Residency Training in Internal Medicine

The Residency Training Program in the Department of Medicine focuses on enabling residents to learn the basic principles and clinical competencies necessary for the practice of general internal medicine through rotations in general ward medicine, continuity practice, geriatrics, emergency medicine, general medicine consultation 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 all 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.

ROTATIONS

General Medicine Services

The composition of the general inpatient services at all three sites is similar with most consisting of one attending physician, two second- or third-year residents, four interns, and 1-2 medical students. Teaching rounds are conducted six days a week. Admissions are taken by interns providing residents with opportunity to supervise and teach team members. Interns carry an average of 5-8 patients. The call cycle is every fourth night. A resident night float system takes all admissions after 9:30 pm to provide ample opportunity for rest at both HUP and PPMC.

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 rounds are conducted 7 days a week. Shifts are limited to 24 hours.

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. 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.

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.

Ambulatory Training

Experience in outpatient care is an important component of our training program. The three cornerstones of the ambulatory experience are the ambulatory block rotations, continuity practices and firm rotation.

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
• 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 and critical care.

Continuity Practice

Each trainee has a continuity practice experience one half day per week 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.

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.

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.

Subspecialty Conference

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, each Monday, Tuesday, Wednesday and Thursday morning.

General Medicine conference

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

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.

Journal club

Journal club is comprised of two separate conference series that are held every other week throughout the academic year. The "Year-in-Review" series is organized by senior residents with the guidance of a subspecialty faculty member. That particular session reviews the most important articles published in the preceding year for each subspecialty. The remainder of the conferences are faculty run and focus on the key concepts of critical appraisal of the medical literature.

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.

Clinical Investigator Toolbox

This elective for medical residents as been created to serve as a general introduction to patient-oriented research for medical residents.  This elective is an intensive two week program offered to junior and senior medical residents. The experience includes structured didactic time, mentoring by designated faculty, and independent activities to promote greater knowledge of patient-oriented research. Each morning will begin with a “Meet the Researcher” Discussion Series to demonstrate the various career paths within clinical research taken by faculty members in the Department of Medicine. Following this discussion, two 1 hour lectures on key topics in patient-oriented research will occur. Following the lectures, there will be time to discuss the topics / articles presented during the two lectures as well as a review by each resident of their progress to date on their research plans. Afternoons will be spent meeting with and identifying a research mentor or identifying a clinical question, developing a research protocol, or conducting a planned research study.  In addition, each participant will attend a Penn Institutional Review Board meeting to learn further about its role in clinical research.

Course Goals:

1) Stimulate the spirit of inquiry and discovery for medical residents by introducing them to the many aspects of patient-oriented research

 

2) Expose medical residents to key research faculty through lectures, informal discussions, and personally arranged meetings to demonstrate the various pathways to an investigative career.

 

3) Identify a mentor in the resident’s anticipated career path

 

4) Introduce models of research methodology to provide the basic tools for the residents to begin implementation of clinical/translational research projects.

 

5) Discuss the ethics of medical research, informed consent, and the role of the Institutional Review Board.

 

6) Complete the Patient-Oriented Research certificate.

 

7) Facilitate the development of self-guided research goals during residency

Distribution of Rotations

PGY 1 year

• 5 months on the general medicine inpatient services at HUP (3 months), Presbyterian Medical Center (1 month), and the Philadelphia VA Medical Center (1 month).
• 2 months in intensive care medicine divided between the HUP Coronary Care Unit (CCU), the HUP Medical Intensive Care Unit (MICU), or the Cardiac Care Unit at the Presbyterian Medical Center.
• 1 month experience in inpatient oncology.
• 2 months of ambulatory medicine.
• 1 month of service block that includes day float time.
• 1 month vacation

PGY 2 year

• 4 months on the general inpatient medical services at HUP and Presbyterian Medical Center.
• 2 months will be spent in either the HUP MICU, HUP CCU, or the Cardiac Care Unit of the Presbyterian Medical Center.
• 2 week experience in emergency medicine in the HUP Emergency Department.
• 2 week experience in geriatrics
• 2 week experience in neurology
• 4 months of elective time are available with no night call responsibilities.
• 2 weeks of a service block that includes jeopardy and night float time
• 1 month of vacation

PGY 3 year

• 3 months on the inpatient ward services at HUP, Presbyterian Medical Center, and the PVAMC.
• 1 month is spent in intensive care medicine in either HUP or Presbyterian Medical Center.
• 2 weeks in the HUP Emergency Department
• 2 week experience in medical consultation
• 4 1/2 months of elective time
• 1 month of a service block that includes jeopardy and night float time
• 1 month vacation