two-year lecture cycle. Also, in-depth case discussions, journal clubs, grand rounds, and interdisciplinary conferences help residents build a solid foundation of radiology knowledge and life-long learning skills.

Each year, four new PGY 2 residents are accepted into the program, which is affiliated with Yale University School of Medicine. The program offers up-to-date equipment to generate diagnostic images, including 64-slice MDCT, PET, combined PET/CT, 1.5 and 3 Tesla MRI, state-of-the-art ultrasound and fluoroscopy equipment, and digital mammography. Saint Raphael’s was one of the first hospitals in Connecticut to install a 3 Tesla MRI, resulting in detailed imaging of the brain, spine, body and musculoskeletal system. On rotations with MRI

RadiologyDiagnostic

See page 47 for application information


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emphasis, residents work closely with their attendings to review and dictate MRI exams that employ some of the most current techniques, including cardiac MRI, MR spectroscopy, MR cholangiography, MR enterography and noninvasive vascular imaging. Also, when on rotations with CT emphasis, residents learn how to protocol and interpret multidetector CT images for the noninvasive diagnosis of various cardiothoracic, abdominal, pelvic, neural and vascular diseases. Residents participate in interpretation of CT angiography, and virtual 3D imaging, such as CT colonoscopy. Our Radiology department has been filmless for many years and uses a Picture Archiving and Communications System (PACS) to electronically save and store radiographic images. Our residents perform or see the majority of the more than 170,000 diagnostic examinations and interventional procedures performed in Saint Raphael’s Radiology department each year.

Diversified experiencesThe Hospital of Saint Raphael has a modern, spacious, inpatient and outpatient Radiology

department that addresses the needs of a diverse population. All Saint Raphael inpatient beds are considered radiology teaching beds, providing residents with a wide spectrum of clinical material and experiences. You will work closely with more than 20 board-certified radiologists, many of whom hold clinical appointments at Yale University School of Medicine. With them, you will review case studies daily and learn how to perform procedures, among them fluoroscopy, myelography, arthrography, arteriography, venography, tumor embolization, angioplasty, vascular stenting, CT and ultrasound-guided biopsy and drainage, and nuclear medicine procedures. Also, while working side-by-side with radiology faculty, you will learn how to interpret CT and magnetic resonance imaging exams. You will become familiar with mammographic screening as well as more advanced techniques, such as stereotactic, ultrasound-guided, and MR-guided breast biopsy. (Turn to the back pocket of this booklet for Radiology faculty biographies.)

Core rotations are performed at Saint Raphael’s, with additional pediatric radiology training taking place at Connecticut Children’s Medical Center and Yale-New Haven Hospital. As a third-year resident, you will attend the renowned four-week course in radiologic-pathologic correlation

D i a g n o s t i c R a d i o l o g y

Residents participate in departmental teaching conferences twice a day.


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at the American Institute for Radiology Pathology in Silver Spring, Maryland, with tuition paid by Saint Raphael’s. This program offers an excellent overview of all body systems prior to taking American Board of Radiology certifying exams.

Each year, members of the Yale physics department teach a comprehensive course in radiologic physics to the junior radiology residents. This course is co-sponsored by Yale-New Haven Hospital and Saint Raphael’s department of Radiology. Topics of instruction include the physics of X-ray production, ultrasound, nuclear medicine, CT, MRI, mammography and radiation biology and protection. This course helps residents prepare for the physics portion of the American Board of Radiology core examination.

At Saint Raphael’s, residents take part in daily teaching conferences, radiology grand rounds, monthly journal clubs, and monthly interdisciplinary conferences attended by physicians and residents from Saint Raphael’s departments of gastroenterology, oncology and pulmonary medicine, among others. You are also required to complete at least one research project during your four years here and are encouraged to use Radiology faculty as mentors. Recent and ongoing research studies have focused on topics such as embolization of lower gastrointestinal hemorrhage, imaging of encapsulating peritoneal sclerosis in dialysis patients, thoracic biopsy complications, MRI of

breast cancer, MR brain spectroscopy, and many others. Senior residents are given the opportunity to present their work to the department and the Saint Raphael medical community at a special annual, year-end academic activity. In the last several years, our residents have participated in the introduction to research initiatives sponsored by the American Roentgen Ray Society (ARRS) and Radiology Society of North America (RSNA). Our residents have presented abstracts and scientific exhibits at national meetings, including those held by the American Roentgen Ray Society and the Radiological Society of North America.

RotationsSaint Raphael Radiology residents

generally start their day with a 7:45 a.m. teaching conference, followed by three hours of clinical service and a noon to 1 p.m. daily lunch teaching conference. Afternoons are spent performing clinical duties, with the workday usually ending by 5:30 p.m., unless you are on night call.

Clinical duties and rotations vary for each resident. Descriptions of the rotations follow:

GI/GU (fluoroscopy), 4 months: Combined rotations emphasize fluoroscopic procedures, such as barium studies (including single and double contrast exams), cystography and urethrography, ERCP, hysterosalpingography and arthrography.

Emergency/Reading Room, 2-3 months: Residents develop their radiographic interpretation skills by reviewing a wide variety of orthopedic, thoracic and abdominal cases from the emergency department, ICUs and inpatient floors, and outpatient clinics.

Musculoskeletal, 4 months: In this rapidly growing field of musculoskeletal imaging, residents are exposed to a wide variety of MRI studies of the joints, bones and soft tissues. Residents review orthopedic radiographs and will have opportunities to participate in bone biopsies and arthrographic procedures of various joints, including the knee, shoulder, wrist and hip.

Cardiothoracic, 4 months: You will gain experience reading plain films of chest, CT and MRI, as well as performing interventional chest procedures – lung biopsies, chest tube placement and thoracentesis.

CT Abdomen, 3 months: These rotations are dedicated to the CT evaluation of the abdomen and pelvis. There is a large case volume daily, read with body imaging specialists. You will prescribe, monitor and read diagnostic CTs as well as perform CT-guided biopsies and fluid collection drainages. You will also take part in reconstructing and interpreting 3-D image studies, virtual endoscopy, CT angiography, cardiac scoring and other specialized CT procedures. The CT scanners are multi-detector machines with CT fluoroscopy and cardiac gating. Biopsies, drainages and 3-D

A technologist views a high-definition image of a heart using 64-Slice Computed Tomography.




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procedures are done on a frequent basis, which allows you to quickly gain proficiency in these techniques.

Ultrasound, 4 months: Our ultrasound section has six state-of-the-art, real-time units with duplex and color Doppler capabilities. You will be actively involved in performing and interpreting abdominal, obstetrical, peripheral vascular, small parts and intracavitary scans, as well as performing ultrasound-guided interventional procedures. Approximately 6,000 cases are performed each year.

Nuclear Medicine, 5 months: This state-of-the-art department trains residents in routine and advanced techniques, such as exercise stress testing, SPECT and PET. A large teaching file and special lecture series help prepare residents for on-call responsibilities.

Vascular and Interventional, 3 months: All types of vascular and non-vascular interventional radiology procedures are performed on a one-to-one basis with subspecialty attendings. These include both routine and more sophisticated procedures, among them: diagnostic vascular and therapeutic procedures such as angioplasty, stenting, venous access, biliary and renal procedures, as well as interventional oncology procedures.

Neuroradiology, 5 months: Incorporating CT, MRI, fluoroscopy and interventional procedures, residents participate in prescribing, monitoring and interpreting a wide variety and high volume of head, neck and spine cases in all areas, under the guidance of subspecialized neuroradiologists. This includes 3-D CT, functional MRI, magnetic imaging spectroscopy, perfusion and diffusion imaging, vertebroplasty, neuroangioplasty and embolization procedures.

MRI Body, 2 months: The department has a 3 Tesla MRI and a 1.5 Tesla MRI that produce more than 4,000 exams yearly. You will prescribe pulse sequences, monitor

images and attend readout sessions. You will also learn how to perform and read routine musculoskeletal MRIs, as well as those that focus on the abdomen, liver and pancreas. Vascular, cardiac, GYN and urologic MRIs are also stressed. A comprehensive MRI physics course is taught every year.

Mammography, 3 months: You will participate in biopsies, needle localizations and diagnostic mammograms with emphasis on problem solving. Ultrasound and MRI of the breast as well as ultrasound-guided procedures and stereotactic biopsies will also be incorporated into the rotation.

Pediatrics, 3 months: You’ll spend one month at the Connecticut Children’s Medical Center, where pediatric skeletal and GU radiology are emphasized. Then, two months in Yale’s pediatric radiology section will follow, where imaging pertinent to newborns and children is learned. Some pediatric imaging is done at Saint Raphael’s through the pediatric clinic and ED.

Research/Electives, 3 months: These three months give residents the chance to gain extra experience in a radiology subspecialty – or conduct research – by working one-on-one with a Saint Raphael physician.

Call scheduleIn the first year, PGY-2 residents take intermittent

“buddy call” and interventional radiology service call. When they are in-house, the PGY-2 residents are closely supervised by the faculty and more senior radiology residents. Residents do not begin independent, in-house call until after successful completion of their first 12 months of training. The PGY 3-5 residents take in-house call in a night float system in which they typically work five or six consecutive nights from 8 p.m. until 8 a.m. Faculty reviews

More than 80 percent of recent graduates have pursued fellowship training after completing their Saint Raphael residency. A partial list of where recent graduates have gone includes:

Abdominal body imaging fellowship Boston University, MAMassachusetts General HospitalYale-New Haven HospitalUniversity of South FloridaUniversity of Maryland

Musculoskeletal fellowshipYale-New Haven HospitalUniversity of IowaBrigham & Women’s Hospital, Boston, MAUniversity of Maryland

Neuroradiology fellowshipYale-New Haven HospitalUniversity of Colorado Denver Health SciencesDuke University, Durham, NCUniversity of California, Los Angeles

Breast imaging fellowshipYale-New Haven Hospital

Thoracic Imaging fellowshipNew York University

Interventional RadiologyEmory University, Atlanta, GAMiami Vascular InstituteBrown UniversityNew York University

Private practiceNew York


Recent graduates


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A Radiology resident provides a preliminary report using PACS.

and signs off on the residents’ dictated reports at the end of each call shift. Residents are then relieved of clinical duties for the remainder of the day. During call time, comfortable and convenient sleep accommodations are available. Most call rooms include a bed, telephone, TV, bathroom with shower, and computer with Internet access.

Additional resourcesFor all residents, Saint Raphael’s Health Sciences Library and computer facilities are open

24 hours a day. More than 2,000 books and 400 journals are housed here, along with seven computers available for use. One computer has a CD burner and a scanner. The photocopier also offers scanning for the purpose of e-mailing. Fax machine is operational during staffed hours. The library has its own home page via any computer within the hospital’s IP range, offering programs such as UpToDate, MDConsult, PubMed, Cochrane and the Microsoft Office programs, among others. These services are complemented by the Yale Medical Library. There is also a radiology library with a large cross-indexed film teaching file and computer resources.

All Radiology residents also become members of the New England Roentgen Ray Society and are able to attend educational conferences in Boston, as well as national meetings.




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General

“My definition of an ‘excellent surgeon’ is one who is not only technically proficient but also well rounded and able to strike a healthy balance between family and career. Nothing puts patients at ease more than an affable, compassionate surgeon who can relate to them on a personal level – this is the surgeon we hope to train in our program.”

– Surgeon Geoffrey S. Nadzam, M.D., program director of the General Surgery Residency Program, director of Robotics

Training and Education


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Upon graduating from med school, Celeste Nelson, M.D., knew she wanted to one day practice general surgery without specialization in a rural community. She interviewed at 18 GME programs throughout the country looking for the perfect residency program to fit her needs.

