Scott Webb (Host): Today, we're going to learn more about the Internal Medicine Residency Program at Community Memorial Healthcare and what students and residents can expect during their time in this highly personalized and respected program. I'm joined today by Dr. Hannah Robinson, she's the Internal Medicine Program Director, and by Dr. Rahul Jalota, he's the current internal medicine chief resident, and they're both with Community Memorial Healthcare.

 Welcome to Wise and Well, presented by Community Memorial Healthcare. I'm Scott Webb. So, welcome back, Doctors Robinson and Jalota. I want to have you start by briefly reintroducing yourself and your role, and then describe the overarching philosophy that drives the Community Memorial Healthcare's Internal Medicine Residency Program. And Dr. Robinson, I'll start with you.

Dr. Hannah Robinson: Thank you. So, I'm Dr. Hannah Robinson. I'm the program director here at CMH for the Internal Medicine Residency Program. I have been at CMH for about 11 years now. I started out as an intern, and I've served in every role in leadership that you can in our program from intern to chief resident now to program director. So, I know this program very well and care very deeply about it.

Our overarching goal as a program is to train well-rounded Internal Medicine physicians that can thrive in any environment whether that's outpatient, inpatient, fellowship, community hospital, tertiary hospital. And so far, our residents have done well in all those situations.

Host: Right. Yeah. And Dr. Jalota, reintroduce yourself.

Dr. Rahul Jalota: Hi. Thank you for having us back. My name is Rahul Jalota. I'm the Internal Medicine Chief Resident for Year of 2025-2026. So, this is my fourth year with CMH. I would say that the overarching philosophy that you described for our program is to produce competent, independent physicians, with emphasis on compassion and quality, as well as good teamwork and integrity.

Host: Yeah. And Dr. Jalota, considering the national landscape of residency training, what do you believe are the signature components that make Community Memorial's program a unique and compelling choice for top medical student applicants across the country?

Dr. Rahul Jalota: Our program's uniqueness comes from the fact that the entire program is invested in each individual resident's well-being and improvement to developing an independent physician. From our program director to the chief resident, it's easy for anybody from any academic year to be able to reach out and ask for assistance.

Beyond that, our team is attentive to those who may need help but may not know who to reach out to. I've seen numerous members of our community from the program director to even residents go out of their way to support one another, whether it is dedicating extra time to teach or coach, or even lending a shoulder to lean on for support through trying times.

We work to support our residents as best we can, not because we're instructed to do so, but because we want to do so. And I think that's one thing that makes our program stand out and unique.

Host: Right. Yeah. Dr. Robinson, I know the street medicine program is an established highlight. Maybe you could detail how caring for the underserved or homeless population integrates into the resident curriculum, and what unique clinical and interpersonal skills residents gain from this commitment.

Dr. Hannah Robinson: So, our patient population here does unfortunately involve a very large, unhoused, or partially housed community. So, we see those patients a lot of times in our hospitals and in our clinics. But as many people know, there are a lot of barriers to those patients being able to access our hospitals.

So, we started the street medicine program with some really excellent community partners so that we can go take care of our patients where they are and we can overcome some of those barriers to healthcare that a lot of our patients face. So once a week we have a street medicine clinic that we staff. It's attended by usually our addiction medicine doctor, but sometimes other internists. And the residents of course go as well. And we see a community that lives in kind of like a semi-established housing. We actually set up a medical tent in a parking lot. And all of the people that live in that community nearby know that we're going to be there. They see us week after week. They come to trust us more and more over time. We basically have a medical tent that anyone is welcome to come into. So, we treat a lot of, you know, skin infections. We do a lot of wound care. We treat a lot of addiction medicine issues. We do suboxone inductions there. And then, you know, just a lot of other common complaints that those patients tend to have.

