Thank you for your interest in Penn's Internal Medicine-Primary Care Residency program. Since its inception in 1997, the program has been a national leader in primary care training. The program is fully integrated with the department's categorical residency training program, yet distinct in its emphasis on primary and ambulatory care. This unique residency program meets the educational needs of trainees anticipating careers in academic or community-based general internal medicine practice. The program also is well suited for residents considering general medicine fellowship training leading to careers in health policy, health services research, quality improvement, clinical epidemiology, or medical education. Even though there is an emphasis on primary care, many of our residents choose to pursue fellowship training in a variety of specialties. It is our belief that the exceptional ambulatory training is beneficial to many of the medical specialties. Through a separate match, six individuals are selected for the internship class. In addition, up to two additional categorical residents are permitted to join the program for their second and third years.
Distinguishing Features
Even among primary care programs, the Penn program is distinct.
Fully integrated: The program is fully integrated with Penn's categorical internal medicine residency program. Primary care residents rotate on the same inpatient teams as the traditional track residents. They are taught by the same faculty and have as inpatient training sites the same teaching hospitals. While the inpatient educational experiences are identical, primary care residents have a smaller number of inpatient rotations to allow for a focus on ambulatory education. All internal medicine residents teach University of Pennsylvania medical students and work closely with the residents, fellows, faculty and consultants from the other departments within the Penn Health System.
Penn General Internal Medicine Faculty: The program's core faculty is drawn from the Department's nationally prominent Division of General Internal Medicine (DGIM), which includes outstanding clinician-teachers, leaders in healthcare, and distinguished investigators in the relevant disciplines of clinical epidemiology, health services research, bioethics and medical education. The Society of General Internal Medicine's Journal of General Internal Medicine is edited by members of the DGIM, and many of the Division's faculty have joint appointments at the Leonard Davis Institute of Health Economics, the Center for Health Policy, the Center for Clinical Epidemiology and Biostatistics, the Center for Bioethics, and the Medical Center's offices of Quality Management and Managed Care. These important relationships contribute to the exciting educational atmosphere of the residency program through seminars, conferences, and electives. The clinical and research faculty are equally committed to providing an outstanding educational experience for residents in the primary care program.
Two continuity practice sites: Primary care residents take advantage of the enormous educational resources found within the University of Pennsylvania Health System. In addition to the three on-campus teaching hospitals, the primary care program utilizes the faculty and community practice sites of Clinical Care Associates, the Health System's primary care network of office practices. Primary Care Residents have two continuity practices: a hospital-based practice at Presbyterian Medical Center (PMC), and a second, community-based site. Interns spend a one-month intensive experience at their community sites and then assume a weekly practice at that same site for the second and third years.
Some examples of clinical sites include:- King of Prussia Medicine - Private practice office run by two former primary care residents. It introduces residents to comprehensive primary care in the community.
- Prevention Point Philadelphia (PPP) - PPP was founded in 1991, originally as an underground syringe exchange organization. Over the years, it has evolved into a multi-service public health organization that provides non-judgmental services such as syringe exchange, basic healthcare, education, and counseling to the most vulnerable, hard-to-reach populations in Philadelphia - the homeless, the uninsured, injection drug users, and sex workers.
- Lax Center - This is a non-profit organization dedicated to the care of patients with HIV disease. In addition to providing clinical care, the center houses an advocacy center, a dedicated team of social workers and numerous programs for both HIV treatment and prevention. Residents rotating through this site master the nuances of primary and HIV care.
- Adolescent Care Center - Division of Adolescent Medicine - This clinic is popular with those residents interested in adolescent medicine. It is staffed by both a general internist and pediatrician from the Children's Hospital of Pennsylvania (CHOP).
- Chinatown Medical Services - This clinic serves the Chinese-speaking members of the South Philadelphia community.
- Puentas De Salud - This clinic serves primarily Spanish-speaking patients in South and Southwest Philadelphia. Founded by Penn physicians, including a former primary care resident, Puentas De Salud provides primary, obstetrical, and pediatric care.
- Esperanza Health Center - This is a free clinic serving primarily Spanish-speaking patients in North Philadelphia. It is staffed by physicians from other local medical schools and provides comprehensive primary care.
