Internal Medicine Residency

Unique Features of Our Program

At Penn, we are constantly looking for innovative ways to improve the education of our residents. We offer a diverse array of programs, tracks, and electives to match each of our residents' personal career goals. We also pride ourselves on our ability to adapt to changes in health care and duty hour regulations. Below are descriptions of some of the more innovative and unique opportunities at our program:

Healthcare Quality and Leadership Track

This track is designed for individuals wishing to pursue advanced training in healthcare quality and leadership. Residents apply in the spring of internship and begin in the PGY2 year. The track has an annual 2 weeks of core didactics and monthly seminars. Residents are also active members of the Unit Based Clinical Leadership teams. more info

Penn Medicine at Botswana

In 2003, the Department of Medicine and the School of Medicine entered into a collaborative agreement with the government of Botswana and the Gates Foundation to develop an HIV care program for the citizens of Botswana. We now have an inpatient firm at Princess Marina Hospital in Botswana that includes two full time faculty, residents and medical students. One senior resident each month rotates there to be a part of the firm, with travel expenses covered by the Department of Medicine. more info

Global Health Track

Individuals interested in serving the global community as a career path can apply to the Global Health Track as part of the categorical application process or in the spring of internship. We can accommodate up to four individuals per year. The curriculum begins in the PGY2 year with a core month of intensive course work in community health. International immersion experiences substitute for elective time in the 2/3 years. more info

ABIM Research Pathway

It is possible to enter the Physician Scientist Program after two years in the standard program followed by a clinical fellowship and three years of research. It enables those with physician scientist aspirations to differentiate a year earlier. This decision is usually made during the fall of the PGY-1 year. Those in the pathway become members of the William Osler Society in Medicine, which serves as a forum for gatherings around research meetings, visiting speakers and provides time and opportunity for mentoring. more info

Clinical Investigator Toolbox

The program has a two week course for junior and senior residents entitled the Clinical Investigator Toolbox. It is designed to teach the basics of research design, principles of informed consent, working with the IRB, etc. Speakers include faculty from across the School of Medicine to provide diverse exposure to careers in academic medicine. Each resident identifies their research interests and then the course directors match those interests with various faculty. Residents subsequently meet with identified faculty to further define their interests and select a research project. The program will pay for any resident to travel to a regional or national meeting to present their work. We will also help you with your posters.

Medical Education Focus

The program attracts many residents with significant interests in medical education leadership. The following options are available for those wanting more in depth experience in medical education.

  • Medical Education elective- A 2 week course is available in the spring for junior residents for more in-depth development of the skills necessary to be an effective teacher and to pursue a career as a medical educator.
  • Core Clerkship teaching month-this is a 4 week experience for senior residents where they focus on the teaching of third year clerkships students. They work closely with the Clerkship director on all aspects of the clerkship.
  • Intensive Senior Clinical Teaching experience- This experience is based at the VA and was designed to optimize resident opportunity to teach and supervise students. Academic hospitalists attend on these services. A teaching curriculum is embedded in this rotation with the goal of improving skills in bedside teaching, feedback and evaluation. Each senior resident has 2 sub-interns and 1 core clerkship student. They care for 12 patients. There is no overnight call.

Health Policy Elective

This elective provides an overview of the U.S. health care system including key features such as financing and organization and then moves on to a more comprehensive understanding of politics and government. The course combines didactic sessions with team-based case studies focused on developing written and oral policy skills for future policy leadership. Guest speakers operating at the interface of medicine, public health, and public policy will illustrate the policy making process and demonstrate the important role physician leaders can play in the process. The experience is capped by a visit to our representatives in D.C.

Procedure and Resuscitation Service

The Procedure Service provides teaching & direct supervision of common bedside procedures. This service is composed of an intensivist and an ICU advanced practitioner who specializes in procedures. The intensivist and advanced practitioner are available to assist with and teach all medicine procedures throughout the hospital. They invite the housestaff caring for the patient in-house to be the primary operators on all procedures. There is also a 1-2 week elective rotation with the procedure service, which focuses on skill development for bedside medical procedures including ultrasound training. The resuscitation arm of the service is the Medical Rapid Response Team, which includes a respiratory therapist and a pharmacist. Intensivists attend all daytime near codes or codes and provide support and feedback to residents on their acute resuscitation skills.

