Joey Wahler (Host): It's shaping the newest doctors. So, we're discussing Mount Carmel's Graduate Medical Education Internal Medicine Program. Our guests are Dr. Karen Avgush, she's Program Director of Mount Carmel's Internal Medicine Residency Program, and Dr. Kevin Rivera, a resident at Mount Carmel Department of Internal Medicine.

This is Wellness in Reach, a Mount Carmel podcast. Thanks so much for joining us. I am Joey Wahler. So first, Dr. Avgush, what is the overall structure of the Mount Carmel GME Internal Medicine Program? And what would you say are the key experiences that it offers residents like Dr. Rivera here?

Karen Avgush, MD: Our program follows in X plus five format, more specifically, a four plus one schedule where residents get to spend four weeks on rotation, like inpatient, elective, or ICU, followed by one dedicated week in the outpatient clinic. This setup allows residents to focus on one area at a time without having to split their attention. It's a great way to improve continuity of care. It makes for a more effective learning experience.

Host: How about that, Dr. Rivera?

Kevin Rivera, MD: I completely agree, and I think it's actually a game-changer to go to that X plus Y format. Reason being, you have this built-in time for wellness, research, studying, and even administrative time, which is not something that's very common across other IM residency programs. And so, I think that's a huge benefit for anyone coming here.

Karen Avgush, MD: We also cap our inpatient service at 14 to ensure residents have the opportunity to build meaningful connections with their patient and engage thoughtfully in their clinical education. interns begin their training with the lighter patient load and gradually increase AS they gain confidence and experience. Each intern is supported by a senior resident during their time on service. And additionally, they also have a dedicated faculty advisor as well as a resident buddy to help foster mentorship and guidance throughout their training

Host: Kevin, how about that buddy system, if you will? Tell me about that.

Kevin Rivera, MD: Yeah, I think the buddy system is certainly a large benefit. And I know, personally, I've relied on them, whether it's been in the ICU or the floors, anything from the very little minutiae and tasks day to day, all the way to clinical management. And so, I do think it's a very big benefit. I think that our didactics are very top notch. More specifically, we have multiple guest speakers from top academic institutions, multiple institutions too. And they provide their cutting edge insights, which I find to be very beneficial.

Host: Sounds like it. Absolutely. And Dr. Rivera, as a resident, what drew you to Mount Carmel's reputation in the first place? What did you know that brought you there?

Kevin Rivera, MD: So, what I heard and what I knew as I was applying is that this was a strong community program that has been around for decades, and they have a very strong reputation for procedural experiences as well as a very robust research, especially for a community program, both of which were very attractive for me.

Host: Gotcha. Dr. Avgush, what's the program's application process? Because this is an important piece here, isn't it, including any specific requirements or deadlines that prospective applicants need to be aware of.

Karen Avgush, MD: Our program participates in the National Resident Matching Program, also known as the match. We accept applicants exclusively through ERAS or the electronic residency application service. We recommend applying as early as possible with our deadline being December 1st. And when you apply, the documents that we require is a dean's letter, also known as an MSPE or medical student's performance evaluation, three letters of recommendation, the applicant's medical school transcript, as well as a passing score, either the USMLE step 1 and 2, or COMLEX level 1 and 2.

And for international graduates, we require an ECFMG certification, as well as being a US citizen or permanent resident, as we do not currently sponsor visas.

Host: Dr. Rivera, how about that application process? Did you find it smooth and easy?

Kevin Rivera, MD: You know, I did. And I will say from a resident's perspective too, while it's really important of course to have those academic credentials, I think that especially the interview and personal statement are opportunities for you to show who you are and how you would fit into our very tight knit community.

Host: How about the unique opportunities the Mount Carmel GME Internal Medicine Program provides for hands-on patient care and clinical rotations? How about that, Dr. Rivera?

Kevin Rivera, MD: Yeah. So as I alluded to earlier, we have very strong procedural experiences here. And more specifically, the lack of fellows is one way in which we're able to have that. So since there's no fellows, you are the first person who's getting the central line. You're the first person that's getting intubations, arterial lines, thoracentesis, paracentesis, et cetera. And so if you're a hands-on learner, then I think that's a huge advantage.

Karen Avgush, MD: We also offer diverse electives including the core Internal Medicine subspecialty and unique options like Street Medicine, which the residents really adore; Radiation Oncology, Ophthalmology, ENT, Allergy and Immunology, Neuropsychology, Orthopedic Surgery, just to name a few. We also have a robust simulation lab, which can be utilized for mock codes, procedural training, and scenario-based learning.

Kevin Rivera, MD: We also have the Academic Accountable Care unit over at St. Anne's, one of our sites. And what's really interesting about this rotation is that you work very closely with nurses, case managers, pharmacists, and you really come up with comprehensive care plans together, which is a fantastic learning experience all around.

Host: Yeah. I would imagine when you're a resident that there's nothing like that firsthand, hands-on experience, right?

Kevin Rivera, MD: Absolutely.

Host: Dr. Avgush, what stands out most overall about the training the program offers? What's the one thing, generally speaking, that this really hangs its hat on, would you say?