We also work with community partners so that when those people come to this parking lot that we set up in, they have access to food, even like dog food, veterinary care sometimes. We have substance use navigators, case managers, social workers, all the important people that help us overcome barriers to be able to actually provide the proper medical care for our patients over time. So, you know, we do see a lot of the same patients there that we tend to see in the hospital and our clinics. Sometimes we're able to have those patients if they need care that can't be provided there in the street medicine setting. Our case managers and social workers are actually able to get them into our clinics. We've had a few patients even get, you know, like elective surgeries that really improve their quality of life, simply because we met them where they're at.

So, the street medicine program, it's very important not to learn, just, you know, evidence-based medicine of how to take care of that particular population, but also understanding what is their social situation, what are the barriers that we need to overcome to meet them where they are and be able to help them access their care.

Host: Dr. Robinson, I want to stay with you. I want to talk about the PCP, the primary care pathway. I know it's a major focus of the program. So for applicants considering a career in primary care, how does this pathway's structure and depth actively prepare them for the complexities of outpatient medicine, making them more competitive for future practice or fellowship?

Dr. Hannah Robinson: Sure. So, being a primary care physician is one of the, you know, most important things that a doctor can do to improve the overall health of the population. But there's often not specific training geared towards exactly how to be the best PCP that you can. So to overcome that, we have what's called the primary care pathway where residents early on their training will let us know that they're interested in being a primary care physician. And we will tailor their training to help prepare them for whatever setting they anticipate themselves practicing in the future. So, they do a little bit more outpatient medicine than inpatient medicine. And they also spend that time in outpatient medicine, really getting the exact experiences that they feel they need to prepare themselves for their future job. So for example, if someone wants to, you know, do a lot of women's health, then they're going to spend more time with our OB-GYN doctors or possibly even our family medicine doctors who do a lot of women's health.

We had one resident who wanted to do primary care as well as sports medicine. And so, she spent more time with the orthopedic surgeons and our sports medicine faculty. So really, the primary care pathway is designed to be very flexible and, most importantly, very tailored to the experience that the resident needs for their particular future.

Host: Right. Yeah. Dr. Jalota, I want to talk about the international medicine experience. I know it's an exciting new offering, and it's a yearly experience. So, can you discuss the logistics of that opportunity where residents may travel, how participation contributes to their education, their perspective on global health challenges, and then finally their career development?

Dr. Rahul Jalota: Right. So, last year was my first time traveling internationally for a medical mission trip to Jamaica. This was our second trip actually. Dr. Robinson had previously gone on a trip when she was a resident. But this was my first medical mission trip. And I'd say it was probably one of the greatest experiences that I've ever had.

Part of the trip included hiking to remote locations to provide basic medical care, which we often take for granted in the United States. Whether it was treatment for diabetes, hypertension, a lot of these patients were in dire need and they were just grateful for our endeavors. This trip, it forced me to grow even further and develop a level of confidence and independence that I didn't have before, which is perfect as I was soon to be graduating from residency.

 Like Dr. Robinson said, much like our street program, this trip required us to use the bare minimum, the basic medications and resources that we had available to us. It required us to become familiar with new medications in order to better serve this population. And I think going on these trips does help for future career development, because it teaches us how to be more clever in how we're practicing medicine because not one medicine will fit everybody's needs. So, this is a trip that I'm looking forward to going again this year.

 Just one thing I would add on is that we were forced to use our bare, like, physical exam skills, our history taking. We brought an ultrasound, a pocket ultrasound to just utilize the best skills that we have, which is our hands and our minds.

Host: Right. Yeah. That's awesome. Dr. Robinson, I'm sure recruitment is highly competitive, right? So, what specific features or rotations demonstrate how the Community Memorial Healthcare Program effectively prepares residents for the complexities of both primary care and hospital medicine, ensuring that they're highly skilled and versatile upon graduation?

Dr. Hannah Robinson: Well, I think our graduates really speak to the success of our ability to train internal medicine physicians who can thrive in any environment. You know, one thing we're really proud of is that we actually do retain a lot of our graduates. So, we know that our residents are happy here because they often want to stay.

