Screening Criteria to Interview with Our Program:
- Minimum scores of 80 or higher on USMLE Step I and II on first attempts preferred.
- Prefer minimum average score of 82 or higher, if either USMLE Step I or Step II is taken more than once (only three total attempts for Step I and II). That means ONLY ONE of the two exams can be repeated AND repeated only once.
- If either score is less than 80, then the two scores averaged together must equal 82 or higher.
- U.S. citizens, permanent residents and J-1 Visa’s accepted.
- Recent graduate (must be within seven years of graduation except when one has been engaged in educational activities since graduation).
Education versus Service
Multi-Choice Practice Exams
Other Educational Safeguards
Practices or Fellowships
Semi-Annual Program Evaluation
Dr. Susan J. Smith began her tenure as program director in October of 1990. The program has undergone striking changes since that time. A few years ago the president of the American Board of Internal Medicine called Dr. Smith to inquire regarding her "educational secrets."
Our faculty and staff, in combination with the small program size, provide a friendly and supportive educational environment. Dr. Smith seeks input from all residents on a regular basis through monthly meetings where concerns are freely discussed and the residents offer solutions to any identified problems.
Practices or Fellowships
The program is custom-tailored to meet individual residents' educational and career needs. Because of the program's personalized approach to education, residents are well prepared for practice, academic, or subspecialty careers. Our residents have entered some of the most highly esteemed programs in the country. Approximately one-third of our graduates pursue careers as hospitalists, one-third enter fellowships and one-third enter traditional general internal medicine practice.
Our graduates have received more generous contracts because of the unique practice management aspect of their training. For example, our residents are trained in documentation requirements and reimbursement codes. They gain practical experience after receiving didactic training. As a result of this simple educational inclusion, our graduates have found themselves being offered higher initial salaries than counterparts without that training.
McLaren Flint: a private nonprofit 436-bed institution that is well endowed. As a result its financial strength allows for investments in new technology and equipment, meeting service needs of our patients without compromising the residents’ education and ample internal funding for resident and faculty research.
College of Human Medicine, Michigan State University: McLaren is one of three medical centers which comprise the Flint campus of Michigan State University’s College of Human Medicine. There are six teaching campuses: Lansing, Saginaw, Flint, Grand Rapids, Kalamazoo, and the Upper Peninsula.
The students take their first two years of coursework in East Lansing where the basic science departments reside. They are then assigned to one of six community campuses for their clinical training. We are NOT just affiliated with Michigan State University; we are an integral part of the college’s educational structure. Our residents are appointed as a "Clinical Instructor Resident" and they serve a vital role in teaching the Flint campus students.
Our residents are diverse coming from different educational systems and cultures and often different parts of the world. We believe that this is a strength of our program.
Different Educational Systems The educational system in most parts of the world is strikingly different than the United States.
Different Exposures: The international medical graduate brings the following attributes to our program:
- Most are disciplined scholars having advanced in educational level through competitive exams;
- Different clinical exposures - both in breadth (different types of diseases) and depth (more manifestations of the same disease);
- Clinical experience accruing at a faster rate than their U.S. counterparts;
- Expose all of us to the glorious cultures of the world at large.
Patient mix reflects internal medicine patients at large, without over-representing any socioeconomic background, ethnic mix or disease process. Click here for Payer Mix and Diversity.
Teaching Service:The general medical teaching service is comprised of three types of patients:
- Staff Patients
- Consults (Other services, e.g., orthopedics, general surgery or psychiatry, ask Staff Medicine to consult or to manage a patient’s medical problems.)
The General Medical Team: There are four color-coded general medical teams each month. Each team consists of a PGY-1, PGY-2, and PGY-3 level resident and medical students as assigned and their Staff Attending.
The Blue and Green teams "partner" under the supervision of one Staff Attending. They round together on their Staff Patients with the Staff Attending, thereby, doubling their patient care exposure and learning opportunities. (Similarly, the Red and Yellow teams round with their Staff Attending.)
Cross-coverage Each team becomes familiar with their partner team’s Staff Patients as well as their own. On the weekends they cross cover each other so that each resident on the service has one day of seven completely free of clinical duties when averaged over four weeks. Click here to see how the staff medicine cross-coverage for weekends works
The PGY-1 resident admits Staff Medicine patients with supervision from the PGY-3 resident. The PGY-2 resident exercises more autonomy in patient care. In addition to Staff Medicine admissions s/he does all of the Staff Medicine Consults.