Karen Avgush, MD: So, we offer a comprehensive educational experience that combines robust clinical training with personalized learning. Our goal is to nurture physicians who are not only skilled, but also compassionate and thoughtful leaders. We want our residents to leave here confident in their abilities, inspired to make a real difference and deeply committed to the patients and communities they serve. This is more than just a training program. It's an opportunity to grow, explore your passion, and step into your role as a physician who leads both with knowledge and heart.

Kevin Rivera, MD: Yeah. So, I think the training and research experiences here are quite robust. And more specifically, I recall during my first week, in the Rheumatology Clinic, I got two case reports and now I'm up to six. And I kind of joked that maybe I should stop taking them, but I probably won't. And really, that's not a one-off experience. I do think that there's very intentional mentorship and infrastructure that make that possible. And on a larger scale too, there's the Mount Carmel Research Foundation that helps with a lot of funding. And actually in one of my cases, I'm looking into possibly doing a whole genome sequencing for a very rare bacterium. And it's been a pretty good experience so far. But again, only made possible because we have all of that fantastic infrastructure in place. And we also have a dedicated statistician as well as other internal funding opportunities where you can actually apply as a resident, which will look really good both on your CV as well as a real life experience.

Karen Avgush, MD: We're really excited to launch our new lifestyle medicine curriculum this year. Residents also receive a generous CME stipend with extra funding available when presenting at national conferences, as well as support for electronics during their intern year.

Host: And so in summary here, Dr. Rivera, for new residents, which you once were not all that long ago, what are some tips for successfully transitioning into this program, would you say?

Kevin Rivera, MD: I think really use and leverage the four plus one structure to your advantage so you can focus fully on your current rotation. You don't have to worry about trying to catch clinic after morning rounds or anything like that. And so, you can fully immerse yourself, which is a huge advantage.

I do think it's also advisable to be very proactive about procedures. I know as one example, when I was in the medical ICU, there was a particular day where I really wanted to do as much of that as I could, and I let the attendings know and I went to a completely different unit over in the cardiovascular ICU to put in a central line and an arterial line. And again, it's really all about taking advantage of those opportunities that we have here.

And as you transition into residency, I do think that it can be really difficult as well. And I think that it's really important to remember to not hesitate to ask for help. No one expects you to do this alone. And so relying on your co-residents, relying on your attendings, really the whole team I think is something that's absolutely crucial.

Karen Avgush, MD: I completely agree. This is an incredibly supportive environment and that makes all the difference. If you don't immediately find that research opportunity that aligns with your interest, I always recommend to feel empowered to create one. Our faculty in the Mount Carmel Research Institute are here to support you every step of the way.

Just as important, lean on your co-residents. As Dr. Rivera said, this is a highly collaborative and welcoming group, which makes the transition to residency much smoother. And above all, enjoy this time. It's a rare and transformative chapter in your journey. Be bold in exploring your interest, follow your passion, and know we're here to support your growth and development every step of the way.

Host: How about the culture of this program simply put, what it really hangs its hat on, most generally speaking?

Kevin Rivera, MD: I do think that the culture here makes the program feel like home, and the faculty know us very personally and they listen to us whenever we give feedback. And that's not something that you necessarily find everywhere. I know that Dr. Avgush has already made many changes based on resident input and, I mean, that makes me feel truly valued.

Karen Avgush, MD: Thank you very much. We do encourage feedback to help strengthen and shape our program. Residents can share input anonymously our online platform, as well as my door is always open. I genuinely welcome the residents' thoughts and suggestions. It's through their feedback that we're able to implement these amazing positive changes in our program.

We also recognize how essential wellness is during residency. Our program offers a dedicated wellness time and a variety of initiatives to support our residents' overall wellbeing. We host a variety of events throughout the year, like gingerbread house, decorating in the holidays, and Easter egg hunt in the springtime. We also have an annual resident retreat. This year, we're going ziplining. I'm excited and a bit nervous. We also have a resident-run garden, which produces a fresh produce for our residents staff, as well as patients facing food insecurity.

Kevin Rivera, MD: You know, I think that this is a place where you can grow quickly into the kind of physician that you want to be. I think, most impressively, you get early responsibility here. You have very close mentorship. You have, as I mentioned a couple of times I think now, that very strong procedural training and ample research opportunities.

So, I think that really for anyone that is looking for a program to blend that strong clinical training with mentorship and community, I think that Mount Carmel's an incredible place to be.

Karen Avgush, MD: I agree. We are committed to developing physician who combine a strong clinical ability with empathy, thoughtfulness, and a true dedication to their patients and the communities they serve. I want to thank everyone here for joining us today. We hope this gives you a bit of a glimpse of what makes our Internal Medicine Residency program at Mount Carmel a truly special place to train. And I'd highly recommend to visit our website if you would like to learn more about our program.

Host: Well said. Well done by both of you. Folks, we trust you are now more familiar with Mount Carmel's GME-IM Program. Doctors Avgush and Rivera, keep up all your great work. And most importantly, perhaps best of luck with the zip lining, right?

Karen Avgush, MD: Thank you.

Host: And to learn more about the graduate medical education program, please do visit mountcarmelhealth.com/mount-carmel-gme. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. Thanks so much again for being part of Wellness in Reach, a Mount Carmel podcast.