GENERAL INFORMATION - (PDF version)
HUP INFO
VA HOSPITAL (PVAMC) FACTS:
PRESBYTERIAN MEDICAL CENTER (PMC) FACTS:
OUTPATIENT CONTINUITY PRACTICE:
EMERGENCY DEPARTMENT:
MENTORING:
RESEARCH:
INTERNATIONAL PROGRAMS:
LIVING IN PHILADELPHIA:
OTHER AMENITIES:
AFTER RESIDENCY:
UNIQUE TO PENN:
GENERAL INFORMATION
Q: How many PGY-1 positions are available?
A: There are 40 standard positions, 6 Primary Care positions,
4 Medicine-Pediatric positions, 1 Medicine-Dermatology position
and 10 preliminary positions.
Q: Where do these interns come from?
A: Our interns come from all over. The current class represents
28 different schools.
Q: By what criteria are Housestaff selected?
A: We look for applicants who value professionalism and teamwork,
who have a strong academic record, and a wide range of interests
and excellent academic potential.
Q: What is the salary?
A: Next year’s salary has not been announced. The current
PGY-1 salary is $
47,160.38.
Q: How many clinical training sites are there?
A: Three. The Hospital of the University of Pennsylvania (HUP),
The Philadelphia Veterans Affairs Medical Center (PVAMC), and
the Presbyterian Medical Center (PPMC). Each site has a faculty
site director, a Chief Resident and a coordinator.
Q: What type of communication devices are there?
A: All housestaff receive cell phones at orientation. We no longer use pagers. This has greatly improved the efficiency of our residents.
Q: How much time do I spend at each site as a PGY1?
A: HUP: 8 - 10 months
PVAMC: 1 - 2 months
PPMC: 1 - 2 months
Q: What is the breakdown of rotations?
| A:Categorical Intern |
| ICU |
1.5 months |
| Wards |
6.5 months |
Ambulatory Block
|
2 months |
| Vacation |
1 month |
| Service Block |
1 month |
|
| A. Preliminary Intern* |
| ICU |
1 month |
| Wards |
6 months |
| Elective |
3 months |
| Vacation |
1 month |
| Service Block |
1 month |
|
* Neurology interns staying at HUP for Neurology will have 1
critical care elective per Neurology’s requirements.
| Junior Resident |
| ICU |
1.5 months |
| Wards |
3.5 months |
ER
|
2 weeks |
| Neuro |
2 weeks |
| Elective |
4 months |
| Service Block |
1 month |
| Vacation |
1 month |
|
| A. Senior Resident |
| ICU |
1 month |
| Wards |
3 months |
ER
|
2 weeks |
| Medical Consults |
2 weeks |
| Elective |
5 months |
| Service Block |
1 month |
| Vacation |
1 month |
|
Q: How many admissions can I get on-call?
A: Five new patients and oftentimes one night float patient that
has already been evaluated by a resident.
Q: How often will I be on call?
A: Interns are on call every 4th night on the wards. The units are a combination of every 4th night call and shift work. There are no overnight responsibilities while on the ambulatory or intern service blocks.
Second and third year residents take call when assigned to call rotations only. There is essentially no call during elective blocks.
Q: When are my days off?
A: All housestaff get 1 Saturday, 1 Sunday and 1 golden weekend
(Saturday and Sunday) off per month when assigned to inpatient rotations. These days off are preset in the online schedule
such that you know your days off for the year so plans can be
made in advance for your time off.
Q: What is the “service block”?
A: Junior and Senior residents on service block are assigned to
night float and jeopardy (sick call) coverage.
Q: Do attending rounds occur daily?
A: Yes. Rounds occur for a minimum of 90 minutes each day.
Q: When do teaching rounds occur?
A: There is dedicated didactic teaching for 30 minutes at least
4 days a week on every service. Topics are part of the core curriculum
for the program.
Q: What are Interdisciplinary Care Rounds?
A: These rounds occur Monday through Friday on each unit for 30
minutes. They include nursing, housestaff, social work and clinical
resource management. They are designed to facilitate patient flow
by assisting with discharge planning. In oncology, discharge planners are assigned to resident teams and are completely integrated.
Q: What is the departments approach to work hour reform?
A: We have strived to maintain a team atmosphere that promotes maximum
continuity of care within the required limitations. The logistical
details will be described in the section for each site.
