The Residency Training Program in the Department of Medicine enables residents to acquire the necessary knowledge, skills and attitudes for the practice of general internal medicine through rotations in general ward medicine, specialty services, continuity practice, geriatrics, emergency medicine, and a wide variety of elective experiences.
Goals
- To provide exposure to a diverse patient population in both inpatient and outpatient settings through the use of three hospitals and outpatient practice sites.
- To provide comprehensive exposure to medical subspecialties through rotations in intensive care medicine, inpatient consultative services, and outpatient experiences.
- To provide the teaching skills necessary to promote the educational mission of the Department and the School of Medicine.
- To develop research skills through dedicated course work and the requirement of a scholarly project for each categorical resident.
- To prepare residents for their role as stewards of our healthcare resources through active involvement in QI/QA activities.
- To recognize the importance of the individual to patient safety through participation in key activities related to transitions in care, procedural safety and communication skills.
Rotations
| Categorical Intern | Junior Resident | Senior Resident | |
|---|---|---|---|
| Wards | 20 weeks | 14 weeks | 16 weeks |
| Cardiology | 4 weeks | 6 weeks | 4 weeks |
| Oncology | 6 weeks | 4 weeks | 2 weeks |
| MICU | 4 weeks | 4 weeks | 4 weeks |
| Emergency Medicine | 2 weeks | 2 weeks | |
| Ambulatory Medicine and Elective | 12 weeks | 16 weeks | 18 weeks |
| Jeopardy | 2 weeks | 2 weeks | 2 weeks |
| Vacation | 4 weeks | 4 weeks | 4 weeks |
General Medicine Services
The composition of the general inpatient services at all three sites is similar with most consisting of one attending physician, 1 second- or third-year resident, 2 interns, and 1 medical student. Teaching and management rounds are conducted 7 days a week. Most admissions are taken by interns providing residents with opportunity to supervise and teach team members. Interns carry an average of 5-8 patients. Interns work 13 hour shifts while residents work extended 26 hour shifts every 4 days.
Critical Care
Rotations in medical and cardiac intensive care medicine are required. Teams consist of an attending and various combinations of residents and interns. Teaching and management rounds are conducted 7 days a week. Interns work 13 hour shifts and residents work 26 hour shifts every 4 days.
Emergency Medicine
Emergency Medicine is a free-standing department at the Hospital of the University of Pennsylvania. Residents function as the primary physician for patients with both acute and subacute problems under the supervision of an Emergency Medicine faculty member. The residency training program in Emergency Medicine enables our trainees to participate in a well developed curriculum including direct patient care experiences, didactic lectures and case presentations.
Geriatrics
The geriatrics rotation occurs at the Penn Presbyterian Medical Center for all second year residents. There is a strong emphasis on interdisciplinary team management and care. A nationally prominent Acute Care for the Elderly unit is located at Presbyterian Medical Center. There are also elective experiences are available in several domains of geriatrics. Residents work extended 26 hour shifts every 4 days with 1 day in 7 off.
Neurology
A two week experience in Neurology is required as a PGY2. Residents function as the primary physician for patients with a variety of neurologic disorders including acute strokes and demyelinating diseases on the inpatient neurology service at HUP. Residents work extended 26 hour shifts every 4 days with 1 day in 7 off.
Ambulatory Training
Experience in outpatient care is an important component of our training program. The four cornerstones of the ambulatory experience are the ambulatory block rotations, continuity practices, firm rotation and ambulatory subspecialty rotations..
Ambulatory Block Rotations
Each intern is assigned to the Ambulatory Block rotation for a month in both the fall and the spring. Highlights include:
- A standardized curriculum of interactive talks and seminars on physical diagnosis, screening and prevention, common outpatient illnesses, the patient-doctor relationship, ethics, medical informatics, and critical appraisal of the literature.
- Selected clinics in medical and non-medical office-based specialties
- Increased amount of time building a patient panel in their own continuity practices.