“I was looking for a program that had a strong history of training good general surgeons,” said Dr. Nelson, a graduate of Dartmouth Medical School. “I wanted a program that emphasized good surgical decision making. I did not want to train at a place that emphasized specialization, or where graduates felt obligated to pursue fellowship training.”

She found all of that and more at Saint Raphael’s.

“The first thing that I noticed about this hospital was how happy the residents were,” Dr. Nelson said. “They seemed to genuinely like each other and to enjoy working together; the relationship between the residents and the surgical nurses was also extraordinarily collegial. This impression, combined with the program’s superb board passage rate, led me to rank Saint Raphael’s amongst my top choices in the match.”

Dr. Nelson began her General Surgery training at Saint Raphael’s in July 2007 and will continue to train extensively through June 2012. “It’s an excellent learning environment,” she said.

Over five years of training, the average chief resident performs approximately 950 cases, including more than 200 cases as chief surgical resident (see chart, page 14). Because Saint Raphael’s is a certified Level II Trauma Center that treats more than 500 patients annually, surgical residents also have the opportunity to function as a primary surgeon in evaluating trauma and treating emergency surgical conditions – experiences that will well prepare them for the complexities and demands of being a surgeon.

Four Categorical and four Preliminary residents admitted as PGY 1’s each yearAffiliated with Yale University School of Medicine, Saint Raphael’s General Surgery program features an inclusive and

clinically oriented curriculum that gives experience in both general and subspecialty surgery. Residents work closely with our 30 full- and part-time faculty staff physicians and benefit from both their clinical experience and didactic teaching. Most faculty members have clinical appointments at Yale University School of Medicine. (Turn to the back pocket of this booklet for General Surgery faculty biographies.)

Clinical rotations teach residents patient evaluation, management, and treatment, giving them the breadth of training needed to manage the total care of surgical patients. Surgical skills and procedures are taught in the simulation lab, where you will learn techniques and practice skills prior to entering the operating room. In the simulation lab, you will learn the fundamental knowledge and core technical skills required to perform basic open and laparoscopic surgery. In addition, you will be able to view operations in real time on a large screen HDTV connected to the OR. Throughout the five years you will assume more responsibility as you proceed through the program.

The primary programs for resident instruction are weekly core curriculum lectures, which review principal components of general surgery and basic science; a weekly morbidity and mortality conference; and surgical grand rounds. A multidisciplinary GI conference and breast conference take place weekly, along with a monthly GI tumor

Surgery



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board conference and journal club. Service-specific case review and didactic conferences also take place three times each week. Residents are assigned topics for presentation and review at these sessions.

Review for the American Board of Surgery In-Training Examination (ABSITE) also takes place at intervals throughout the year with practice oral and written sessions.

Comprehensive curriculum

As a surgical resident, you will share with attending surgeons all responsibilities related to their patients’ pre- and postoperative care. The amount of clinical responsibility is commensurate with your level of training, clinical skills and technical ability. Most residents experience the following:

As a PGY 1: Participate in a broad range of surgical procedures during rotations in general and thoracic surgery and learn to care for critically ill patients during an SICU rotation. (See chart for details on types of procedures focused on in

each principal area of study.) You will also be assigned a mentor faculty member to serve as a resource throughout your residency. Your mentor will help you initiate a research project during the year.

As in each of your five years here, you will receive a book allowance, plus have 24-hour access to a Health Sciences Library committed to meeting the informational, educational and research needs of the hospital community. More than 2,000 books and 400

journals are housed here, along with seven computers available for use. The library has its own home page via any computer within the hospital’s IP range, offering programs such as UpToDate (an evidence-based clinical information resource); MDConsult; PubMed (an online medical computer program that enables residents to engage in literature searches for clinical projects and patient care, as well as write articles with the guidance

“As a resident I found that Saint Raphael’s was simply a very nice hospital to work at. The teaching, the staff, the patients – I found the whole package to be extremely rewarding. It’s no surprise that I decided to stay here.”

– Surgeon Denise Barajas, M.D.Director, Women’s Center for Breast Health

G e n e r a l S u r g e r y

Representative Operative ExperienceThe average number of operative experiences within the defined categories of the Residency Review Committee (RRC) for the four chief residents who graduated in 2010:

Operation Average Defined CategorySS&B 66 25Head/Neck 45 24Altr 244 72Abdomen 291 65Liver 12 4Pancreas 5 3Vascular 166 44Endocrine 13 8Trauma Op 24 10Trauma NOp 23 20 Thoracic 55 15Pediatric 39 20Plastics 19 5Laparoscopy B 131 60Endoscopy 126 85Laparoscopy C 139 25


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of attending physicians); Cochrane; and the Microsoft Office programs, among others. These services are complemented by the Yale Medical Library.

As a PGY 2: Increased responsibility in patient management and operative procedures. Each resident receives surgical loupes. You’ll gain experience in general and endoscopic surgery, and surgical critical care, and participate in extramural rotations in pediatric surgery, oncologic surgery and burn management.

As a PGY 3: More independence. As a senior resident, you’ll assist and perform complex surgical procedures. You’ll gain experience in general, vascular, oncologic and transplant surgery. Those who exceed academic standards may be given the opportunity to perform a one-month elective this year. Prior approval by the program director is required.

Guided by faculty and peers on the Research Council Committee, all Categorical residents are required to have their research project completed by the end of this year, with submission for publication or presentation. Indeed, Saint Raphael residents regularly present at regional meetings of the New England division of the American Cancer Society, New England Surgical Society, the annual meeting of the Connecticut Chapter of the American College of Surgeons, the annual Connecticut Trauma Conference, and the annual meeting of the American College of Surgeons. Recent research papers and presentations include “Open Abdomen Management in the Non-Trauma Population: A 5 Years’ Experience in a Community Teaching Hospital,” “Accurate Fluoroscopic Measurement of Adjustable Laparoscopic Gastric Band Stoma Diameter,” “Laparoscopic Marsupilization and Partial Hepatectomy Is an Effective Alternative to Major Hepatectomy in High Risk Patients with Hepatic Cystadenoma,” “Prospective Analysis to Determine Adherence to Quality Standards in Breast Surgery at a Community Teaching Hospital,” “Laparoscopic Repair of an Adult Morgagni Diaphragmatic Hernia: Video Presentation and Review of Literature,” “Abdominal Aortic Aneurysm Endovascular Repair Complicated by Infection with Clostridium Septicum,” “Outcomes of Emergent Ventral Hernia Repair-A Case for Elective Repair of All?”, “Transarterial Chemoembolization (TACE) with Drug-Eluting Beads (DEBS) for Unresectable Liver Tumors.”




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As a PGY 4: An important transitional year. To set the stage for ascension to the chief year, you will oversee the thoracic service and have increased clinical and operative responsibilities. General and thoracic services are the primary focus of this year.

As a PGY 5: Chief resident status, satisfying the requirements for eligibility to the American Board of Surgery. You will lead surgical teams, conduct teaching rounds with junior house staff and perform more than 200 cases. You’re also given the opportunity to select and attend at least one major scientific meeting, with all expenses paid by the surgery department.

The curriculum also addresses the Accreditation Council for Graduate Medical Education (ACGME) six core competencies of Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-Based Practice. These competencies are embedded in the curriculum and residents must become proficient with them at the level expected of new practitioners. Educational experiences are structured to provide specific knowledge, skills and attitudes required for residents to demonstrate competence in these areas.

RotationsWhile 80 percent of your training will take place at the Hospital of Saint Raphael,

you will also spend some time at three other Connecticut hospitals. At the Connecticut Children’s Medical Center you will gain added expertise in pediatric surgery; at Hartford Hospital you will focus on transplantations, and at Bridgeport Hospital you will receive training in the surgery and management of burns. In addition you will spend three months during your second and third years at Roger Williams Medical Center in Providence, Rhode Island, for a surgical oncology rotation.



Your schedule is likely to change during each rotation, with the length of your workday dependent on clinical volume. Generally, each day begins with your sign-in at 6 a.m., followed by patient rounds until 7:30. The remainder of the morning is spent in the operating room, on nursing units, in the endoscopy suite or attending to patients in clinic or private practice offices. A morbidity and mortality conference takes place from 7:30 to 8:30 a.m. each Wednesday, followed by a two-hour core curriculum block. Each month, grand rounds are presented during the 8:30 a.m. session. Surgical clinics take place once a day while surgical consults occur as often as needed – often throughout any given day. Didactic conferences take place from noon to 1 p.m. three days a week on the general surgery service and bi-weekly on the vascular service. Tumor boards, breast conference, indications conference and other conferences are scheduled weekly or monthly. Afternoon rounds are dedicated to providing patient care and updating the night call team.

The program adheres strictly to the ACGME duty hours policy, which includes limiting duty hours to 80 hours per week averaged over four weeks, having one day in seven free from all educational and clinical responsibilities, and maintaining a minimum of 10 hours between duty shifts. Duty periods of PGY-1 residents do not exceed 16 hours in duration while PGY-2-5 residents do not exceed continuous on-site duty of 24 hours. Since it is essential for patient safety and resident education that effective transitions in care occur, you may remain on-site up to four additional hours in order to accomplish these tasks or to participate in didactic activities. During call time, comfortable and convenient sleep accommodations are available. Most call rooms include a bed, telephone, TV, bathroom with shower, and computer with Internet access.

Evaluation processAt the end of each rotation, residents receive a written evaluation of their clinical

knowledge, technical performance, interaction with members of the healthcare team, professional attitude and overall progress toward becoming a successful surgeon. You will also meet no less than twice each academic year with the General Surgery program director or associate program director to receive a written summary of your performance.

Each year, you must also successfully complete the written ABSITE sponsored by the American Board of Surgery. Practice oral and written sessions are held several times during the academic year.

The DaVinci® Surgical System uses robotic technology to extend the benefits of minimally invasive surgery.

2009 Graduates

CT Fellowship: University of Kentucky, Lexington, KY

MIS Fellowship: Mount Sinai, New York, NY

MIS Fellowship: Danbury Hospital, Danbury, CT

Flight Surgeon: Langley Air Force Base, Langley, VA

2010 Graduates

Pediatric Surgery Fellowship, Miami Children’s Hospital, Miami, FL

Thoracic Fellowship, Albany Medical Center, Albany, NY

HPB Fellowship, Auckland City Hospital, Auckland, NZ

Vascular Fellowship, UMDNJ, New Brunswick, NJ


See page 47 for application information 17

A partial list of where recent graduates have gone after completing their Saint Raphael residency includes:

Recent graduates


18

Internal

Students present cases to the associate program director during daily rounds.

“There’s as much style to medicine as there is science. Textbook knowledge is essential, but it doesn’t teach you how to be caring or compassionate. That’s something we try to impress upon residents, and something that makes Saint Raphael’s special – physicians really care about patients, students and each other.”

– Cardiologist Robert Morrison, M.D., faculty


19

MedicineInternal

When Ashar Usmani, M.D., began looking for an Internal Medicine residency program in the United States, he carefully considered two things: 1) How proficient patient care was; and 2) How medical education was incorporated into medical care. “I was looking for a good balance between medical education and patient

care,” said Dr. Usmani, who earned his medical degree at Dow Medical College in 2007, followed by a year-long internship in Pakistan. Saint Raphael’s Internal Medicine Residency Program struck a perfect balance.

“I looked primarily in the Northeast at about 30 programs,” said Dr. Usmani, who came to the U.S. in 2008 to conduct research at Yale Medical School. “What struck me immediately about Saint Raphael’s was the hospitality of the faculty and the friendly environment,” he said. “We’re one big happy family.”

What he also liked about the program was that he could choose to prepare for a career in patient care, or step into the field of academia. “I had both options,” he said.