Q: How does the program teach quality improvement?
A: The concept of Quality Improvement (QI) is taught
in a variety of activities and forums. All QI activities are supervised
and evaluated by faculty with training and interest in quality
and safety.
As an intern, you will complete a project involving evaluation
of the care you deliver to your panel of continuity outpatients,
and you will develop a plan to improve that care.
As a resident, and a member of an outpatient "firm",
you will be involved in the QI activities your firm has chosen
to address in their practice. Involvement dependson
the status of the project, but may include activities as diverse
as patient education, dissemination of practice improvement tools,
team-building and post-intervention data collection.
Both interns and residents also participate in a longitudinal,
web-based chart audit every spring, to evaluate the delivery of
care based on widely accepted parameters of quality. The results
of the audit are discussed in preclinic conference and other forums,
and are used to impact firm and program QI goals for the following
year.
Q: Does the program have a patient
safety curriculum?
A: Yes. The program uses one of HUP’s Patient Safety Officers
to plan and implement 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. 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.
Q: Are there required ambulatory rotations?
A: Yes.
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.
- An 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.
- Simulated training in procedures at the Penn Simulation Center.
- Standardized patient experience to improve communication skills.
Firm Rotations: Each PGY 2
has one and each PGY 3 has 2 required firm rotations designed
to solidify their ambulatory skills learned in residency. The
experience is designed to provide an immersion in the practice
with a focus on acute medicine and quality improvement.
Q: How is the curriculum organized?
A: The blueprint for the curriculum has been created by the Curriculum
Committee made up of Core Faculty from each specialty of
Internal Medicine. These individuals created the curriculum based
on what they feel is most important for a general internist to
know about that specialty. Each specialty has a list of key articles
that represent cutting edge research, as well as landmark papers
that are available to residents through PULSE -
our residency portal.
Q: What is the conference curriculum?
A: An integrated conference curriculum provides 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. All conference material is available
through our resident portal. 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: (12:00 - 1:00 p.m - Monday,
Wednesday, Thursday and Friday)
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
here are a physician scientist and a patient safety series.
Intern report: (1:15 - 2:15 p.m. - Monday, Wednesday,
Thursday)
This is similar to resident report but is focused for interns.
It is run by the chief residents and occurs twice a week with
equal emphasis on inpatient and outpatient cases. Interns are
expected to hand off their pagers to residents during intern
report.
Grand Rounds: (12:00 - 1:00 p.m. - Tuesday)
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.
These conferences are webcasted from HUP to PPMC and are available
online after the event.
Subspecialty conferences: (8:00 - 9:00 a.m. –
Monday, 2n /4th Tuesday and Thursday)
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.
Journal club: (8:00 - 9:00 a.m. – 1st and 3rd
Tuesday)
Journal club begins in September. This is an evidenced-based
conference where residents discuss articles from the literature.
Residents are responsible for selecting the article and faculty
member who is an expert in the content under discussion. An
additional faculty member facilitates each session with expertise
in critical appraisal. Specific worksheets are completed for
each article.
General Medicine conference (8-9 am on Wednesdays)
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 (1-1:30 on clinic days)
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.
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HUP FACTS
Q: Is there a Night Float System?
A: Yes! A resident on night float accepts all patients admitted
to the hospital between 9:30 p.m. and 8 a.m. Monday to Thursday;
11:00 p.m. to 8:00 a.m. Friday, Saturday and Sunday.. This is
staffed by junior residents who do approximately eight night float
shifts per year during their service blocks.
Q: Is there short call?
A: On occasion. On the 3rd day of your four-day call cycle, interns
can pick up a maximum of 1 patient from the night float resident
at 8 a.m. This patient has already been evaluated and thus short
call involves assuming the care of a worked-up patient.
Q: How many people are on a team?
A: There are 12 floor teams: 4 on Rhoads (2 liquid and 2 solid
tumor) and 8 (2 GI, 2 pulmonary and 4 general medicine) on Founders.
A typical team is made up of one attending, one resident, two
interns (sub-interns often substitute for interns) and 1 third
year medical student.
Q: Are there non-housestaff covered patients?