- Penn Health for Women - Multidisciplinary clinic that specializes in women's health and provides comprehensive women's health services. It is house in Penn's suburban outpatient practices in the “Main Line” area of Philadelphia.
- Prison Health Systems - This clinic provides care to inmates of the Philadelphia prison system. This unique clinical experience includes care of inmates with HIV disease. This clinic is well-suited for those who desire a unique clinic experience and are perhaps considering a career in infectious diseases.
- United Community Clinics - This is a free clinic staffed by volunteer faculty from the University of Pennsylvania. It delivers care in a neighborhood catchment area and has strong relationships with members of the community.
Curriculum and Training:
- Primary care internists must be well trained in all venues of general internal medicine.
- The practice of primary care must be learned in realistic settings with progressive responsibility and expert mentorship.
- The knowledge base of primary care internal medicine is deep and broad and allows internists in both primary care and the medical specialties to obtain proficiency in caring for patients with complex disease.
- Primary care training requires a dedication to lifelong learning.
The primary care residency is comprised of clinical rotations, outpatient experiences, specialty practice opportunities, and dedicated seminars and conferences. Clinical rotations are carefully chosen so as to contribute to the education of well-rounded generalists. The following is a brief explanation of the schedule for each year:
Internship (PGY-1): The majority of the internship year is spent gaining the knowledge and skills necessary to be an excellent inpatient physician and team leader. Primary care interns have approximately five inpatient ward months, one inpatient geriatrics month, and 2 ICU months. They work side by side with traditional track interns, and rotate between all three inpatient sites (Hospital of the University of Pennsylvania, PMC, and the Philadelphia VA Medical Center). Both the categorical and primary care interns are scheduled in a “6+2” format that allows for six weeks of inpatient rotations followed by two weeks on dedicated ambulatory time. This “block-scheduling” model allows dedicated time in each arena and decreases conflicts between inpatient and outpatient educational time.
The two-week ambulatory blocks months are spent increasing knowledge and skills in outpatient medicine. Interns spend extra sessions in their own continuity practice, rotate through specialty clinics, and have seminars and conferences dedicated to physical diagnosis, prevention, patient-doctor communication, and office practice.
One month of the internship is spent in community practice, at the office which will become a second continuity practice site. This month is spent entirely on-site at the community practice, working with the physicians in the office, on home visits, with nursing home patients, or in whatever other arenas those physicians practice. The community practice sites are chosen from the large Penn primary care network. Many of the supervising physicians have won teaching awards and all are highly regarded as teachers and clinicians.
Junior Residency (PGY-2): During this year, residents gain further experience in inpatient care with 4 additional ward months, 1 ICU month, and 1 month of emergency medicine. The amount of time spent in ambulatory training expands, with 5 months spent on outpatient rotations. During this time, residents spend more time in both continuity practices (hospital-based and community), and rotate through a variety of specialty practices such as dermatology, orthopedics, cardiology, and endocrinology. Time is also available for residents to design their own clinical or research experiences.
During each ambulatory block rotation, there is a specific curriculum of didactic topics taught by clinical and research faculty, and by the residents themselves. Topics include outpatient orthopedics, women's health, physical exam, dermatology, Quality Improvement, and psychiatry. When residents return for their ambulatory block, they maintain continuity with their patients and their colleagues. Residents practice together, have clinic conferences together, and take part in an ongoing seminar series.
Senior Residency (PGY-3): During the senior year, more than half the time is spent on outpatient rotations, with 3-4 months on inpatient rotations. Time is available for both inpatient and outpatient electives. As part of the senior year requirements, all third year residents are expected to design and complete a scholarly project. The program director and other DGIM faculty are available to serve as advisors and mentors. Also in this year, time and practice experience at both the hospital and continuity-practice site continue to expand. Residents continue to serve as teachers to medical students. The clinic conference and seminar series continue as a forum to bring all primary care residents together across the 3 years of the program.
To apply: The program has a separate match number. Otherwise, the application process for the primary care track is part of the same process used for the categorical track. Please indicate your interest in primary care by checking the appropriate box on the application form. Interviews and information sessions are held on the same days for both programs.
Good Luck,
Marc Shalaby,
M.D., F.A.C.P.
Program Director, Primary Care Residency
Department of Medicine
Presbyterian Medical Center
39th and Market
Philadelphia, PA 19104-2699
(215) 662 9233