Associate Program Directors
Eboni Price, MD, MPH
Associate Program Director
As Associate Program Director for ambulatory training, I welcome opportunities to enhance our residents’ educational program through their continuity clinical experiences as well as the ambulatory block rotation. Major training objectives for outpatient training include:
- Using an analytic approach to diagnosing and managing ambulatory problems
- Incorporating preventive health maintenance into patient care
- Understanding the role of continuity of care in managing chronic illnesses
- Incorporating patient education and counseling into their outpatient practice
- Using information technology to access on-line medical information
- Assimilating scientific evidence and apply it to outpatient medicine
- Learning how to improve quality of care by assessing one’s clinical performance
Over the last two years, we have expanded our residents’ outpatient training from hospital-based clinics to community-based clinics. The biggest advantage to working in the community is a greater appreciation of our patients’ world, and an enhanced understanding of how to tailor health care to their needs and preferences in a manner that is culturally sensitive. New Orleans is an ethnically diverse city whose citizens come from different countries, speak multiple languages, practice a variety of religions and represent different socioeconomic levels. All of these aspects of diversity potentially impact patient perceptions of health and illness and ultimately their health behavior. Working in the community is the best way for our residents to learn how to improve the quality of and to tailor health care for diverse patient populations. One of our major training sites is the Tulane University Community Health Center where residents rotate as part of the ambulatory block rotation.
Opportunities for public health research projects at TUCHC and elsewhere are abundant and strongly encouraged as key components of professional development. Small projects such as developing and evaluating quality improvement initiatives within a clinic or hospital setting are indeed practical experiences to have prior to joining any clinical practice. I enjoy mentoring residents in research projects and will continue to do so in the upcoming years as a scholar for the Amos Medical Faculty Development Program sponsored by the Robert Wood Johnson Foundation.
Having completed my entire medical and research training at the Johns Hopkins University Schools of Medicine and Public Health and the Baylor College of Medicine, I have worked in academically rigorous, diverse health systems and will continue to use these experiences to enhance medical education in outpatient medicine.
Eboni G. Price, MD, MPH
Internal Medicine Residency Associate Program Director
Chad Miller, MD
Associate Program Director
I planned to leave New Orleans after medical school, but Tulane offered what no other residency could. After interviewing around the country, I found no program that had the balanced emphasis on both education and clinical reasoning like Tulane does. On this website, you’ll find a description of how Tulane is run by the residents. In it’s own right, it’s a good idea: it ensures that a resident has control over his or her life, and that big decisions are made in accordance with what is best for the residents and their patients. But the added benefit I found was that the resident ownership feature of Tulane developed exceedingly strong leadership abilities in myself and my fellow residents.
Of course, Tulane’s patient diversity was unparalleled in my search. The diversity of severity of disease, types of disease and, most importantly, the diversity of people makes for fertile soil for the growth and development of outstanding clinicians. But of all of these great attributes, nothing was as compelling as the type of person that was attracted to, and joined the Tulane team. Tulane attracts quality people to its residency, not just quality students. The program seeks individuals with a moral compass… people who see life as something bigger than themselves. And having found that direction, this team makes life-changing contributions to the people of New Orleans each and every day. We empower, and in doing so, find ourselves fulfilled. The medical care is exceptional: delivered with the highest degree of kindness and dignity, regardless of creed, color, or ability to pay. I stayed because I believe in the mission.
Now that I have completed my residency, I have assumed the positions of Associate Program Director and Associate Clerkship Director. It is my responsibility to help coach the residents, interns, and students, and in doing so, I see it as my station to ensure that they are coaching each other. Coaching someone else is the optimal way to test your own knowledge of a subject, and it is inherent in our Hippocratic oath: “I shall perpetuate the art.” Residents take pride in coaching interns, students, and each other. The Tulane philosophy cultivates an exceptional educational environment, ripe with respect and camaraderie that translates beyond the hospital wards. It is no surprise to find residents spending time together after work in the French Quarter, or on the athletic fields, or at a Saints Game, or at each other’s homes. Teams that play together, stay together… and we do both exceptionally well. Life’s too short to do anything else.
For the medical students, their initial exposure to Tulane Internal Medicine takes place during their first year. Each resident takes two to four first year students and coaches them on bedside manner and how to obtain efficient and accurate patient histories. During the second year of medical school, as part of the Clinical Diagnosis Course, the students are paired with residents on the wards to learn the finer points of the physical exam as well as clinical reasoning. This not only ensures that students are learning, but ensures that residents are at the highest level of obtaining a history and performing physical exam on their own patients.