A: Yes. There are 3 non-teaching services (NTS): Cardiology, Oncology
and General Medicine. The following diagnoses are assigned to
the NTS’s: Oncology accepts chemotherapy admissions greater
than 48 hours in duration, transfusion therapy, heparin therapy
for thromboembolic disease in oncology patients, bone marrow harvests,
autologous bone marrow transplants; post BMT complications; Cardiology
accepts electrophysiology cases;
uncomplicated interventional, and heart failure cardiology patients.
General Medicine alternates admissions with the general medicine
teaching service and carries a census of 36 patients daily. The
total number of patients managed by non-teaching services is about
100/day.
Q: What is the patient mix?
A: 1/3 have no UPHS provider, 2/3 have UPHS providers. Our patients
come from the surrounding West Philadelphia area, which is a very
diverse inner city population, the region of the Delaware Valley
and many states in the Mid-Atlantic region.
Q: What is the typical daily schedule?
A: It varies by service but includes daily attending rounds, interdsciplinary
rounds and conferences.
Q: Are there private attendings?
A: Each subspecialty service has 1 attending for a 2 week block.
The entire department rotates on the same schedule. For example,
the pulmonary division has 1 faculty member on general consults
for each 2 week block. Any pulmonologist admitting a patient will
do so to that attending and service. Thus, there is only 1 pulmonary
attending for all pulmonary admissions.
Q: What are the hospitalist services?
A: We have had hospitalists since 1999. They staff the Martin
Service – named after a beloved Program Director at Penn.
There are 12 hospitalists, four of whom are on service every month.
All of the unassigned admissions and admissions from many of the
general medicine practices are admitted to this service. These
individuals are the teaching attendings as well as the attending
of record for their services.
Q: Is there a required experience in Neurology?
A: Yes. A two-week experience in Neurology is required. 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.
Q: What systems are in place at HUP to support duty hour
reform?
A:
- The long call teams admit from 8 am until 9:30
pm during the week and 11:00 pm on weekends. . Night float admits
until 8 am. The post call teams must sign out by 1 pm. All services
have day floats (interns on service block) to support post call
workload. The role of the day float is to receive a preliminary
signout from the post call interns and begin completing necessary
tasks. At 5pm, the day float signs out the remaining items to
the on-call team.
- Web-based patient identification and sign out system.
- 24-hour blood culture and phlebotomy services are available.
- Dedicated clerical support to make post discharge appointments.
- Telemetry transport services.
Q: What type of technology is available at HUP?
A: HUP has the following resources:
- Wireless network throughout
- Wireless computer on wheels for each team to improve efficiency
- Sunrise Electronic Order Entry System
- Clinical Portal called Medview to pull all clinical systems
into one use friendly portal
- Online discharge summaries
- Outpatient EMR
- Access to the School of Medicine biomedical library
- Up-to-Date Clinical resource.
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VA HOSPITAL (PVAMC) FACTS:
Q: Where is the VA Hospital located?
A: An 8-minute walk across campus from HUP.
Q: How do the facilities compare to the HUP facilities?
A: There is an 8 story clinical addition which houses all of the
outpatient clinics, a MICU, and a nursing home.
Q: How much time will I be spending there?
A: On average, each intern and senior resident spend 1 month per
year at the VA.
Q: How does the VA support work hour reform?
A: Given the low volume of overnight admissions, the VA uses a
senior resident night float. Monday through Friday, a senior resident
from elective comes in at 8 pm and takes sign out from the “on-call”
VA senior resident. The “on-call” resident leaves
by 10 pm and returns at 8 am on the post call day. After the transition
of care, the NF resident goes home and sleeps so they can return
at 8 pm. The “post-call” resident takes sign out from
their post call interns by 1pm and then stays to complete the
post call work. The assigned VA residents will only take in house
call on Saturday and Sundays.
Q: What are the differences between HUP and PVAMC?
A:
- There are 2 inpatient teams composed of 1 attending, 2 residents,
4 interns, and 1-2 students.
- Housestaff have more management responsibility.
- Ancillary services include 24-hour phlebotomy and IV teams.