The Staff Attending, Management and Teaching Rounds – Combined and Separately Scheduled The Staff Attending rounds with the team(s)on the patients under his/her supervision every day of the week for combined teaching and management rounds. During these rounds, the team is at the bedside of each and every patient so that the "teachable moment" can be identified and optimized. In addition, separate teaching rounds are often conducted which augments the bedside teaching done during combined rounds. However, in the combined rounds at least one hour every day is devoted strictly to teaching – above and beyond the time devoted to management.)
Medical Students: The 3rd year internal medicine clerkship (also called the junior medicine clerkship) runs throughout the year. The 4th year internal medicine clerkship is based in the intensive care unit and residents will also interact with students when on the ICU rotation.
At McLaren, patients become residents' patients or Staff Patientsbecausethey do not have an established private doctor. They are NOT triaged based upon socioeconomic status or insurance coverage. New staff patients follow-up with their resident physician at the Internal Medicine Residency Group Practice where they become a member of the resident’s panel of patients for whom s/he serves as primary care physician. The residents have their own professional business cards, which facilitates doctor-patient bonding.
4 months General Medicine
2 months ICU
1 month Faculty Practice
1 month Night Float
1 month Hematology-Oncology
2 months Ambulatory Block Month
3 weeks Vacation/3 days Conference
4 months General Medicine
1 month ICU
1 month Geriatrics - outpatient
1 month Outpatient Cardiology
1 month Night Float
2.5 months Electives
3 weeks Vacation
2 weeks Conference
3 months General Medicine
1 month ICU
6 months Electives
1 month Emergency Medicine
4 weeks Vacation
2 weeks Conference
Education versus Service
McLaren Flint employs and contracts with other health care practitioners so that resident education is never compromised to meet the service needs of the institution.
Caps on Service:
- No more than five admissions per PGY-1 resident in 24 hours
- No more than eight admissions per PGY-1 resident in 48 hours
- No more than twelve patients per PGY-1 resident’s total patient load, i.e., service
Duty Hour Limitations
- 80-hours (or less) work per week
- One-day of seven free of clinical duties
- No more than six hours of wrap-up work following a 24-hour call
- Twenty-four hour call every fourth night ONLY six months of the thirty-six months of residency
- During General Medicine rotations residents have only two 24 hour calls, one Friday night and one Saturday night, all others are "short call" until 9 p.m.
Other Educational Safeguards
Uncovered Services: Residents do not cover private attending's Internal Medicine patients who are admitted to the hospital. This is an important feature of safeguarding the educational environment and avoiding an over-emphasis on resident service.
Board Passage Rate: Over the past fourteen years and 168 graduates there has been only two who have failed the Internal Medicine Board Exam on his/her first attempt to result in a 99% pass rate cumulatively over the last fourteen years. A few years ago there were only fourteen programs from over 400 that had a three-year rolling average board passage rate of 100%. Until 2001, our program had a six-year rolling average of 100%.
A few years ago, Dr. Smith received a call from the American Board of Internal Medicine’s president who asked what her " educational secrets" were. He had noted that she had taken a program of questionable quality and turned it into one of the best in the country. Since that time Dr. Smith has given a great deal of thought to this question. She believes she has identified some of her educational secrets.
There are a robust series of conferences; many are unique to this program. Click here for a comprehensive list.
Multiple Choice Practice Exams
During the first year of residency there is an exam given every two months on assigned readings in the Washington University Manual of Medical Therapeutics. There is an Ambulatory Exam given twice a year (for all three levels of residents) which reflects the ambulatory tutorials. And, for three months there is a specific discipline or subspecialty on which the curriculum focuses, e.g., nephrology. At the end of that three month period the second and third years residents take a "Board-style" exam. Each of these exams serves an important educational and feedback function.
Opportunity for Resident Input
Administrative Council: Each month the Program Director meets with all faculty, core staff and Chief Medical Residents to review problems or issues within the program. Also during that meeting individual residents are nominated for recognition for Meritorious Behavior.