We also have a lot of graduates who have been successful in many different types of environments. You know, we have residents who now are attendings at tertiary care centers with every subspecialty available to them that you can imagine. We have residents who work in the austere jail setting, doing, you know, addiction medicine, primary care in that setting. We have, you know, residents who work in isolated hospitals where they don't have specialists to turn to and they have to perform all their own procedures.

So, I think one thing that makes our program really competitive is that you truly can come here and graduate and be whatever type of internist you want to be. And I think that's because we have a very interesting patient population to learn from. We have a very high acuity pathology, and we also are really able to tailor everyone's education to be what it needs to be for their future success. So, we're not such a large program that you're going to get lost in the mix. I'm going to know who you are as an individual, you're going to know me. I'm going to know all your particular, you know, strengths and areas for growth. And we're really going to be able to tailor your education so that you can be successful in any environment. It's not a program where you're going to slip through the cracks. So, I think the success of our graduates really speaks to what an excellent program we are and what excellent internists we train here.

Host: Yeah, it really does seem like a common thread, Dr. Robinson, running through this is that it's not one-size-fits-all. It really is tailored to the student, if you will, which in this case will be future doctors, right? That's perfect.

Dr. Jalota, I know that all work and no play is not a good thing for any of us really. I'm not a doctor, but I'm going to go ahead and say that, you know, pretty emphatically. So, let's talk about the work-life balance and how essential it is for residents' well-being. Let's talk about the tangible support systems schedule, innovations, resources that the program provides to actively help residents maintain a sustainable, healthy life while they're training.

Dr. Rahul Jalota: For one, we do have a quarterly mini retreat for the residents where they'll go out on one of their didactics days and do an activity of their choosing. And then, once a year, we do also have a full-day retreat where every resident is excused from their clinical rotation, and they can go out on outings. We've done in the past, we've gone to wineries, we've gone kayaking. We went to an amusement park last year. We have a therapist available to us as well. And we're setting up and have a pretty well-established therapy room on our resident floor.

Beyond this, we do have resident wellness days that the residents may take once per quarter. And this isn't something that's necessarily formalized, but they reach out to either myself, our coordinator, or Dr. Robinson, and let us know that they need to take a wellness day, no questions asked. It can be for medical reasons or it may just be just to get some extra rest.

Host: Sure.

Dr. Hannah Robinson: As I've alluded to in the past as well in one of our earlier questions, our program directors, our associate program directors, they're pretty understanding that our residents are humans. And we just want our residents to not only be successful, but also to be healthy. And the amount of support that our program gives is an attestation to that, and that's one reason that I wanted to stay on as chief resident, because I wanted to be part of the supportive community.

Scott Webb: Yeah. I love that. I love that you said, you know, not that it maybe needed to be clarified, but you know, doctors, medical personnel, medical staff, medical experts, you guys are all humans, right? So, yes, we're talking a lot about in medicine robots and AI and all of that, but there really are human beings behind that, you know, supporting all of that, making all of that work. And it's good to know that there's a work-life balance, right?

Dr. Rahul Jalota: Right. And we do what we can to try and minimize burnout.

Host: Yeah, absolutely.

Dr. Hannah Robinson: If I can just add to that, you know, we do very much believe that you have to take good care of yourself to be able to take care of others. So, I think that underlines our training here and our philosophy that we think residents need to learn and carry with them throughout their careers, because that's a concept you need to carry with you to be a successful physician in the long term.

Host: Absolutely. Yeah. Yeah. Dr. Jalota, let's talk about-- I'm going to have you pitched, if you could, to me, to the audience, if you had to pitch the top three reasons a highly motivated medical student should rank Community Memorial Healthcare as their number one choice, why would that be, or what would they be?

Dr. Rahul Jalota: It's funny, when I was interviewing here as a resident, I had to choose why CMH was my number one choice, I said it was the free food. But now, looking back, I think the free food is just a representation of the level of support that our program gives us, along with everything else that I had said.