- A critical appraisal of the literature series is introduced during the first six months by Dr. Rosen who also holds a Masters Degree in Clinical Epidemiology.
- Individual practice-based learning projects. Interns are expected to identify an area of improvement for their outpatient practice, develop a chart abstraction tool, abstract their charts, develop and implement an action plan and then repeat the audit in the spring of year 2.
Continuity Practice
Each trainee has a continuity practice experience where they act as the primary care physician for a panel of patients. The patient population consists of patients discharged from the inpatient services, as well as new referrals from the community. Interns and residents practice in firms under the supervision of dedicated faculty members. All faculty are general internists in the Division of General Internal Medicine.
In addition to practicing together, faculty and residents work
together to create an ongoing series of weekly conferences based
on cases, a curricular framework,
and the most recent medical literature.
In addition to their continuity practices, residents may choose
from a variety of ambulatory electives available in both inpatient
and outpatient based specialties. Interns and residents spend 30-40 1/2 days each year in their clinics.
Firm Rotation
This is a two week block experience in which one is immersed in their outpatient clinic. The experience includes phone triage, urgent care, your standard clinic panel, QI projects and coverage for your firm's patients. Each intern, second and third year will spend 2, 4, 2 weeks respectively as the firm resident..
Subspecialty Elective
There are two week required rotations in the outpatient practices of specialty faculty.
Conference Curriculum
An integrated conference curriculum has been developed to provide interns and residents with broad exposure to the principles and competencies of general internal medicine. The purpose and format of each conference is slightly different to provide residents with diverse learning venues. In addition, a variety of both clinical and basic science conferences are held throughout the week in all of the specialties. The weekly conferences include:
Resident report
This is the highlight of the curriculum. It is a didactic, patient based conference held 4 times a week. It is run by the chief residents with faculty support. There is equal emphasis on inpatient and outpatient cases. Multiple formats are used including intake, formal case presentations and clinical skills sessions. Integrated into Resident Report is a physician-scientist series designed to introduce housestaff to cutting edge research by the faculty. There is also a patient safety series.
Intern report
This is similar to resident report but is focused for interns. It is run by the chief residents and occurs three times a week with equal emphasis on inpatient and outpatient cases.
Grand Rounds
This is the premier didactic conference for the entire Department showcasing topics by departmental, regional and national faculty. The formats include formal lectures, panel discussions of controversial issues, and CPC's and M&M's presentations by senior residents.
Subspecialty Conference
These conferences are devoted to inpatient and outpatient management topics presented by core faculty. All sessions are interactive and case based for residents on elective, each Monday, Tuesday, Wednesday and Thursday morning.
General Medicine conference
This is part of the Ambulatory didactic program and covers topics in Ambulatory medicine for which attendance is mandatory for residents on any elective. This conference provides more advanced, case-based discussions of some of the same topics addressed in the intern series; community-medicine series (including a discussion of the medical safety net); and discussion of common syndromes that cross specialties (e.g., falls, dyspnea, edema).
Pre-clinic conference
Residents and faculty meet for 30 minutes before the session begins for a resident-led, faculty supervised case-based discussion of a common ambulatory problem.
Journal club
Journal club is comprised of two separate conference series that are held every other week throughout the academic year. The "Year-in-Review" series is organized by senior residents with the guidance of a subspecialty faculty member. That particular session reviews the most important articles published in the preceding year for each subspecialty. The remainder of the conferences are faculty run and focus on the key concepts of critical appraisal of the medical literature.
Research Training
Scholarly Pursuit
All categorical Housestaff are required to engage in scholarly pursuit, which can be broadly defined as participation in clinical or basic science research, critical reviews of the literature, case reports and series, book chapter and community service activities. Faculty mentors are available for all residents so that they may initiate a project that can be continued throughout all three years. Third year residents are encouraged to both publish their work and present at national meetings which is sponsored by the Department of Medicine. Those interns interested in pursuing advanced research training should consider entering the Physician Scientist Program.