Use of Simulation

Penn Medicine has a simulation center minutes from HUP. It is used in several ways during your training:

  • During orientation, you are trained in how to conduct a handoff. You participate in didactics and simulated handoff exercises with feedback provided through video technology and facilitated debriefing.
  • During orientation, you will spend a day at the sim center being trained in common bedside procedures and US.
  • In the spring of internship, you will participate in a standardized patient program designed to assess your communication skills and professionalism.
  • At the beginning of your PGY2 year, you participate in rapid response and code reviews.

Patient Safety and Quality Curriculum

One of the Assistant Program Directors is one of HUP’s Patient Safety Officers. She plans and implements the curriculum. One resident report each month is used to teach basic safety concepts around real cases that represent errors or near misses. Didactic content is included in the ambulatory curriculum at the intern level. A robust M&M occurs as part of Grand Rounds 6 times per year. Residents are involved in all aspects of these conferences and also participate in Root Cause Analyses.

Residents are exposed to accepted tools of quality improvement in a variety of settings over the course of residency. All interns participate in a workshop during their ambulatory rotation. This workshop consists of didactics and exercises using common tools of quality improvement, including registries, process maps and cause-and-effect diagrams. These tools are applied to a project based in their continuity practices, and presented to colleagues and faculty. As upper -level residents, they are asked to expand these projects or work on existing practice projects at the level of the practice. These expanded projects include readings and exposure to faculty in leadership roles in the institution. Projects incorporate members of other disciplines, and greater use of the QI tools incorporated into our electronic medical record. Again, residents present to colleagues, practice staff and faculty. All residents have the care of their patient panel incorporated into end of year face-to-face feedback in the practice, and are asked to delineate a data-driven plan for improvement over the ensuing 6 months.

Mentoring

Our advising program is a multifaceted program that seeks to incorporate strong individual relationships into a multiple mentor model of career and life advising. The program adapts to each resident, with some general goals stratified by level of training. The goal is to provide specific support and structure to nurture talented trainees through the rigor and discovery of intern year.

Interns

  • The intern class is divided into approximately 8-10 groups of 6-8 interns each, and each group is assigned to a core faculty member (an associate program director, or another faculty member heavily involved in residency teaching and curriculum development). This person is the “program advisor.”
  • Interns from all tracks are integrated into the program
  • The groups meet for the first time during intern orientation week, and subsequently have two small group dinners over the course of the fall.
  • Each intern is required to meet with his or her program advisor in the fall to review early evaluations and talk one-on-one about life in the program.
  • Later in the year, interns will meet with Dr. Bellini in the winter for a mid-year progress review, then again with their advisors in the spring.

Residents

  • Each resident continues to have intermittent individual meetings with their program advisor throughout the second and third years of the program, scheduled at the request of the resident.
  • For those residents with interest in academic or research careers, the Clinical Investigator Toolbox course is highly recommended.
  • Program advisors routinely help residents plan for the next stages of their careers. This frequently includes reading personal statements, performing mock interviews, reviewing resumes, and other preparation for a fellowship or job interview. In addition, advisors often help residents prepare for poster or oral research presentations.

Intern Wellness Program

There is a longitudinal Self-Care Curriculum for Interns with the goal of teaching various self-care strategies and more importantly, normalizing self-care as an expectation of residency training and beyond.

There are four sessions distributed longitudinally throughout intern year, delivered during Ambulatory Blocks. Sessions are usually mixed didactic/experiential and include:

  • Self-Care Strategies Session – This session utilizes Nominal Group Technique (individual brainstorming then group sharing) to review concrete self-care strategies in both physical and emotional domains. Interns are given a handout with contact numbers of local PCPs, GYNs, urologists, dentists and mental health professionals and told they are expected to find their own health teams and are given four (program leadership approved) ½ days a year, to be taken during their ambulatory blocks, that they can utilize for their own health appointments.
  • Physician Impairment Session - This mostly didactic session is aimed at helping interns identify warning signs of distress, burnout and disability. Emotional and physical health resources will again be provided with the session materials.
  • Awareness Exercise Session - This is a guided self-reflection exercise explores the factors in each participant’s lives (at work and outside of work) that are draining and sustaining.
  • Emotion Handling Session - This is a mixed didactic/interactive session reviewing communication strategies to use with patients who are expressing emotions like anger, anxiety, grief, etc. The session is then transitioned to discussing and normalizing the complex emotions that interns themselves experience during their daily encounters and emotional handling strategies are reviewed.