Internal Medicine Residency

Categorical Internal Medicine

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.
INTERN SCHEDULE

6+2 Scheduling System

The 6+2 is a block scheduling system. For most of the year, categorical interns spend 6 weeks in a row on inpagtient services followed by 2 weeks in the ambulatory setting. This system simplifies scheduling, makes it predictable, avoids burnout, and separates inpatient from outpatient responsibilities. Furthermore, it increases intern camaraderie by creating intern cohorts that travel through intern year together. Since implementing this system, the progrm has been able to grant more than 90% of interns their first choice vacation.

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 28 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 28 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 28 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 28 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 Ambulatory Block rotations for two weeks at a time. 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.

Management Conference
This is a combined intern and resident conference highlighting core management topics given by selected faculty.

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.

Tuesday Didactic Series

These conferences are devoted to inpatient and outpatient management topics presented by core faculty. These sessions are more advanced, case-based discussions aimed at the resident level.

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.

Nighttime Intern Series

These conferences are taught by the senior resident in house. They focus on teaching scripts designed to highlight management issues.

Night Float Report

This is an intake report for all interns and residents on the night shift. Faculty are assigned to facilitate. The Chair of Medicine is a frequent facilitator.

Service Didactics

Just about all services have 30 minutes of didactics in the morning or afternoon 4 days a week.

Journal club

Journal club occurs virtually through our resident portal. A faculty member is responsible for posting an article and listing several key points. Residents are expected to provide electronic comments. New articles are posted every two weeks.

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.