Since beginning his residency training at Saint Raphael’s in 2009, Dr. Usmani said he has found the supervised autonomy and patient interaction to be valuable components of his education. “I not only learn from books, I also learn from my patients,” he said.

Dr. Usmani said he would like to follow up his residency with a fellowship at Saint Raphael’s. “It was an excellent decision to come here,” he said. “It has helped me in my own growth as a professional and as a person.”

Saint Raphael’s Internal Medicine Residency Program is a program that boasts a consistent three-year rolling pass rate of 100 percent on the American Board of Internal Medicine board exams, an achievement that few hospitals can claim. Accredited by the Accreditation Council for Graduate Medical Education (ACGME), the Internal Medicine Residency Program and Saint Raphael’s Cardiology Fellowship Program received five-year accreditation by the ACGME in 2011.

Both our accredited Preliminary and Categorical teaching programs offer renowned faculty in an outstanding academic health science setting. Whether your professional goals involve primary care or a subspecialty, Saint Raphael’s will help you become a highly skilled and compassionate clinician.

Our Internal Medicine training program balances primary care with acute medicine. With our close affiliation with nearby Yale University School of Medicine, our program can help you become a high-caliber, caring clinician with a scientific yet humanistic foundation in Internal Medicine.

Teaching programWe want you to get the most out of your residency experience at the Hospital of Saint Raphael. The Department of

Medicine’s full-time faculty is devoted solely to resident teaching – at the bedside, in the resident continuity clinic, in small- and large-group didactic sessions, and through mentorship of scholarly activity. (Turn to the back pocket of this booklet for Internal Medicine faculty biographies.) We have implemented a unique schedule that alternates four weeks of inpatient or subspecialty elective experience with two weeks of ambulatory medicine for the duration of training. Progressive responsibility in both inpatient and ambulatory settings is emphasized.



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Ambulatory MedicinePrimary care outpatient medicine is experienced in

two ways: continuity clinic where residents develop, in essence, their own practice as they become the primary physician for a panel of patients. Residents will also work in teams, such that in the context of the alternating block schedule, one member of the team will always be on an ambulatory rotation, allowing continuity within this small group. A formal curriculum is delivered through conferences that occur morning and afternoon on Monday, Wednesday and Friday, as well as the educational half-day on Thursday morning. This curriculum is excellent preparation for the practice of general Internal Medicine. Preventive care and ambulatory diagnosis and treatment are emphasized.

Each two-week ambulatory medicine block includes:

Primary care clinic – On average, there are six half-day continuity clinics during each ambulatory Medicine block throughout all three years of training. The resident-to-attending ratio is generally 2 or 3:1, and all patients are discussed with an attending. Residents become responsible for a specific group of patients, and care for those patients all three years. Residents also work as part of a clinic team, designed to function as an independent practice. All clinics are supervised by Saint Raphael faculty.

Specialty and subspecialty medicine – Each two-week block has a different emphasis; examples include:

PGY 1: Ophthalmology, Urology, University of New Haven Student Health Service, Psychiatry, Gynecology, Pediatrics (Adolescent Medicine), Geriatrics;

PGY 2: Endocrinology, Gastroenterology, New Haven STD Clinic, HIV Clinic, Oncology, Pulmonology, Connecticut Hospice;

PGY 3: Dermatology, Rheumatology, Gynecology, Allergy, Orthopedics, Rehabilitation Medicine, Cardiology, Geriatrics.

During these experiences, residents rotate through the private practice offices of specialty physicians to learn the “pearls” of diagnosing specific conditions, how to medically manage problems and acute emergencies, and when to refer patients.

Community ambulatory rotation – PGY 2 residents spend a month at the office of a general community internist, learning skills needed to perform medicine in the private practice setting. This experience provides an opportunity for residents to learn office practice management, interact with insurers and managed care personnel, and observe varied approaches to care. This networking often leads to practice opportunities in the area.

Inpatient MedicineDuring rotations on our critical care units, residents are part of a multidisciplinary team

that includes full-time intensivists and subspecialty fellows providing teaching and supervision. Residents will become experienced in managing critical illness and participate in all facets of care, including family meetings.

On other general medicine inpatient rotations, the teams consist of one supervising resident, two PGY 1’s and one student, with full-time supervision by a hospital-based clinician educator. Residents have primary responsibility for evaluating and managing patients as they are admitted to the hospital, and throughout their hospital stay. Consultant teams consisting of a subspecialty attending, fellow and rotating resident are readily available and provide support in patient care. Depending on the rotation, residents may have admitting responsibility daily or every other day.

I n t e r n a l M e d i c i n e

A “medical challenge conference” is held monthly as preparation for the board exam. Using a computer display with scanned photos, smears and short-answer questions, residents play as part of a team. It’s proven to be a fun and informal way to review medicine in a competitive setting.


21

Rotations include advanced telemetry (step-down), inpatient cardiology, medical oncology, medical telemetry (includes stroke), and general medicine.

All rotations involve collaboration with a night float service. Only supervising (PGY 2 and PGY 3) residents have overnight call during critical care rotations. (More information on call facilities and responsibilities is listed on page 23.)

Additional Core RotationsAll residents complete rotations in

emergency medicine, geriatrics, neurology and medical consultation.

Emergency Medicine – You will have the opportunity for first contact with the full range of patients presenting to the Hospital of Saint Raphael emergency department, a Level II trauma center. There are also didactic sessions and a peer teaching case conference.

Geriatrics – Offers a balanced outpatient/inpatient experience in geriatrics. You will learn the basics of assessing geriatric patients and managing common syndromes. With a geriatrician, you will see patients in Saint Raphael’s Senior Assessment Clinic, and make home visits with a geriatric physician assistant.

Neurology – This is primarily an inpatient consultation service. Focus is on becoming facile with the neurological examination, and the management of common neurology problems. Hospital of Saint Raphael is a certified stroke center and residents will participate in daily multidisciplinary stroke rounds.

Consultation Medicine – This rotation gives the resident an opportunity to provide internal medicine consultation to

the surgery, psychiatry and obstetrics and gynecology services, including preoperative risk assessment and perioperative management of medical problems.

CurriculumThe didactic curriculum is organized

around a topic-based approach to learning. Faculty present intensive daily interactive conferences grouped by topic, designed to promote reading and retention. For example, if the topic of one three- or four-week period is cardiology, all activities and lessons relate to this subject – daily noon conferences, Department of Medicine Grand Rounds, ambulatory conferences, etc. At the end of the period, residents show what they have learned by taking part in a medical quiz game modeled after Jeopardy! Questions tie in to the study topic, focused on information essential for passing board exams.

Other opportunities that enhance learning include:

Resident morning report: A daily review of overnight admissions with the night float residents with chief resident and faculty participation; also, there are full case presentations three times weekly; and a pathology, radiology or electrocardiology session once per week;

Intern report: Once-weekly conference for PGY 1’s and students only, focusing on evaluation and management of a variety of common and uncommon medical conditions, with an emphasis on clinical reasoning;

PGY 3 Board review sessions: Led by full-time faculty, sessions primarily use MKSAP questions relating to the monthly topic, where residents answer questions with an audience response system;

Conferences (e.g., autopsy conferences): Offers hands-on anatomical correlation of clinical findings;

Medical grand rounds: Includes rounds at the Hospital of Saint Raphael and Yale;

Small group sessions: Organized by PGY, with a variety of topics such as interactive sessions on EKG interpretation, radiology and other interpretative skills; ethics discussions; and cultural competency conferences.

Resident Teaching OpportunitiesYou may supervise medical students

from Yale University School of Medicine or University of Connecticut, or Physician Assistant Students from Yale University or Quinnipiac University on inpatient rotations.

Peer teaching conferences: At noon conference, each PGY 3 resident, working with an attending, presents a topic with text and literature review to fellow residents and faculty members.

Journal Club: Residents work with faculty to analyze an article, discussing study design, strengths, weaknesses, and application to the clinical setting. There are small group journal club sessions organized by post-graduate year.


The director of ambulatory education reviews the weekly pre-clinic conference curriculum with residents.



Saint Raphael’s Health Sciences Library and computer facilities: Open 24 hours a day. More than 2,000 books and 400 journals are housed here, along with seven computers available for use. One computer has a CD burner and a scanner. The photocopier also offers scanning for the purpose of e-mailing. Fax machine is operational during staffed hours. The library has its own home page via any computer within the hospital’s IP range, offering programs such as UpToDate; MDConsult; PubMed (enables residents to engage in literature searches for clinical projects and patient care, as well as write articles with the guidance of attending physicians); Cochrane; and the Microsoft Office programs, among others. These services are complemented by the Yale Medical Library.

Research: Our curriculum stresses the importance of research methodology. All Categorical residents work on a research project and are strongly encouraged to publish research findings. You will receive considerable instruction and support in hypothesis generation, protocol design, and statistical analysis of data and manuscript preparation. Many residents present oral and poster presentations at the annual meeting of the Connecticut Chapter of the American College of Physicians.

Elective rotationsResidents choose from a wide variety of elective opportunities at Saint Raphael’s, Yale-New

Haven Hospital and the VA Connecticut Healthcare System, West Haven campus. Each elective emphasizes subspecialties or related fields of medicine, enhancing training and introducing residents to career opportunities.

Electives offered at Saint Raphael’s include:

Cardiology – You will evaluate and follow patients with a spectrum of cardiac diseases, both at the inpatient level and in the clinic. Bedside skills and physical diagnoses are emphasized and provide important correlations with techniques for invasive and noninvasive cardiac diagnoses. You will round with the attending and cardiology fellow, plus follow patients in the Coronary Care and the Cardiothoracic Intensive Care units. Competence in EKG interpretation is ensured. Weekly conferences at Saint Raphael’s and Yale enhance the overall experience.

Gastroenterology – This elective will give you excellent exposure to the spectrum of acute inpatient gastrointestinal and hepatic disorders. Bedside teaching is provided by the full-time attending staff, as well as three gastroenterology fellows. You will work up and evaluate patients, plus observe endoscopic procedures on patients with whom you are involved. Daily teaching and work rounds include review of diagnostic imaging and biopsy materials with experienced attending physicians. Four clinical conferences take place weekly – one at Yale, three at Saint Raphael’s.

22

Residents and program director discuss patients during teaching rounds.



23

Hematology Oncology – You will work under the supervision of a Yale fellow and an attending Saint Raphael hematology-oncology physician. At the inpatient level, you’ll evaluate and follow patients, with emphasis on diagnosis and therapy of common neoplasms and hematologic disorders, as well as management of common treatment complications. Management of patients in our outpatient Father Michael J. McGivney Center for Cancer Care is stressed, with ample opportunity for longitudinal follow-up. Weekly conferences at Saint Raphael’s and Yale provide further discussion and teaching opportunities. Competence is achieved in reviewing the peripheral smear and a variety of biopsy samples.

Infectious Diseases – You will be an important member of the team, providing consultation and follow-up on patients with a challenging and stimulating variety of infectious and inflammatory disorders. Working closely with the Yale fellow and a full-time Saint Raphael attending staff member, you will gain important experience in diagnosis, therapy, and comprehensive management of common and not-so-common infections. Clinical microbiology is emphasized, and there are many opportunities for the Yale fellow and attending to teach students. Weekly ID conferences are held at Yale.

Nephrology – You’ll work closely with fellows and participate actively in conferences at both Saint Raphael’s and at Yale-New Haven Hospital. You will attend the weekly renal clinic, weekly dialysis conference, and various clinical nephrology and physiology conferences at Saint Raphael’s and Yale. Emphasis is on evaluation, diagnosis and treatment of acute renal failure, chronic renal failure and glomerulonephritis. Discussions are held concerning electrolyte and acid-base abnormalities, and the application of basic renal physiology to the clinical understanding of these entities. The evaluation of patients with hypertension is also reviewed.

