Pikeville Medical Center-University of Kentucky IM Residency offers academic rigor, mentorship, and rural health impact in a 300+ bed university-level hospital with 45k ED visits/year. Our small cohort (4/year) ensures one-on-one attending guidance, integrated subspecialty support, engaged outpatient faculty, and multidisciplinary rounding. Residents gain clinical, research, and administrative experience, fostering balanced training and long-term professional growth.