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 service at Princess Marina Hospital in Botswana that includes two full time faculty, residents and medical students. Senior residents can rotate there to be a part of the firm, with travel and housing expenses covered by the Department of Medicine. more info

Global Health Equities Track

Individuals interested in serving the community both locally and abroad can apply in the spring of internship to the Global Health Equities Track. 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 and global health. Track residents have an additional ambulatory practice experience in the community during elective time. International immersion experiences occur during elective time in the 2/3 years. more info

ABIM Research Pathway/Physician Scientist Program

It is possible to enter the ABIM Research Pathway 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

Academic Development Program

Beginning in the PGY2 year, all residents participate in the Academic Development Program during the Interactive Learning Module. 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 Track

The program attracts many residents with significant interests in medical education leadership. This track was established in 2015 to promote careers in medical education. The track includes coursework relevant to medical education careers and the following:

  • 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 winter of internship, you will participate in a standardized patient program designed to assess your communication skills and professionalism.
  • In May/June of your PGY1 year, you participate in rapid response and code reviews to prepare for second year.

Patient Safety and Quality Curriculum

The Safety and Quality curriculum is quite robust and is taught in the first two years.

Learning to understand and improve the healthcare delivery system in which you work is an important part of becoming a physician. The leadership of Penn’s Department of Medicine depend on you – our residents - for your eyes, ears, ideas, and solutions to improve and redesign the care for the patients we collectively serve. For this reason, our Internal Medicine Residency Program has a unique, longitudinal, 2-year curriculum in the fields of healthcare Quality, patient Safety, and high Value care. We call this curriculum, QSV for short. This curriculum is designed to provide you with the knowledge and skills to understand your role as a resident and future physician leader in identifying, reporting, and analyzing patient safety problems in healthcare, as well as how to organize, design, and implement a quality improvement project. This curriculum is grounded in the principle that the ideal way to learn these skills is through hands-on, experiential learning using real patient safety problems and working on real quality improvement projects that impact the residency program, department, and health care system in which you work.

During the PGY-1 year, you will learn how to recognize, report, and approach an error or unsafe condition within healthcare. Unlike many programs, we don’t just give you an access code for our safety event reporting system and learn it on your own…you will spend time in our computer lab practicing how to enter a safety event using Penn’s online “Safety Net” event reporting system. You will also work with our physician and nurse patient safety leaders to investigate an actual safety event that was reported by a residents in the Department of Medicine and experience the “inner workings” of the hospital’s patient safety department while learning how to approach and dissect these complex problem to uncover their root causes. At the end of the PGY-1 year, you will experience a team-training simulation related to a code or other emergency situation. Through learned practice and feedback in a safe, simulated environment, you will become competent in the teamwork and communication skills that are necessary to successfully lead a clinical emergency situation. You will experience this simulation with nurses, pharmacists, and your peers. There are 14 formal hours of curriculum in the PGY-1 year devoted to the QSV Curriculum in the PGY-1 year.

Under the guidance of experienced faculty mentors from diverse clinical specialties within internal medicine, you will work longitudinally in your PGY-2 year with a group of your peers and learn how a quality improvement team is formed. Together with other healthcare professionals, you will tackle a QI problem that is both important to the Department of Medicine and interesting and important to the residents. You will be involved in every step of the quality improvement process – from defining and scoping the problem, to identifying and meeting with stakeholders, to developing a specific aim statement and target quality metrics, to finally implementing a test of change that you and your team design and measuring its impact. We take your ideas into consideration each year as we choose the area of QI focus. There are 26 formal hours of the QSV curriculum in the PGY-2 year.

By the time you enter your PGY-3 year, we anticipate that you will be competent in the fields of healthcare quality, safety, and value and will serve as a role model, teacher, and leader of these skills for your interns and medical students. Some of our upper year residents continue their quality improvement work and present and publish this work as part of their scholarly pursuit requirements.

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 mentoring 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.

6+2 with Interactive Learning Modules (ILMs)

The entire program is now in a 6+2 model with six weeks inpatient and two weeks non-inpatient. The '+2' includes standard elective time for second and third years and ILM's for all. The intern ILMs are composed of longitudinal clinic time, facilitated learning activities, academic and health and wellness time. Each intern ILM has a theme around which additional clinical time, didatics and evidence-based medicine are emphasized.

The PGY2 ILM's include academic development time (see below), ambulatory clinics alighed with career goals and wellness time. One ILM is heavily concentrated on safety and quality.

The PGY3 ILM include their individualized Learning Plans (ILPs). These plans are developed by each Senior in the spring of the PGY2 year. Senior residents can choose longitudinal preceptors in the clinical area of their likely career path and thus have the opportunity to have 12-16 clinics with a designated faculty member over the course of a year. In addition, they can have significantly more academic time for research, community projects, board prep, etc.