Pulmonary and Critical Care – Pulmonary physiology and physiopathology are emphasized as you evaluate and follow a variety of patients in the intensive care unit, the inpatient setting and the clinic. This elective represents an opportunity to study and understand the radiographic correlation with anatomy and disease. You’ll work closely

with the Yale fellow and Saint Raphael’s faculty members, as well as with members of the Radiology, Pathology and Surgery departments. Weekly conferences are held at Saint Raphael’s and Yale, including the Connecticut State Chest Conference, in which students are expected to actively participate. You’ll also gain valuable exposure to bronchoscopy, thoracentesis, pleural biopsy and invasive critical care monitoring.

Endocrinology and Rheumatology are built into the ambulatory schedule but are also available as elective rotations at Yale-New Haven Hospital.

Daily scheduleMany factors, of course, determine what each day is like. For most

Internal Medicine residents, a typical day at Saint Raphael’s includes signing in at 7 a.m.; attending morning report until 8 a.m. (patient pre-rounds for PGY 1’s); and carrying out management and teaching rounds from 8:30 to 10:30 a.m. and patient care from 10:30 a.m. to noon. A noon conference with free lunch takes place each weekday, followed by other care responsibilities.

Also scheduled on various days are medical grand rounds, quality and patient safety conferences, professor’s rounds (case discussions with a senior clinician), autopsy conference and a renal pathology conference.

Call scheduleSome rotations require PGY 1’s to take sign-outs from their other

daytime colleagues and remain “on-call” until 8 p.m., when the night float arrives. Supervising residents take call every fourth night when in the ICU.

For night residents, comfortable and convenient sleep accommodations are available. Most call rooms include a bed, telephone, TV, bathroom with shower, and computer with Internet access.

Night float consists of two-week blocks on a specific unit or ward. PGY 1 night floats are supervised by PGY 2 or 3 residents with attending physicians always available.

CardiologyBaylor University, TXBaystate Hospital, MAHospital of Saint Raphael

EndocrinologyUniversity of Oklahoma

GastroenterologyNorwalk Hospital, CT

GeriatricsHospital of Saint Raphael

Yale School of Medicine/ Yale-New Haven Hospital

HematologyYale School of Medicine/ Yale-New Haven Hospital

Hematology/OncologyAlbert Einstein University, NYEmory University, GAUniversity of Buffalo, NY

NephrologyBrigham & Women’s Hospital, MAHospital of Saint Raphael

OncologyNational Institutes of Health

Yale School of Medicine/ Yale-New Haven Hospital

Pulmonary/Critical CareEmory University, GANorwalk Hospital, CT



Recent graduates

IM Resident Fellowships (2009-2011 Graduating Classes)


24

Oral and Maxillofacial

“I don’t mean to sound boastful, but there’s really no program like ours. We have a strong, dedicated faculty, a good mix of didactic and hands-on experience, and some of the best young residents around. Our residents, in fact, are sought after. We regularly get calls from practices looking for new associates. Every resident who leaves here is well prepared either to enter a private practice or start their own.”

– Leonard Skope, D.D.S., assistant program director of the Oral and Maxillofacial

Surgery Residency Program


25

Oral and

Maryann Udy, D.M.D, researched nearly 90 residency programs and considered 40 before selecting Saint Raphael’s for her postgraduate Oral and Maxillofacial Surgery (OMS) Residency Program. “I was looking for a residency with well-trained, highly respected faculty,” said Dr. Udy, who earned her D.M.D. degree from the University of Nevada, Las

Vegas (UNLV) School of Dental Medicine. “I wanted to train at a facility that would optimally prepare me for private practice OMS. It was also important to select a program with a reputation of successfully placing residents in fellowships if I elected to do so in my later residency years.”

Dr. Udy, who began her training at Saint Raphael’s in 2009, said many things impressed her about Saint Raphael’s OMS program, including its leadership and reputation. “It is well known that Hospital of Saint Raphael OMS residents are sought after for partnerships in practices due to their proficiency in the field,” she said.

“The most valuable part of my training has been the surgical experience I’ve gained early on,” Dr. Udy noted. “The surgical cases are abundant and all levels of residents participate as primary resident surgeons. This includes both outpatient sedation procedures as well as those in the operating room. Being utilized to this degree early in training allows us to be proficient, well-rounded surgeons when we near the completion of our four years. We also get invaluable experience on our rotations and are utilized as a primary team member,” she said. “The general surgery, plastic surgery and anesthesia rotations, in particular, are highly beneficial.”

Each year, two applicants are selected to enter Saint Raphael’s Oral and Maxillofacial Surgery Residency Program, which is affiliated with Yale University School of Medicine. Accredited by the Commission on Dental Accreditation, the program teaches residents the full scope of skills needed to practice OMS in either a hospital or private office, including the use of all current techniques of pain and anxiety control. The four-year curriculum also provides all the prerequisites and requirements needed to qualify for, and succeed in, the American Board of Oral and Maxillofacial Surgery’s certification process.

Saint Raphael OMS residents gain experience from providing a full range of ambulatory services in a modern outpatient clinic, with teaching and supervision provided by a full-time director, a part-time assistant director, and more than 20 board-certified voluntary faculty from community practices. The outpatient experience at Saint Raphael’s OMS Clinic is supplemented by rotations to Yale-New Haven Hospital where the OMS residents work alongside general practice and pediatric dental residents in new, modern facilities under the direction of OMS faculty common to both hospitals. (Turn to the back pocket of this booklet for Oral and Maxillofacial Surgery faculty biographies.)

Major surgical experience is also gained in the emergency and operating rooms of both the Hospital of Saint Raphael and nearby Yale-New Haven Hospital, so that each resident receives a progressive education in both major and minor OMS.

Clinical teachingResidents perform most services offered in Saint Raphael’s outpatient Oral and Maxillofacial Clinic – a spacious, state-of-the-art

facility that sees a wide range of patients and is fully equipped to provide the full scope of OMS ambulatory surgery and anesthesia. Many patients come from poor, inner city neighborhoods and face multiple health issues. Saint Raphael’s “Smiles to Go!” mobile dental van, which provides preventive dental care to needy schoolchildren and others in the area, refers many patients to the clinic. Thus, Saint Raphael’s offers OMS residents a broad and thorough medical education. Patients are also referred regularly for OMS care from the General Dental and Pediatric Dental training programs at Yale-New Haven Hospital, as well as from private practices in the area.

Surgery


Maxillofacial


Residents provide hands-on care from the beginning, although responsibilities are progressive and are based on skill and experience. Supervised operating experience is encouraged, with the complexity of the case matching the resident’s ability.

On most days, formal teaching rounds take place in the morning, followed by clinical instruction, conferences, lectures and seminars. Afternoon work rounds are conducted by the chief resident. Faculty are consulted both formally and informally by all residents involved in patient care.

While most of each of the four years is spent providing inpatient and outpatient OMS care at Saint Raphael’s and Yale-New Haven Hospital, residents gain added expertise from rotations through Anesthesia, Medicine, Emergency Medicine, General Surgery, Otolaryngology, Plastic Surgery and Oral Pathology. Each of these areas focuses on the following objectives:

Medicine (2 months in PGY 1): Developing patient evaluation skills is the main thrust of this rotation. Residents spend much of their time focusing on body systems and functions, along with tools used to diagnose illness – particularly electrocardiography, general radiography and clinical laboratory tests. The resident will learn to take a comprehensive health history and become competent in reviewing systems, conducting physical examinations and accurately reporting and interpreting findings. Treatments of common medical illnesses will also be discussed, with emphasis on cardiac, pulmonary, hepatic, renal and endocrine conditions.

Anesthesia (4 months in PGY 1): Participating in all department clinical and didactic activities, residents leave this rotation with the ability to evaluate the physical status of a patient, and assess whether there are physiologic risks to that patient receiving anesthesia. The resident will study anatomy and physiology of the respiratory, circulatory and nervous systems, as well as learn their responses to various preoperative medications, general anesthesia and pain control medications. Different techniques for administering and monitoring anesthesia will be learned, and patients of various degrees of complexity will be seen. The resident will become proficient in managing emergencies and complications related to anesthesia, including establishing and maintaining an airway; maintaining respiration and circulation; and performing both basic and advanced life support. Competence in managing both perioperative and post-anesthesia recovery – including prevention, early detection and management of possible problems – is stressed.

Emergency Medicine (1 month in PGY 2): Along with residents rotating from other programs within the hospital, the resident will focus on evaluating patients with a wide range of acute surgical and

medical conditions. Additionally, there are opportunities to perform minor procedures including suturing lacerations, abscess incision and drainage and minor orthopedic procedures. Residents also become familiar with ECG and laboratory data analysis, use of emergency drugs, emergency airway management, cardiopulmonary resuscitation and neurologic evaluation.

General Surgery (4 months in PGY 2): As a member of the General Surgery team, the OMS resident is assigned to a variety of surgical

resident teams with a variety of general surgical emphases, including intensive care. The resident will admit and work up patients, prepare patients for the operating room, participate in operating room cases, manage postoperative patients and attend all rounds and conferences. Knowledge

of general principles of surgery – including tissue handling and wound care – will be a focus, as well as preoperative assessment and management. Peri- and postoperative management of fluids, electrolytes, blood products and surgical nutrition will be stressed, along with preventing and managing common postoperative complications. Treating critically ill or trauma patients is also a component.

Plastic Surgery (3 months in PGY 2): Conducted at Hartford Hospital and the Connecticut Children’s Medical Center, the general principles and techniques of plastic surgery are learned as residents experience the pre-, intra- and postoperative management of patients undergoing a variety of plastic surgery procedures, with emphasis on craniofacial. The resident is assigned to duties based on level of experience and participates in all reports, rounds and conferences.

Oral Pathology (1 month in PGY 3): Residents spend one month at the Long Island Jewish Medical Center in New Hyde Park, N.Y., taking part in its accredited oral pathology training program. Duties include examining and evaluating patients, preparing specimens for histopathologic examination, reviewing histopathology specimens and presenting findings to supervising faculty. Residents also participate in all didactic activities, particularly clinicopathologic conferences.

Call scheduleWhile assigned to OMS, junior residents are on call every third or

fourth night with chief resident and faculty backup. Calls are taken either from home or within the hospital, depending upon the clinical needs of the service. During rotations to other departments, residents follow that department’s call schedule.

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O r a l & M a x i l l o f a c i a l S u r g e r y

There are no specific electives in the program. Each block is scheduled with specific specialty-related rotations. A sample schedule for the four-year program looks like this:

PGY 1 PGY 2 PGY 3 PGY 4

July OMS Emergency OMS OMS

August Medicine Surgery OMS OMS

September Medicine Surgery OMS OMS

October Anesthesia Surgery OMS OMS (Yale)

November Anesthesia Surgery OMS OMS (Yale)

December Anesthesia Plastic Surgery OMS OMS (Yale)

January Anesthesia Plastic Surgery OMS OMS

February OMS Plastic Surgery OMS OMS

March OMS OMS OMS OMS

April OMS OMS OMS OMS (Yale)

May OMS OMS Oral Pathology OMS (Yale)

June OMS OMS OMS OMS (Yale)


Lectures, seminars and moreWeekly lectures, conferences and seminars are conducted by

physicians and dentists on the Saint Raphael staff, by faculty of Yale University School of Medicine and by guest lecturers. These include:

Mondays: Journal club, case conference and orthodontic conference, as well as a tumor board at Yale-New Haven Hospital;

Tuesday afternoons: OMS lecture series and implant conference;

Wednesday mornings: Surgical morbidity and mortality conference and surgical grand rounds;

First and third Thursday: Head and Neck tumor conference;

Third Thursday: Pathology review and OMS grand rounds;

Friday morning: Teaching Conference with Chief.