The typical daily schedule at the PVAMC:
| |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
| 7:00 - 8:00 |
PreRound |
PreRound |
PreRound |
PreRound |
PreRound |
| 8:00 |
Work Rounds |
Work Rounds |
Work Rounds |
Work Rounds |
Work Rounds |
| |
|
|
Intake Reports |
|
|
| 9:00 |
Discharge Rounds |
Discharge Rounds |
Discharge Rounds |
Discharge Rounds |
| 9:30 |
|
|
Discharge Rounds |
|
|
| 10:00 |
Atd Rounds (On call and good day) |
Atd Rounds (On call and good day) |
Atd Rounds (On call and good day) |
Atd Rounds (On call and good day) |
Atd Rounds (On call and good day) |
| 12:00 |
Resident Report |
HUP Grand Rounds |
Joint Conference/VA Grand Rounds |
Resident Report |
Critical Care Conference |
| 1:15 |
Intern Report |
|
|
Intern Report |
|
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PRESBYTERIAN MEDICAL CENTER (PPMC) FACTS:
Q: Where is PMC?
A: A 10-minute walk through campus
from HUP.
Q: How much time will I spend there?
A: Approximately 1-2 months per year as an intern; 2-3 months
as a resident.
Q: Are there non-housestaff covered patients?
A: Yes; there is a large non-teaching service for periprocedure
Cardiology patients and for private specialty and general medicine
admissions. Housestaff do not cover these patients at night but
provide emergent care when necessary.
Q: What is the call cycle?
A: Every fourth night.
Q: Is there a Night Float System?
A: Yes. A resident night float accepts all patients admitted to
the hospital between 11 p.m. and 8 a.m. seven days a week. This
is staffed by junior residents who do approximately seven night
float shifts per year.
Q: Is there short call?
A: Yes. On the 3rd day of your four-day call cycle, interns can
pick up a maximum of two patients before 3:00 pm. The patients
may be from the night float or be new admissions.
Q: What is PPMC’s approach to work hour reform?
A: Same system as HUP.
Q: What is the ACE unit?
A: The ACE unit is the Acute Care for the Elderly unit located
at Presbyterian Medical Center. It is the core of our geriatircs curriculum. There is a strong emphasis on
interdisciplinary team management and care. The Geriatrics faculty
are the attendings for this rotation.
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OUTPATIENT CONTINUITY PRACTICE:
Q: Where will I practice?
A: Housestaff practice in groups at one of three sites: PVAMC, 3701 Market Street or Penn Center for Primary Care. You will practice as a member of your firm for three years.
Q: When will I practice?
A: There are no outpatient practice responsibilities during ICU
rotations, night float or vacation.. Housestaff on ward rotations
practice in the afternoon to ensure adequate continuity on the
inpatient services. Clinic is on Day 3 or 4 of your call cycle.
Each person is assigned to a primary day and an alternate day;
the alternate day is used when either on-call or post-call day
falls on the primary clinic day. When on a call rotation, clinic
is reduced to 2 times/month. Residents on elective have at least
5 half days every two weeks. This allocation of clinic has been
designed to address the competing inpatient and outpatient priorities
experienced by resients on busy inpatient services.
Q: What is the faculty to resident ratio?
A: It is 1:3
Q. What is a firm?
A. Those residents that practice at 3701 Market Street belong
to one of 4 firms that are run by a faculty firm chief with 2-3
core faculty preceptors. Each resident has their own panel of
patients within the practice that they keep throughout the three
years of residency. Residents attend their practices one to two
half-days a month when on a call rotation and then 2-3 times a
week when on elective rotations. Each PGY 2 has one and each PGY
3 has 2 required firm rotations designed to solidify their ambulatory
skills learned in residency. The experience is designed to provide
an immersion in the practice with a focus on acute medicine and
quality improvement.
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EMERGENCY DEPARTMENT:
Q: What percentage of ER patients are admitted to medicine?
A: The HUP Emergency Department treats over 80,000 patients per
year. Although the patient population comprises an undifferentiated
sample of the medical problems managed by academic emergency departments,
the acuity level is considerably higher than many other such departments
and accounts for 35% of all admissions to HUP.
Q: What is the ER experience like?
A: Emergency Medicine is a separate Department. Medical Housestaff
play a critical role in evaluating and triaging all types
of patients who present for care.
Q: How often do I work in the Emergency Department?
A: JARs and SARs spend 2 weeks in the ER.
MENTORING:
Q: Is there a mentoring program?
A: Yes, interns are assigned in random groups to key selected
faculty. They meet monthly to discuss various topics both within
and outside the workday. There is an intern retreat in the fall
where the entire class gets together for a night and the following
day. By the end of the internship, career path dictates the choice
of faculty mentors.