I have adopted a number of clinical teaching responsibilities, one of them being Tuesday School. Based on the Friday School concept for residents, the Medicine Clerkship students meet once a week to discuss four to five detailed patient cases firmly grounded in the objectives outline by CDIM. Tuesday School fosters group learning and encourages coaching between students. I intend for students to leave the clerkship with the mindset that medicine is a collaborative effort. It is through coaching one another that we, as physicians, grow in our personal practice and ensure the future of our profession.
This is just a snapshot of what I do and some of the things that take place at Tulane everyday. If Tulane sounds like a place for you, or you want to know more, please do not hesitate to contact me. If you are interested, we’ll make you a great teacher. I promise.
Chad Miller, MD
Internal Medicine Residency Associate Program Director
Philip Skelding, MD
Associate Program Director
When I chose to come to Tulane for my Internal Medicine residency, many of my mentors at Harvard Medical School were jealous. Jealous that I would have the chance to come to New Orleans and help re-make the local healthcare delivery system in the aftermath of Hurricane Katrina. A spirit of entrepreneurship arose from the destruction and that spirit remains strong today. Coupled with the ongoing efforts for national healthcare reform, there can hardly be a more exciting and dynamic place to come train than Tulane. Those who recognize this and who join our residency will have a wealth of unique educational opportunities unavailable in any other program.
My role as an Associate Program Director is to oversee the ambulatory training of our residents. Although the majority of residency training occurs in the inpatient setting, the majority of practice after residency will take place in the outpatient setting – including for those who subspecialize. And while inpatient care can be dramatic and impressive, the discerning individual will realize that the long-term differences in the course of chronic illnesses result from outpatient management. The ability to see what did not happen – the averted stroke or myocardial infarction, the delayed progression of chronic kidney disease, or the preservation of quality of life – is just one of the many rewards of outpatient care.
Most medical students do not get to experience the important role that continuity of care plays in outpatient practice. The development of meaningful relationships with patients through continuity of care is one of the most fulfilling aspects of the practice of medicine. Not only does continuity provide the opportunity to get to know patients as people rather than as diagnoses, it also promotes a sharper, keener type of clinical judgment for detecting smaller, subtler, clinically important changes in patients.
A visit to an outpatient General Internist often serves as the point of entry into our healthcare system. This gives outpatient practicioners the privilege of being able to think about a case without the clouding influence of the thoughts and diagnostic efforts of others. Since access to healthcare remains poor for many in New Orleans this is a big responsibility, but it also offers a big reward: the chance to make a diagnosis and an intervention at an earlier stage, again resulting in a greater long-term impact.
Aside from the life-changing differences this can make for your patients, the work you do in the outpatient setting also gives you a chance to make a big difference at the system level. When outpatient Internal Medicine is practiced intelligently and efficiently duplicate testing and imaging is avoided and the cost of care is reduced to an appropriate level. Amidst our current economic climate and the ongoing work to reform the national healthcare system, this is more important than ever.
Our ambulatory training program works to prepare residents for all of these aspects of outpatient practice. Residents will spend every fifth week dedicated solely to ambulatory training, without the interference of overlapping ward responsibilities. During ambulatory weeks residents will have seven half-day clinical sessions. Five of these will take place in Internal Medicine resident continuity clinics where residents will follow their own panel of patients. Two of these sessions will be in subspecialty clinics and since residents will be returning to these clinics every fifth week they will get to develop continuity in those sites as well, in addition to getting to know their subspecialty attending physicians.
Tulane has three sites for Internal Medicine resident continuity clinics. Each site exposes residents to a different medical system, a different patient population, and a different clinical setting, whether hospital-based or community-based. These kinds of diversity help residents gain an understanding of the larger healthcare system and provide a basis for deciding on the type of practice they would like to pursue after residency. In addition, each site will instruct residents about the critical role of coordination of care, a unique role reserved for those who practice General Internal Medicine.
The remaining three half-day sessions in each ambulatory week will be devoted to didactic learning, one of which will be an ambulatory conference. The intern ambulatory conference curriculum will focus on core topics such as hypertension, diabetes, dyslipidemia, and so forth. The upper-level resident ambulatory conference curriculum will explore more advanced topics and will follow a two-year cycle. As is the case throughout our residency program, residents will teach one another in conferences. Enhanced learning will take place in concert with the development of improved teaching skills.
New Orleans is a unique American city. It has a rich culture that cannot be found anywhere else, as I realized after living all over the United States and even overseas. Its spirit and vitality are readily apparent through its food, music, neighborhoods, festivals and most of all, its people. Their diversity – of education, socioeconomic background, race, ethnicity, nationality, language – is a chief asset of the city and a great strength of our residency program. In a similar way, the Tulane Internal Medicine Residency program is a great program and is stronger than ever. Our greatest strength is our residents and being a part of our team will provide an opportunity to enjoy a wealth of professional opportunities in a one-of-a-kind place. Come join us!