From September to November and March to May, an oral pathology course also takes place from 7:30 to 10:30 a.m. on six Saturday mornings.

Residents, with the help of a faculty preceptor, are also required to participate in a scholarly project during each year of training, with a goal of publishing and presenting the results of their work before the end of the fourth year. At the conclusion of every year, each resident presents a paper for the Resident Research Competition.

To further the clinical residency education at the hospitals, residents also attend a course in head and neck surgical anatomy and meetings conducted by the Connecticut Society of Oral and Maxillofacial Surgeons. Chief residents also attend one scientific meeting during the final year of training. Additional seminars and conferences are decided upon individually, particularly when a resident has had a paper accepted for presentation at a major national meeting. Saint Raphael’s also provides a generous book allowance to residents.

EvaluationsEach resident is monitored daily by the program director and assistant

director. Formal assessments are made in writing every six months and reviewed by the resident, director and other appropriate faculty members.

To track their progress, residents also take the Oral and Maxillofacial Surgery In-Service Training Examination each year. A “mock board” oral examination is carried out annually in conjunction with the residency program at the University of Connecticut to evaluate the resident’s didactic performance.

Additional resourcesFor all residents, Saint Raphael’s Health Sciences Library and

computer facilities are open 24 hours a day. More than 2,000 books and 400 journals are housed here, along with seven computers available for use. One computer has a CD burner and a scanner. The photocopier also offers scanning for the purpose of e-mailing. A fax machine is operational during staffed hours. The library has its own home page via any computer within the hospital’s IP range, offering programs such as UpToDate, MDConsult, PubMed, Cochrane and the Microsoft Office programs, among others. These services are complemented by the Yale Medical Library. Within the OMS Clinic, there is a comfortable conference room with study desks for each resident and full audiovisual and computer capabilities for conferences.

27

O r a l & M a x i l l o f a c i a l S u r g e r y

A partial list of places where recent graduates have entered private practice after completing our OMS program includes:

Our most recent department self-study showed that each fourth-year resident: • managed more than 60 traumatic injuries and pathologic conditions • performed more than 2500 dentoalveolar surgeries • placed more than 40 dental implant devices • performed more than 200 outpatient anesthetics • participated in more than 175 major operating room cases

CaliforniaConnecticutLouisianaMassachusettsMichiganMontanaNew York North DakotaPennsylvaniaSouth Dakota


Recent graduates


28

Transitional

“The curriculum is specially designed to meet the educational needs of medical school graduates looking for one year of fundamental clinical education before entering a chosen career specialty, or for those who have not yet decided on a career and want to explore their options in a closely supervised setting.”

– Ernest Moritz, M.D., program director of the Transitional Year Program


29

Having lived in the New Haven area for five years, Christopher Painter, M.D., was familiar with Saint Raphael’s Transitional Year Program long before he applied. “Some of my classmates participated in the Transitional Year Program and had a very positive experience,” said Dr. Painter, a graduate of Yale Medical School. “They felt the

breadth and depth of the program was very good.”

In his own search, Dr. Painter looked at 10 different programs around the country and concluded that Saint Raphael’s would be a good fit for him as well. “I was looking for a place that had a teaching-friendly environment and offered an opportunity for growth,” he said. “I wanted to stay here and I liked the variety that the Transitional Year Program offered.”

The format of Saint Raphael’s Transitional Year Program allows residents to gain valuable experience and develop a broad knowledge base in several clinical areas before transitioning to their residency program. “It’s the interface between Medicine and Surgery,” said Dr. Painter, whose specialty is Anesthesia. “When you’re on a medical or surgical rotation, there’s no mystery involved. You get to see both processes. That’s a strength of the program.”

Another strength is diversity. “At Saint Raphael’s, you take care of people from all walks of life,” Dr. Painter said. “I think diversity and variety are key.”

Each year, nine residents are accepted into Saint Raphael’s Transitional Year Program, which provides well-balanced graduate medical education in several key clinical disciplines.

Integrating rotations in Internal Medicine, General Surgery, Emergency Medicine, Pediatrics, Radiology and elective time, the Transitional program is sponsored by Saint Raphael’s Departments of Medicine and Radiology and is affiliated with Yale University School of Medicine. Assignments are broken into blocks, with residents assuming the same responsibilities as Categorical residents on respective services, including rotations in critical care units and specific medical and surgical services. You may also arrange electives in many of the hospital’s available clinical teaching services, and orient them toward acute or ambulatory care. Among the choices are anesthesiology, dermatology, endocrinology, gastroenterology, infectious diseases, nephrology, neurology, ophthalmology, podiatry, radiation oncology and radiology.

During every rotation, you will be an integral member of the patient care team and encouraged to fully participate in department conferences and teaching activities. Full-time faculty and senior house officers provide individual supervision and teaching. Because we want you to get the most from your residency experience, our full-time faculty is devoted primarily to resident teaching – whether at a patient’s bedside or as a mentor for a reading group. (Turn to the back pocket of this booklet for Transitional Year faculty biographies.)

Resident performance is evaluated monthly by department faculty, and the program director meets quarterly with individual trainees – assuring that you receive the counseling and tailored curriculum needed to best meet your career and training goals.

Year


30

T r a n s i t i o n a l Y e a r

Core rotationsEach Transitional Year resident’s schedule is individually

designed to meet both resident needs and program requirements. Over the course of the academic year, however, each resident rotates through the following four-week blocks:

1 block Medical Intensive Care Unit

1 block Cardiology

1 block Telemetry Medicine

2 blocks General Medicine

2 blocks General Surgery

1.5 blocks Pediatrics

1 block Emergency Medicine

2.5 block Electives (including 0.5 block Radiology “selective”)

1 block Vacation

Internal MedicineMedical rotations include separate assignments to the intensive

care unit (ICU) and cardiology teams. On all medical rotations you are part of a team that includes full-time faculty and senior residents. In the ICU and cardiology rotations, supervision is provided by a full-time intensivist and cardiologist, respectively, and subspecialty fellows. On general medicine and telemetry rotations the teams consist of one senior resident, two PGY-1 residents and a student, with full-time supervision by a hospital-based clinician educator. Subspecialty fellows and additional teaching attendings provide teaching and supervision. Residents have primary responsibility for evaluating and managing patients as they are admitted to the hospital and throughout the hospital stay. Consultant teams consisting of a subspecialty attending, fellow and rotating resident are readily available and provide support in patient care.

Also scheduled on various days are medical grand rounds, chairman’s rounds (case discussions with a focus on clinical decision-making and systems of care), professor’s rounds (case discussions

with a senior clinician), autopsy conference and a variety of subspecialty conferences.

During each rotation, you’ll begin your day with a 7 a.m. sign-in. Work rounds with the clinician educator take place from 8 to 10 a.m., followed by independent work time. A noon conference with free lunch takes place each weekday, followed by time for admissions, team teaching or other care responsibilities.

During your Internal Medicine rotations, you will participate in several programs specifically designed to enhance your learning experience, including:

Regular conferences: Include autopsy with hands-on anatomical correlation of clinical findings; EKG interpretation with an attending cardiologist to learn the techniques of basic and advanced EKG reading; Hospital of Saint Raphael medical grand rounds and Yale medical grand rounds (transportation provided).

Peer-teaching conferences: A PGY 2 or 3 resident, working with an attending, presents a topic with text and literature review to fellow residents and faculty members.

Journal club: Residents work with faculty to analyze an article and discuss principles of evidence-based medicine, individual study design, strengths, weaknesses and application of the study to the clinical setting.

“Medical Quiz Show Conference” (modeled after Jeopardy!): Using a computer display with scanned photos, smears and short-answer questions, residents play monthly as part of a team. It’s proven to be a fun and informal way to review medicine in a competitive setting.

General SurgeryTransitional residents are assigned to general surgery teams, each

under the direction of an attending physician and a chief surgical resident. You will be an active participant in pre- and post-op management, surgery and clinic. Exposure to several subspecialties is facilitated through team assignments, vascular and thoracic, among them.

The central work area of the main treatment room of the Emergency Department


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T r a n s i t i o n a l Y e a r

Emergency admissions, pre-op assessment, participating in surgical procedures like thoracotomy and laparotomy, and post-op care of patients are also part of the experience. Weekly clinic time allows for both patient follow-up and experience in outpatient management of common surgical problems, such as peripheral vascular disease and ostomy care. Organized conferences provide additional opportunities for learning and discussion.

Emergency MedicineUnder the direction of full-time, board-certified physicians,

residents receive training and experience in acute adult medical and surgical illnesses such as chest pain, stroke, myocardial infarction, syncope, pneumonia, acute cardiopulmonary arrest and trauma patient evaluation in our Level II Trauma Center. The educational emphasis is specific for emergency medicine and includes daily instruction and teaching, plus working closely with Internal Medicine and General Surgery residents. Didactic educational materials specific to emergency medicine are provided and interesting patient scenarios are formally presented at the end of the rotation.

Daily experiences range from triage of major emergencies to decisive management of common ambulatory problems. Communication and interaction with patients, families and other physicians are emphasized. Triage decisions, discharge instructions and follow-up plans are among the many topics discussed during personal emergency physician supervision.

PediatricsThis rotation will provide you with valuable experience in

managing both well and sick infants, children and adolescents, as well as in interacting with concerned parents and family members. Pediatrics is our ambulatory rotation, and the emphasis is on outpatient care.

Most of the 12,000 patients seen in the Saint Raphael Pediatric Clinic each year are by appointment, but urgent and semi-urgent cases are also seen each day. This clinic experience will teach you the

principles of pediatric diagnosis, treatment, health maintenance and health education. You will work closely with residents from Yale-New Haven Hospital, with supervision by our full-time Pediatric faculty.

ElectivesWorking with the program director or another faculty advisor,

you’ll arrange for electives oriented toward acute or ambulatory care. In addition to a two-week “selective” in radiology, other choices include anesthesiology, dermatology, endocrinology, gastroenterology, infectious diseases, neurology, ophthalmology, podiatry and radiation oncology, among others. You are encouraged to take the electives that interest you most and best match your career objectives. Most Transitional residents perform these electives at Saint Raphael’s, although they can also be done at Yale or the VA Connecticut Healthcare System, West Haven campus. Most of our residency programs rotate through these centers. Up to four weeks of electives away from Saint Raphael’s, including opportunities away from New Haven, may be arranged.

Additional resourcesFor all residents, Saint Raphael’s Health Sciences Library and

computer facilities are open 24 hours a day. More than 2,000 books and 400 journals are housed here, along with seven computers available for use. One computer has a CD burner and a scanner. The photocopier also offers scanning for the purpose of e-mailing. Fax machine is operational during staffed hours. The library has its own home page via any computer within the hospital’s IP range, offering programs such as UpToDate, MDConsult, PubMed, Cochrane and the Microsoft Office programs, among others. These services are complemented by the Yale Medical Library.

Based on your interests, research and study opportunities are also available in a variety of clinical departments. These are arranged one-on-one with the program director and other faculty members.

A partial list of where our recent graduates have gone after completing our Transitional program includes:

Yale School of Medicine/Yale-New Haven Hospital, AnesthesiologyYale School of Medicine/Yale-New Haven Hospital, OphthalmologyYale School of Medicine/Yale-New Haven Hospital, Radiology

Tufts University RadiologyBeth Israel Deaconess Medical Center Anesthesiology

Hartford Hospital Radiology

University of California Irvine Anesthesiology

Mount Sinai Hospital Radiology

University of Connecticut AnesthesiologyYale School of Medicine/Yale-New Haven Hospital, Radiation Oncology

Wake Forest University Ophthalmology

Indiana University Dermatology

Hospital of Saint Raphael Radiology


Recent graduates


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Yale-Integrated

Residents work side-by-side with dedicated faculty members – many tops in their field – who greatly enhance the clinical services available to patients. They also add an important

dimension to Saint Raphael’s Graduate Medical Education program.