Resident-Director’s Meeting: The residents and faculty meet together monthly. During that meeting the agenda is formulated around issues or problems which the residents, faculty and chief residents want to discuss. Together during that meeting problems or issues are identified and their solutions are sought through a free-flowing dialogue. The input of residents is vital to finding a workable and practical solution. In addition, meritorious behavior is recognized and rewarded and the birthdays of the month are celebrated.
Semi-Annual Program Evaluation: Twice a year, specific features of the program are evaluated by the residents anonymously. The residents are asked to use a 9-point scale (1 poor and 9 outstanding) to rate various components of the program. The results are submitted anonymously and tabulated to produce average scores. This is one of Dr. Smith’s greatest sources of pride. What the residents say about their own program anonymously, and en masse (n=28 or more) is the highest compliment she could ever receive. Click here for the latest Semi-Annual Program Evaluation
Observations of Site Visitors and Medical Students
On several occasions visitors to our program have remarked that its residents are "happy" and seem like a family. Our own volunteer faculty have compared our program to others and commented that it is unique in the commitment made to the residents, not just in educational support but also in terms of emotional and family-like support.
Support at Critical Times for our Residents
Unfortunately, as a "family" we have experienced not only happiness but also sadness. We have had the deaths of residents’ immediate family, the diagnosis of cancer, divorces, miscarriages, and ill family members who are a long way away. Through all of these life events, we have tried to support our residents providing them with what they need. Whenever necessary we have made emergency provisions so residents could go to the bedside of an ill family member. We have participated in funerals and prayers for the deceased, and we have cried over the painful experiences some of our residents have endured. At a recent informal graduation luncheon, each resident spoke about some major life event through which they received extraordinary support during their residency.
On both a happy note and a sad note, one of our senior residents was put on bed rest three months before graduation due to a multiple pregnancy (triplets) and concern about the pregnancy’s high risk and possible outcome. We had not a moment’s hesitation in telling her that she would be able to finish her three months of training whenever she chose to do so.
The six communities comprising Michigan State's clinical campus provide an abundant population base for collaborative projects across communities. The McLaren/MSU Program is unique in providing not only expertise to guide young investigators, but also research funds (in excess of $150,000 per year) and protected time for doing research during each year of a resident's training. There is a full time Director of Research who teaches a seminar in clinical research and who is available to mentor residents in their research projects. In addition, the program sponsors a once per month Internal Medicine Research Forum. At the Internal Medicine Research Forum, residents and/or faculty present preliminary thoughts about research projects, essentially "works in progress" and receive valuable assistance from the internal medicine residents and faculty who are present on research design. In this manner, 35 other residents and nine faculty get to participate in each resident’s research project through a simple one-hour forum. This expands our research experience to approximately forty times what it would be if we had exposure only to our own projects.
Over one-third of the residents’ training occurs in office settings. The outpatient experiences are varied and have specific clinical exposures and educational objectives.
The benefits package is competitive with health insurance, dental insurance, optical coverage, short and long-term disability insurance, life insurance, white coats, free interlibrary loans, three and four week vacations, the latter at the third year level and funding and time for outside conference attendance. (For the last twenty years, there has been an increase in resident salaries each and every year on October 1st.)
The Best of a University AND a Community Atmosphere
Opportunities provided by the McLaren/MSU Residency Program in Internal Medicine combine the benefits of a small, personalized educational program with the advantages of a university program. For more information, call (810) 342-2063.
The Flint Community
Flint is a culturally rich community. It boasts an outstanding symphony, the Flint Institute of Art, the Flint Institute of Music, and Bower Theatre which is the practice and performance center for the Flint Youth Theatre (a local drama school). Whiting Auditorium hosts the symphony and touring Broadway Shows, dance troops and various other performers. Together with the Sloan Museum and the planetarium these institutions comprise the Cultural Center, which is located next to the main branch of the Flint Public Library near downtown Flint. Click here for more information on the Flint Community.
Flint boasts of three colleges including two with Graduate Schools. U of M Flint campus , Mott Community College , and Baker College. ; In addition, the educational opportunities for children include several private schools, including a non-religious prep school, as well as very good to excellent public educational systems.
The cost of housing in Flint is one of its best-kept secrets. It is possible to own a home in Flint for little more (and often less) than what one would pay for a small apartment in other cities. Click here for Flint area real estate listings.