So, my first reason would be the support. No questions about that. The second would be that we're always working with continued innovation. So whether it's developing our street medicine program further, improving our didactics to include more workshops, progressing our international trips, we're always looking to improve. We're not trying to stay the same, but always grow.

And then, the final thing I would probably say is, just from a resident perspective, I think it's important to know that we don't have 24 hour shifts. There's no call schedule, there's no 24-hour shifts, so you know what schedule that you're going to get, for the most part. And we try to adhere to that schedule as much as possible.

Host: Yeah. I'm glad you said that, Dr. Jalota, because you watch these medical TV shows and I always wondered, I'm like, "Is that a real thing? Do residents have to do that? Do they literally work 24 hours straight? And it sounds like some do, but not there, right?

Dr. Rahul Jalota: Correct. And there's some programs that even do 28, 32-hour shifts. Thankfully, ours are limited to our 12-hour shifts, and sometime we'll go a little bit over, but it's usually limited to that 12-hour shift.

Host: That's perfect. Dr. Robinson, going to finish with you. Admittedly, I am far too old to become a doctor, to change careers, all of that. But for the audience members, top three reasons.

Dr. Rahul Jalota: So, I think the first compelling reason that we're such a good program is simply the culture of this hospital. You know, it starts at the top. And we as a healthcare system are very committed to patient safety and quality of care. So, we want to take care of our patients in an excellent fashion at all times. And, you know, that is true throughout the hospital setting. So, the culture of our hospital is that we all work together. We're all kind to one another. We speak up when things aren't going well. And if we notice something that needs to be improved, we work to improve it.

The second reason is that our patient population is an excellent one to learn from. So, we have very high acuity here. We have very diverse pathology here. You know, a lot of students may hear this is a community hospital and not realize the level of care that we actually provide to the patients in this community hospital. There's not a tertiary center in town or close by that we're competing with. So, all those very sick, very interesting patients, they're not going to a tertiary center. They're coming here and we take care of them here. We work really hard to keep patients in our community and in this hospital. So, we offer a lot of services that most community hospitals don't. So instead of transferring our patients out, we're able to keep them here and learn from them. For example, we have ECMO capabilities. We have an expansive IR program. We do a lot of things that allow us to keep our patients here and learn from them here that other community hospitals may actually transfer to a tertiary center for, but that's not necessarily our common practice.

Our patient population, you know, there's a lot of drug use in this community unfortunately. There's a large unhoused population. There's actually a nomadic agricultural population that passes through town. And those populations tend to have very interesting pathology. Like, you're going to see very unique things that you don't see other places when you come to this hospital. So, that's one reason. It's a great place to learn.

And then, finally, I would say that our faculty truly are exceptional. No one here is made to teach. Everyone here teaches because they want to teach and because they're good at it. Our faculty are dedicated to practicing evidence-based medicine. I think we have very rigorous academics here. And our faculty truly are comprised of people who are not only kind and compassionate, but also very effective teachers and are willing to spend the one-on-one time working with residents. I mean, even as an intern, you're going to get a lot of one-on-one time with, you know, the subspecialists, the hospitalists, the primary care doctors, just you and them working together, learning how to take care of patients directly from the experts. So, I think that one-on-one time with faculty and the academic rigor that we require is really important and a really good reason to want to come to our hospital.

Host: Well, doctors, you have definitely sold me. I wish I were younger. I wish could take advantage of this. But I know you've been on before and I just appreciate, and I'm sure listeners do as well, your time, your compassion, your expertise. Thanks so much.

Dr. Hannah Robinson: Thank you for having us.

Dr. Rahul Jalota: Yeah, thanks for your time. It was nice talking to you.

Host: And that's Dr. Hannah Robinson, Internal Medicine Program Director, and Dr. Rahul Jalota, he's the current Internal Medicine Chief Resident. And for more information, go to mycmh.org/internal-medicine. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Thanks for listening. This is Wise and Well, presented by Community Memorial Health Care.