OrthopedicsThis Yale University-affiliated training program selects five

orthopedic residents each year for work at Saint Raphael’s, the VA Connecticut Healthcare System’s West Haven campus, Waterbury Hospital and Yale-New Haven Hospital. Residents rotate through each, with the final year divided into periods spent as chief resident at Yale-New Haven Hospital, the VA Healthcare System, and in laboratory investigation and the study of basic science. The varied patient populations of these four hospitals provide an excellent opportunity to experience the many aspects of orthopedic surgery.

Residents maintain an active conference schedule to study both

clinical material and basic science. Residents are also expected to pursue independent investigative projects. While at Saint Raphael’s, residents are expected to present their cases at the weekly Tuesday morning conference. The PGY 4 covers the total joint cases. Saint Raphael’s does the most total joint cases in Connecticut and there is an abundance of cases from which the resident can choose. The same attending physicians and clinical professors who work at Yale also cover Saint Raphael’s. Therefore, there is a continuity of teaching throughout the residency.

OtolaryngologyThe Hospital of Saint Raphael Section of Otolaryngology is one

of three teaching sites for PGY 3, PGY 4 and PGY 5 residents in the Yale University School of Medicine residency program. It offers a great breadth of clinical material in surgery and the ENT clinic. Residents have access to an on-site, surgical simulation laboratory. Clinical

Many Yale University School of Medicine and Yale-New Haven Hospital programs include a rotation at the Hospital of Saint Raphael, where residents gain unique experiences treating the diverse populations that come to a community hospital.


Yale-Integrated

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Programs

materials range from routine otolaryngological procedures and cosmetic facial surgery to advanced endoscopic sinus surgery, head and neck oncology and skull-based tumors, such as pituitary tumors and acoustic neuromas.

PediatricsEach PGY 1 resident spends four weeks

at the Hospital of Saint Raphael, where they learn about the practice of outpatient general pediatrics. Their responsibilities include well-child visits, sick visits and newborn nursery rounds. Third-year pediatric residents rotate for four-week blocks as well and have an opportunity to spend one rotation as “chief,” in which they have more teaching and administrative responsibilities. During their chief rotation, they also have an opportunity to learn more about the New Haven community by going on site visits to different community agencies.

The Section of Pediatrics is part of the Department of Women’s and Children’s Services and consists of a newborn nursery with 12 bassinets, a Newborn Intensive Care Unit with eight beds, the Pediatric Primary Care Center and Chapel Pediatrics; there is currently a small inpatient unit with three beds. Pediatricians also provide medical care for youths in Saint Raphael’s 20-bed children’s inpatient psychiatry unit.

Saint Raphael’s emphasis is on providing residents with a view of community hospital practice, direct experience with a wide range of pediatric problems, and experience in the private sector of pediatric practice. Saint Raphael’s logs more than 20,000 pediatric visits yearly, including 11,000 to the Primary Care Center and 5,000 to Chapel Pediatrics.

The section also provides care for over 1,000 newborns and child psychiatry inpatients.

Pediatricians also provide medical services outside the hospital at the New Haven Juvenile Detention Center, the Children’s Center residential treatment facility, at neighborhood clinics located within nearby schools and through Saint Raphael’s nationally recognized Project MotherCare clinic.

Plastic SurgeryThe Section of Plastic Surgery at the

Hospital of Saint Raphael is integrated with Yale University School of Medicine and the Yale Plastic Surgery Residency Program. Of the 13 plastic surgeons on the attending staff and four on the courtesy staff, most have dual and integrated roles at Yale-New Haven Hospital and Yale University School of Medicine. A senior resident in plastic surgery from Yale rotates at Saint Raphael’s every three months, as does a Hospital of Saint Raphael General Surgery resident at the PGY 1 level. The Plastic Surgery Clinic meets every Thursday afternoon, and the Quality Assurance Conference is held monthly in conjunction with Yale.

Saint Raphael’s offers plastic surgery residents the opportunity to experience all aspects of this specialty including hand, breast, skin cancer, micro, replantation and cosmetic surgery.

All residents deal with congenital and acquired defects in both adults and children. Chief residents in General Surgery receive extensive exposure from cleft lip to jaw cancer. Many go on to enter two- or three-year plastic surgery training programs.

Podiatric SurgeryThe Hospital of Saint Raphael is one

of the major rotation sites for the Yale-VA Podiatric Surgery Residency Program, a three-year program that offers comprehensive training in all aspects of foot and ankle care.

The residency accepts five residents per year and is completed through rotations at each of the four major affiliated hospitals: Hospital of Saint Raphael, Yale-New Haven Hospital, Hospital of Central Connecticut and VA Connecticut Healthcare System. Numerous community hospitals and surgery centers round out the training program, providing a fine combination of inpatient, outpatient, routine and urgent care.

Residents assigned to the Hospital of Saint Raphael complete internal medicine, orthopedic surgery and podiatric medicine and surgery rotations, with a strong emphasis on senior level surgical care. The residents gain invaluable training in the operative repair of foot and ankle trauma, joint replacement and elective reconstructive surgery of the foot and ankle, in part, due to the strong relationship developed between the Orthopedics and Podiatry services.

The comprehensive residency program is structured to provide high-quality clinical, academic, and research opportunities. The training far exceeds minimal activity volume set forth by the Council on Podiatric Medical Education, and the experience gained adequately prepares graduates for the certification pathways of the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics and Medicine


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Saint Raphael residents enhance their expertise in patient care and disease diagnosis through rotations and clinical experiences throughout the hospital.

AnesthesiologyThe department of Anesthesiology covers all phases of general,

regional and local anesthesia for all types of surgical and obstetrical cases. The department is also involved in evaluating and treating chronic pain.

Department mortality and morbidity meetings take place monthly. The department also sponsors a monthly series of presentations by nationally known speakers.

Emergency MedicineThe Hospital of Saint Raphael’s Emergency department is a high-

volume, high-acuity department with 60,000 patient visits annually. Under the supervision of board-certified Emergency Medicine physicians, interns and residents from medical and surgical disciplines evaluate and treat patients of all ages with a broad spectrum of injuries and illnesses.

The department is a certified Level II trauma center, certified stroke center, and provides immediate access to acute interventional cardiology.

A number of advanced services are utilized in the department – a paperless electronic documentation system, computerized order entry and access to electronic medical records. Also with digital radiography, images can be accessed from any workstation. The department has also implemented bedside ultrasonography, advanced airway management with Glidescope, and point-of-care laboratory testing.

PathologyResidents learn to appreciate the complexities of pathology by

working closely with Saint Raphael pathologists. An understanding of the pathologist’s contribution to patient care and the specific acquisition of skills and knowledge are gained through individual instruction and numerous clinical conferences.

Saint Raphael’s laboratories are well equipped, largely automated and have ample capabilities for methodology evaluation, new procedure development and quality assurance studies. Major procedures in all divisions of surgery and medical specialties make for an unusually fine source of material in surgical pathology.

Clinical

The playscape for patients in Child and Adolescent Psychiatry

Our innovative programs and services, combined with our commitment to technology and vision for the future, position Saint Raphael’s as one of New England’s premier hospitals and sources of medical education.


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Clinical

PsychiatrySupervised by a faculty psychiatrist

board-certified in psychosomatic medicine, PGY 3 residents take part in Saint Raphael’s psychiatric consultation service by evaluating patients on medical and surgical units. In this role, they gain valuable experience providing psychiatric assessments and treatment including counseling and pharmacotherapy.

Internal Medicine residents rotate through the outpatient clinic where they gain exposure to acute and chronically mentally ill patients.

More than 900 child, adolescent and adult psychiatric inpatients are treated at Saint Raphael’s each year. Featuring a comprehensive, integrated model of inpatient and outpatient care, services include a day hospital, evening chemical dependence

treatment, and 24-hour emergency care. PGY 1 residents can also elect to rotate through Saint Raphael’s 20-bed inpatient Child and Adolescent Psychiatry unit.

The department of psychiatry regularly holds grand rounds attended by residents, physicians, mental health professionals and others interested in the topics, which cover a full range of behavioral health treatment and research.

Radiation OncologyRadiation Oncology services are provided

through Saint Raphael’s Father Michael J. McGivney Center for Cancer Care. Residents rotating through this busy facility gain valuable clinical experience from the wide spectrum of malignancies being treated. The department

is equipped with state-of-the-art equipment, including modern, supervoltage linear accelerators with electron capabilities, intensity modulated radiation therapy, orthovoltage and superficial equipment, computerized simulators, three-dimensional isodose planning, physics, consultations, radioactive implants, high-dose rate afterloading equipment and Mammosite, and stereotactic radiosurgery with CyberKnife®.

Residents work side-by-side with radiation oncologists, examining patients and participating in their oncologic management. Residents learn how to perform a head and neck examination, plus observe procedures in both the department and operating room. They also participate in several multidisciplinary conferences.

Resources

The Hospital of Saint Raphael is one of the select hospitals in the country with the cancer-fighting technology of CyberKnife®, using radiosurgery to destroy operable and inoperable tumors anywhere in the body with pinpoint accuracy.


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Fellowships“The presence of fellowships provides our residents with additional educational and research opportunities, and improves their ability to obtain subspecialty training.”

– Robert Nardino, M.D., program director of the Internal

Medicine Residency Program


Fellowships

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Cardiovascular DiseaseTraining in Cardiovascular Disease is a three-year program accredited by the Accreditation Council for Graduate Medical

Education (ACGME). Two fellows per year are accepted, with a total complement of six fellows. All applicants must have completed a three-year Categorical Internal Medicine residency.

The Cardiovascular Disease fellowship training program is designed to provide the subspecialty fellow with didactic instruction, and clinical experience in the pathophysiology, diagnosis, treatment, and management of patients with cardiovascular disease. Four-week rotation blocks provide the framework for exposure to all required elements of cardiology training, with an emphasis on the development of cognitive, clinical, interpretive and procedural skills. Interpersonal skills, professional attitudes and humanistic qualities of the Cardiovascular Disease residents are continuously assessed through competency-based education initiatives:

• Cardiovascular Disease fellow rotations at the Hospital of Saint Raphael;

• Clinical rotations including the Coronary Care Unit, Cardiothoracic Intensive Care Unit, Clinical Consult Service, Electrophysiology Service and the Ambulatory Clinic;

• Invasive rotations in the Cardiac Catheterization Laboratory and the Electrophysiology Laboratory;

• Non-invasive rotations in echocardiography, stress testing, nuclear cardiology and ECG interpretation with exposure to cardiac CT and cardiac MRI; and

• Elective rotations in specific areas of cardiology, including cardiac MRI and cardiac CT.

Cardiovascular Disease fellows are assigned to the weekly longitudinal Ambulatory Clinic. Two fellows per session are supervised by a full-time attending cardiologist in a faculty practice office setting. The Ambulatory Clinic, which is staffed by nurses and a cardiac nutritionist, is complemented by on-site interaction with the cardiac rehabilitation program, a staff endocrinologist, and the director of the Lipid Clinic.

Cardiovascular Disease fellows attend the weekly multi-disciplinary cardiology management conference, the didactic core curriculum lectures, cardiac catheterization laboratory conference, noninvasive imaging conference and board review sessions, as well as the quarterly morbidity and mortality conference, cardiology and cardiothoracic surgery journal clubs, and ECG conference. Additionally, attending physicians have direct teaching responsibilities during each of the rotation blocks. These small group sessions allow for the free discussion between the sub-specialty fellow, the house staff and the attending staff.