Q: Is there career counseling?
A: Yes, there is extensive counseling by the Program Director,
Chair and Division Chiefs of each subspecialty. There are also
identified faculty in each division for this purpose.
Q: Are interview skills taught?
A: There is an annual retreat for junior residents to practice
interview skills with senior faculty.
RESEARCH:
Q: Is there a “scholarly requirement”?
A: Yes. Each resident in the categorical and the primary care
programs must complete a scholarly project in order to graduate.
Scholarship is broadly defined and includes reviews of clinical
topics, original work resulting in abstracts or manuscripts, laboratory
experience and community service.
Q: How does the program support resident research?
A: The program has created a two week course for junior 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.
Q: How productive are the residents?
Very productive. Over the last two years they have published over
60 peer-reviewed manuscripts. Please review the program bibliography
Q: Are there research electives?
A: Yes. Research electives are available to all trainees within
the three year program. The amount of time available is based
on the research goals.
Q: Is there a Research Pathway?
A: Yes. 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.
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INTERNATIONAL PROGRAMS:
Q: Are international experiences available?
A: The University of Pennsylvania has formal affiliations with
over 40 universities worldwide.
Q: What is Penn Medicine at Botswana?
A: 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.
Q: What is the Global Health Track?
A:
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. We expect to take four individuals as interns. 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 nd/3 rd years. Please see
http://www.uphs.upenn.edu/medicine/education/resappinfo/sponsor/global_health.html
LIVING IN PHILADELPHIA:
Q: Where will I live?
A: Most residents live across the bridge in Center City. A few
live in nearby suburbs or West Philadelphia (University City).
Housing is comparably priced in Philadelphia - approx. $900/mo.
for 1 bedroom.
Q: What about transportation to and from work?
A: The hospital supplies parking or commuter passes to all housestaff.
Those rotating at PPMC can park on-site.
Q: What is there to do outside of work?
A: Philadelphia is a multi-cultural city with something for everyone.
There are museums, parks, theaters, a renowned orchestra, the
waterfront and much more. Philadelphia also has a wide variety
of restaurants for every budget - with several nationally acclaimed
five star delights.
Q: How do the housestaff get to know each other?
A: Through rotations together - especially their ambulatory medicine
months. Each ambulatory group sponsors a party each month for
the rest of the program. There are monthly happy hours as well
and special social events each month.
OTHER AMENITIES:
Q: How will I eat?
A: Debit cards for meals are provided by the Office of Graduate
Medical Education. Rotations requiring greater than 60 hours/week
receive $75/month benefit. Lunch is usually served at Resident
and Intern Report. Philadelphia is noted for its excellent and
affordable restaurants.
Q: Are white coats available?
A: The Department provides 2 long white coats to all housestaff.
Free laundering is available through the department.
Q: Are scrubs available?
A: Yes.
Q: Are lockers available?
A: Yes.
Q: Are their program sponsored social events?
A: Yes. There is a very active social committee that sponsors
1-2 events/month. We have monthly parties at the home of an intern,
a Philadelphia Phillies night, a Philadelphia 76ers night, a night
at the Mann Music Center and a day at the beach. More events are
being planned. Events are planned by the Social Committee.
Q: Is there a retirement plan?
A: You can contribute to a 403B but there is no matching.
AFTER RESIDENCY:
Q: What do most of your residents do after completing
the program?
A: A large portion of our residents go on to train in a subspecialty
fellowship, including general medicine fellowships. Increasingly,
we are seeing more of our residents enter general medicine practice.
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UNIQUE TO PENN
- Outstanding breadth of clinical training at 3 sites
- HUP: A university-based tertiary care referral center
- PPMC: An academic community hospital
- PVAMC: A Veterans Affairs medical center
- 1 full weekend off per month
- Days off scheduled up front for the year
- Extensive Career Counseling
- Clinical research training course
- Tremendous research opportunities plus research support (Department
of Medicine ranked #3 in NIH funding)
- Diverse and closeknit housestaff from a wide range of backgrounds.
- Active social committee
- Penn Medicine at Botswana
- Large non teaching services to enable housestaff to focus
on the more interesting and complex cases
- Global Health Track
- Integrated patient safety curriculum.
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Updated:
9/12/2007