Cardiovascular Disease fellows have ongoing opportunities to strengthen presentation and teaching skills.

Sub-specialty fellows identify and present the cases at the multi-disciplinary cardiology management conference, cardiac catheterization laboratory conference, and morbidity and mortality conference, as well as present papers at the cardiology and cardiothoracic journal clubs. Teaching responsibilities of the Cardiovascular Disease fellows include didactic lectures, interpretation of ECGs, and discussion of interesting cardiology cases with the medical house staff assigned to the CCU, and on the cardiology elective. Cardiovascular Disease fellows also facilitate the discussion in the weekly internal medicine case management conference.

Cardiovascular Disease fellows actively participate in clinical research initiatives, which include original hypothesis-generated research, and multi-center clinical trials. Cardiovascular Disease residents are encouraged to participate in professional organizations, and attend local and national conferences.

C a r d i o v a s c u l a r D i s e a s e



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GeriatricsThis fully accredited, one-year fellowship in Geriatric Internal Medicine will

lead to eligibility for Certification in Geriatric Medicine. One fellow is accepted annually. Applicants must have completed a three-year residency program in Internal Medicine. The Geriatric fellowship is designed to provide the sub-specialty resident with detailed instruction, exposure and experience in the pathophysiology, diagnosis, treatment, management and understanding of geriatric syndromes and related conditions.

Geriatric fellowship rotations

Inpatient and geriatric consult team and interdisciplinary geriatric program unit – Fellows will become part of the interdisciplinary team with a geriatrician, advanced practice geriatric nurse, social worker, physical therapist, occupational therapist, pharmacist and chaplain, in the provision of consultative care. In an effort to maintain and maximize function of older adults, fellows will be exposed to the full spectrum of geriatric syndromes. Such syndromes include dementia, delirium, falls, immobility, depression, polypharmacy, end-of-life issues and functional assessment.

Outpatient Geriatric Assessment

Fellows will be part of the interdisciplinary geriatric team, providing geriatric consultative services to a variety of referral services. The goal of this rotation is to help fellows become experts in assessing geriatric syndromes that imprint on function in older adults as well as interfacing with a variety of professional referral sources.

Geriatric Continuity Experience

Under the auspices of the Hospital of Saint Raphael’s ElderCare Program, fellows will provide ongoing primary care for older adults. The goal of this experience is to enable fellows to learn to manage older adults with multiple chronic conditions. The ElderCare Program is a series of primary care sites throughout the Greater New Haven area located in senior residences and senior centers. Currently, the Hospital of Saint Raphael, in conjunction with community partners, operates seven such sites.

G e r i a t r i c s

Residents and fellows are involved in direct community outreach, including educational programs for various groups.


Fellows will also have the opportunity to complete home visits with physician assistants and local home care agencies as needed as part of their continuity experience.

Geropsychiatry

Working with a board-certified geropsychiatrist, the fellow will be exposed to the broad scope of common psychiatric syndromes, psychopharmacologic interventions, basic psychodynamics and psychotherapeutic interventions and family assessments in dealing with older adults. The intensity of the inpatient unit as well as the hospital-wide consultative service provides the required clinical experience in this rotation.

Geriatric Rehabilitation

Working under the direct supervision of a board-certified physiatrist, fellows will have contact with older adults undergoing rehabilitation under the auspices of the outpatient rehabilitation program. Fellows will participate in the interdisciplinary management of older adults with stroke, traumatic brain injury and musculoskeletal disorders.

The Sister Anne Virginie Grimes Health Center

Fellows, under the direct supervision of the fellowship program director and geriatricians at the facility, will follow patients over a set period of time. Direct observation of case presentations, chart audits, clinical and teaching skills provide information for feedback and instruction. Fellows will also attend the weekly program director rounds at the facility.

Saint Raphael’s program provides ongoing opportunities for the fellow to develop presentation and teaching skills. In addition to attending weekly didactic conferences on a variety of geriatric topics and monthly geriatric journal club, fellows are expected to present four to six conferences per year to a variety of hospital and professional audiences. The geriatric fellow also has multiple responsibilities and interactions in terms of teaching and supervising the Internal Medicine residents while they complete their geriatric rotations under the general direction of the geriatric fellow and the faculty. This process is structured to enable the geriatric fellows to develop teaching skills while completing bedside teaching rounds with the residents, reviewing the direct application of geriatric principles to individual patients, and specifically instructing residents on the management of multiple geriatric syndromes. The fellows also direct the interdisciplinary team meetings under the supervision of the attending physician.

Research

Fellows will receive scheduled tutorials as part of the ongoing lecture series on research methodologies in geriatrics and gerontology. The goal of this activity is to provide each fellow with the skills necessary to critically assess research in gerontology and geriatrics and to be able to formulate research questions related to the same.

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G e r i a t r i c s


The Sister Anne Virginie Grimes Health Center, a 125-bed skilled nursing facility, is part of the Saint Raphael Healthcare System and is located proximal to the main hospital, providing both short-term rehabilitation and long-term care services to older adults.


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The Saint Raphael Nephrology program director and fellows meet with patients in the hospital’s dialysis centers.

N e p h r o l o g y

NephrologyThe Hospital of Saint Raphael offers a two-year, post-doctoral fellowship in

Nephrology leading to board certification. The fellowship is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Up to two fellows are accepted annually after completion of a three-year residency program in Internal Medicine. The Nephrology fellowship program is designed to provide the subspecialty fellow with didactic instruction and clinical experiences in the pathophysiology, diagnosis, treatment and management of patients with diseases of the kidney.

Nephrology fellowship rotations: There are seven major educational/patient care experiences that focus on different aspects of renal medicine:

Inpatient Consult/ESRD Rotation

Fellows participate in a very active consultation service evaluating and treating patients with acute and chronic kidney disease, acid-base and electrolyte disorders and hypertension, as well as disorders of mineral metabolism. This will include patient care in the ICU and non-ICU setting. The Hospital of Saint Raphael is unique in that it offers a broad range of renal replacement therapies to care for the needs of their patients. This includes traditional hemodialysis, peritoneal dialysis, continuous venovenous hemofiltration (CVVH) and sustained low efficiency dialysis (SLED). The fellow will also gain experience in the placement of temporary vascular access, performance and interpretation of urinalysis and performing and interpreting percutaneous renal biopsies.


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Longitudinal Renal Clinic Rotation

The fellows actively participate in outpatient evaluation of patients with proteinuria, hematuria, hypertension, electrolyte disorders and acute and chronic kidney disease in a weekly supervised clinic setting. This rotation provides the trainee the opportunity to watch certain diseases unfold over time, to intervene when appropriate with pharmacologic and other therapies, to develop close, nurturing relationships with patients, and develop integrated treatment programs drawing on individual health professionals, community agencies and educational materials.

Outpatient Hemodialysis Rotation

In this rotation the fellow will manage a shift of hemodialysis patients for the two years of their fellowship. Through this experience they will learn and gain experience in all aspects of the patient’s hemodialysis care. During this rotation, they will also gain exposure to other state-of-the-art modalities, such as home hemodialysis, self-care dialysis, nocturnal hemodialysis and in-center peritoneal dialysis.

Outpatient Peritoneal Dialysis Rotation

The fellows will manage a cohort of peritoneal dialysis patients through the two years of fellowship and gain the education and expertise necessary to become competent in outpatient peritoneal dialysis. The fellows will also spend two weeks each year in the peritoneal dialysis unit receiving concentrated instruction on how a successful peritoneal dialysis unit functions.

Inpatient Transplant Rotation

Inpatient transplantation training occurs in cooperation with transplant program at Yale-New Haven Hospital. The fellow will rotate on the Yale inpatient transplant service for three one-month blocks over the two years of their fellowship. Through this experience (and the outpatient transplant clinic rotation) the fellow will gain expertise in managing issues particular to renal transplantation.

Outpatient Transplant Clinic Rotation

The fellows will attend a half-day a week transplant clinic, four months each year for the two years of their fellowship. Here, they will have the opportunity to evaluate potential transplant donors and recipients as well as gain clinical experience in the long-term management of transplant recipients in the ambulatory setting.

Research Rotation

Nephrology fellows are expected to pursue a clinical research project under faculty guidance. There are five dedicated monthly research blocks throughout the course of the fellowship. Fellows will receive scheduled tutorials as part of an ongoing lecture series on research methodologies.

ConferencesThere is a wealth of educational experiences throughout the fellowship. Multiple teaching conferences include (but are not

limited to) a monthly renal biopsy conference, literature review, research-in-progress conference, as well as weekly patient care and core curriculum conferences. Nephrology fellows are also expected to be involved in the education of students, house staff and faculty.

Saint Raphael’s Dialysis Centers are blending new amenities, such as heated chairs and touch-screen TVs, with a flexible and dynamic program to satisfy a full range of patient needs.

N e p h r o l o g y



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Y a l e f e l l o w s GastroenterologyHematology Oncology Infectious DiseasesPulmonary and Critical Care Medicine

Gastroenterology

Two Gastroenterology fellows are on service at Saint Raphael’s each weekday, with continuous availability for emergency consult coverage on nights and weekends. Working closely with faculty, these fellows provide formal consultations and offer informal opinions; serve as a focal point of the teaching service; and interact daily with residents and students. They also provide role models for medical and surgical residents.

Fellows are exposed to the complete range of inpatient and outpatient gastroenterological procedures, including diagnostic and therapeutic endoscopy using the most current endoscopic techniques. Fellows daily come in contact with acute problems of varying types and severity; participate in Saint Raphael’s weekly gastroenterology clinic; and perform colonoscopy screenings in a biweekly colorectal cancer screening clinic.

Formal teaching conferences take place weekly, and a journal club meets monthly. Excellent opportunities for clinical research are also available.

Hematology Oncology

During this two-year program, fellows spend at least three days a week in Saint Raphael’s newly remodeled and expanded inpatient cancer unit, or in its outpatient Father Michael J. McGivney Center for Cancer Care. In both areas, fellows take part in evaluating and treating both new and follow-up patients under faculty supervision.

The program is designed to provide comprehensive training in the diagnosis and multidisciplinary management of neoplastic disorders. The first year of training is entirely clinical. Each fellow works primarily with one faculty member, receiving

state-of-the-art training in a community hospital setting. Fellows are exposed to a complete range of inpatient and outpatient procedures, such as bone marrow aspiration. They routinely come in contact with acute oncologic problems of varying types and severity. There are also increased opportunities to perform consultations for hospitalized patients on non-medical services.

The second year of training includes both clinical experience and research.

The program also includes an extensive lecture series focused on cancer pathologenesis and the biologic basis of treatment; outpatient clinics structured to focus on specific diseases, followed by an interdisciplinary tumor board meeting; weekly teaching conferences; and monthly journal clubs. Excellent opportunities for medical research are also available. For an overview of the many cancer clinical trials under way here, visit the Saint Raphael website, srhs.org/clinicaltrials.

Infectious Diseases

One fellow each month participates in inpatient infectious diseases consultation services, seeing patients with a wide variety of community-acquired infections, nosocomial infections and HIV-related infections.

During this clinical training, fellows spend time with most of Saint Raphael’s five Infectious Diseases attending physicians. They accompany these attendings to the clinical microbiology laboratory, where they receive instruction on interpretation of gram stains and other aspects of clinical microbiology. They also actively participate in the weekly Yale Infectious Diseases clinical conference, which includes clinical case presentations and didactic lectures.

Yale fellowsYale fellows enrolled in the following programs also obtain valuable experience at Saint Raphael’s. Contact with residents is extensive,

with Yale fellows fully integrated into all aspects of patient care and medical education.

The Hematology Oncology rotation at the Hospital of Saint Raphael is a unique opportunity for trainees to gain insight in the management of cancer patients who are low income with many medical and social comorbidities. Under the direct supervision of Saint Raphael medical oncologist Andrea Silber, M.D., (left) the fellows will learn how to provide high quality evidence-based care, with special attention to appropriate use of healthcare resources.


One first-year fellow and one second-year fellow each spend his or her HIV outpatient continuity clinic time at Saint Raphael’s Haelen Center. Fellows here are supervised by dedicated HIV physicians who provide primary care to a growing number of patients. Fellows have the opportunity to engage in clinical research dealing with HIV-related infections, general infectious disease problems and hospital epidemiology.

Pulmonary and Critical Care Medicine

A primary training site for Pulmonary and Critical Care Medicine, Saint Raphael’s receives 24/7 coverage from Yale fellows. They participate in a consultation service, evaluating and treating patients with obstructive lung disease, interstitial lung disease, pleural diseases, lung cancer and the spectrum of acute pulmonary disorders.

Fellows make daily rounds with attending physicians and residents in the Medical Intensive Care Unit. They become an essential part of the MICU team, working and consulting with attending physicians to provide state-of-the-art care and diagnosis. Informal teaching sessions also routinely take place.

Fellows also assist in invasive pulmonary and critical care procedures, among them intravascular catheter placement, thoracentesis and bronchoscopy. Their presence augments both the quality of learning for residents, and the quality of care for patients.

Fellows are expected to present clinical cases they’ve worked on at Saint Raphael’s to the Connecticut State Chest Conference. They are also responsible for presenting cases for discussion at Saint Raphael’s biweekly pulmonary, radiology, pathology and thoracic surgery conferences. A monthly critical care journal club is also led by the fellow.

GastroenterologyHematology Oncology Infectious DiseasesPulmonary and Critical Care Medicine

Y a l e f e l l o w s

A medical technologist processes HIV and HCV viral load samples using a next-generation bDNA instrument in Saint Raphael’s Microbiology Lab. The Lab’s Molecular Section also performs PCR testing for Group B Streptococcus and Clostridium difficile and will soon be implementing MRSA screening using the GeneXpert® System.

GastroenterologyHematology Oncology Infectious DiseasesPulmonary and Critical Care Medicine

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All work and no play? No way! Social activities, team-building exercises and well-deserved leisure time are all important aspects of Saint Raphael’s residency program. And whether

you’re single, married or have a family with children, there’s lots to do.Organized, monthly group outings include baseball games and

indoor rock climbing. A summer picnic, holiday party and recognition dinner generally take place annually. There’s also much to enjoy on your own – whether you’re looking to dance all night, quietly sip a cappuccino, hike a mountain trail, shop for shoes or just sit under a tree with a good book.

Located on Long Island Sound between New York and Boston, New Haven is a city that combines New England charm with cosmopolitan life; internationally known museums with international cuisine.

Settled in 1638 and full of historic buildings with wonderful architecture, it’s a diverse community that features a lovely, historic Green; grand, old homes and modern apartment buildings; a long shoreline with walking paths; several parks with hiking and picnicking areas; unique shops, restaurants and bookstores; a huge downtown library; access to the countless academic, sports and cultural programs offered at Yale and other area universities; and so much more.

Distinct neighborhoods that preserve and showcase different nationalities and ethnic groups are located throughout the city. Indeed, one of the most well known areas, Wooster Square, is a hub for Italian restaurants, the best pizza (former President Clinton’s favorite!) and renowned Italian fairs and festivals. New Haven’s annual International Festival of Arts & Ideas, artidea.org, also annually draws thousands of people from throughout the world to take part in two weeks of diverse theater, music, dance, poetry, visual art and lecture presentations.

AroundLife outside the residency program


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Around Connecticut

New Haven is also home to the Long Wharf Theater, Yale Repertory Theater and the historic Shubert Performing Arts Center, featuring some of the top theatrical talent in the nation. Nightlife buzzes with many live musical performances. There’s something for every taste – classical, jazz, swing, pop, rap and rock. And during the summer, free outdoor concerts take place on the Green and at various city parks.

For the sports lover, there’s public access to numerous skating rinks; minor league baseball and hockey teams within a 30-minute drive; the University of Connecticut’s nationally ranked men’s and women’s basketball teams; and the annual New Haven Open at Yale tennis tournament. Several local universities come alive each football season. And several ski slopes are just an hour’s drive away. There are also many places along Long Island Sound and rivers to rent boats, fishing equipment and jet skis.

New York and Boston are both less than two hours away and easily accessible by car or train.

For the art lover, the city has a half-dozen major museums with international collections, as well as dozens of galleries. Most of these are located in the Chapel Street-Broadway area, and within walking distance of Saint Raphael’s.

Surrounding New Haven are suburbs that feature classic New England landscape – long, sandy beaches and boardwalks; forests; mountains; and many lakes and rivers that are great for water activities. Among the other varied offerings from neighboring communities: beautiful nature preserves with wild birds, trails and sea creatures; the Peabody Museum of Natural History; the Shoreline Trolley Museum; rose gardens; Sleeping Giant State Park and the Eli Whitney Museum; horse-drawn wagon rides; several public golf courses; pick-your-own pumpkins, strawberries and other treats; and the list goes on.

To learn more about New Haven and Southern Connecticut, visit these websites:

• New Haven Chamber of Commerce: newhavenchamber.com• City of New Haven: cityofnewhaven.com• Greater New Haven Convention and Visitors Bureau:

newhavencvb.org• Info New Haven: infonewhaven.com• Connecticut Department of Tourism: ctvisit.com

New Haven is a culinary delight with more than 200 restaurants. It’s easy to find a delicious meal satisfying any budget or ethnic taste.


46

How to apply

Lynn-Marie Wright Internal Medicine and Geriatrics

Elizabeth Joyce Diagnostic Radiology

Kathy Contois Internal Medicine

Stephanie Pane Transitional Year and Nephrology

Amy Murphy Cardiovascular Disease

Lillian Figueroa, C-TAGME,

General Surgery

Lisa Mancini, (not pictured)

Oral and Maxillofacial Surgery

(from left to right)

Program Coordinators


Residency programsDiagnostic Radiology

Radiology accepts applications only through the Electronic Residency Application Service (ERAS). All positions are filled through the National Resident Matching Program (NRMP), so you must be registered on the NRMP website, nrmp.org. The Radiology code is 1090420A0. For additional information, contact Hospital of Saint Raphael program coordinator Elizabeth Joyce at 203.789.3118 or [email protected].

General SurgeryGeneral Surgery accepts applications only through the Electronic

Residency Application Service (ERAS). All positions are filled through the National Resident Matching Program (NRMP), so you must be registered on the NRMP website, nrmp.org. The General Surgery codes are 1090440C0 and 1090440P0. For additional information, contact Hospital of Saint Raphael senior residency program coordinator Lillian Figueroa, C-TAGME, at 203.789.3443 or [email protected]

Internal MedicineInternal Medicine accepts applications only through the Electronic

Residency Application Service (ERAS). All positions are filled through the National Resident Matching Program (NRMP), so you must be registered on the NRMP website, nrmp.org. The Internal Medicine codes are 1090140C0 and 1090140P0. For additional information, contact Hospital of Saint Raphael program coordinator Lynn-Marie Wright at 203.789.6080 or [email protected].

Oral and Maxillofacial SurgeryOral and Maxillofacial Surgery accepts applications only through

the Postdoctoral Application Support Service (PASS) of the American Dental Education Association. Fill out this online-only application by visiting the ADEA website, adea.org. All positions are filled through the National Dental Matching Program. For more information or assistance on registering with this program, visit natmatch.com/dentres. For additional information, contact Hospital of Saint Raphael program coordinator Lisa Mancini at 203.789.5924 or [email protected].

Transitional Year Transitional Year accepts applications only through the Electronic

Residency Application Service (ERAS). All positions are filled through the National Resident Matching Program (NRMP), so you must be registered on the NRMP website, nrmp.org. The Transitional code is 1090999P0. For additional information, contact Hospital of Saint Raphael program coordinator Stephanie Pane at 203.789.3989 or [email protected].

FellowshipsCardiovascular Disease

The Cardiovascular Disease Fellowship program accepts applications only through the Electronic Residency Application Service (ERAS). All positions are filled through the National Resident Matching Program (NRMP), so you must be registered on the NRMP website, nrmp.org. The Cardiovascular Disease Code is 1090141F0. For additional information, contact Hospital of Saint Raphael program coordinator Amy Murphy at 203.789.6045 or [email protected].

GeriatricsTo obtain an application for the Geriatric Fellowship program,

please call the program coordinator, Lynn-Marie Wright, at 203.789.6080 or [email protected].

NephrologyNephrology Fellowship accepts applications only through

the Electronic Residency Application Service (ERAS). All positions are filled through the National Resident Matching Program (NRMP), so you must be registered on the NRMP website,nrmp.org. The Nephrology code is 10550550. For additional information, contact Hospital of Saint Raphael program coordinator Stephanie Pane at 203.789.3989 or [email protected].

You can also contact our residency programs by mail at:

The Hospital of Saint Raphael 1450 Chapel St. New Haven, CT 06511 Attn: Graduate Medical Education Program

47

How to apply


By car:From Hartford (North): Leave I-91 at Exit 1 (Downtown

New Haven) and continue straight on the exit expressway, where it merges with North Frontage Road. Continue through four lights, and turn right at the fifth light on to Orchard Street. After the first light, you will see a garage to your left and another to your right.

From Shore Towns (East): Leave I-95 at Exit 47 (Downtown New Haven) and continue straight on the exit expressway, where it merges with North Frontage Road. Continue through four lights, and then turn right at the fifth light on to Orchard Street. After the first light, you will see a garage to your left and another to your right.

From Waterbury and Upstate New York (Northwest): Follow Route 69 South to Route 63 South (Whalley Avenue), continue down Whalley for about two and a quarter miles and take a right on Sherman Avenue. Take a left at George Street and an entrance to the hospital garage will be on the left. Additional parking is available by taking the next left on to Orchard Street. Parking will be on the right side.

48

Directions

From Bridgeport and New York City Areas (West): Leave the Wilbur Cross Parkway at Exit 57 (Route 34 East) and continue on Route 34 until you cross Ella Grasso Boulevard. Continue straight ahead on to Derby Avenue. Derby Avenue changes into George Street. Once past Sherman Avenue, a garage is on your left. Additional parking is available if you take the next left on to Orchard Street. The garage will be on your right.

Or, leave I-95 North at Exit 47 (Downtown New Haven) and continue straight on the exit expressway, where it merges with North Frontage Road. Continue through four lights and then turn right at the fifth light on Orchard Street. After the first light, you will see a garage to your left and another to your right.

Please note ... Saint Raphael’s has two major parking garages, the George Street Garage and the Orchard Street Garage. Interviewing residents can park for free in either garage. Just be sure to bring your parking ticket inside the hospital to be validated.

By bus:Contact Connecticut Transit at 203.624.0151 or visit cttransit.

com. Routes run between 6:30 a.m. and 6:30 p.m. weekdays and Saturday, and 7 a.m. to 6 p.m. on Sundays/Holidays, includes service to and from Tweed-New Haven Airport and Union Station. For more information call 203.624.0151.

By train:Amtrak (from Boston), Metro-North (from New York)

and Shore Line East (from New London) all make regular stops at New Haven’s downtown Union Station, which is less than two miles from Saint Raphael’s. For details, contact:

Amtrak at 800.872.7245 or amtrak.com/destinations/newhaven-ct.html

Metro-North at 800.638.7646 or mta.info

Shore Line East at 800.255.7433 or shorelineeast.com

The Hospital of Saint Raphael is located at 1450 Chapel Street in New Haven, Connecticut, and is easily accessible by car, bus or train.


hsr gme folder 2011

Documents