University of Pennsylvania Health System

The Primary Care Program is fully integrated with the Department's categorical residency training program, yet distinct in its emphasis on primary care 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, clinical epidemiology or medical education. Many residents choose to do fellowship training and graduates have gone into most areas of specialty training. Through a separate match, six individuals are selected for internship. In the spring of internship, up to two additional categorical residents may join the program.

Distinguishing Features: Even among primary care programs, the Penn program is distinct.

Fully integrated: The program is fully integrated with the Penn categorical program. Primary care residents are part of the same inpatient teams as the traditional track residents; they are taught by the same faculty and use as inpatient training sites the same teaching hospitals as the categorical program. Primary care 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.

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, each with its own outpatient clinical practice,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. Residents have two continuity practices: a hospital-based practice at Presbyterian Medial 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 in the second year.

Penn General Internal Medicine Faculty: The program's core faculty are drawn from the Department's nationally prominent Division of General Internal Medicine (DGIM), which includes outstanding clinician-teachers, leaders in health care, 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 DGIM members; 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.

Community health needs: The program is deeply responsive to the surrounding community of West Philadelphia. Primary care residents take on significant commitments in meeting that community's health care needs, while gaining additional perspectives through continuity practices in adjacent communities and suburbs.

Curriculum and Training:

The curriculum was shaped by the following principles and values:

Primary care internists must be well trained in all venues of general internal medicine practice. 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, but it is also broad. Primary care training is a lifelong undertaking.

The primary care residency is comprised of clinical rotations, outpatient experiences, specialty practice opportunities, and seminars and conferences. A complete list of conferences, interactive workshops, and seminar plans is available if you are interested. Clinical rotations were chosen that contribute to the education of well-rounded generalists. The following is a brief explanation of the schedule for each year:

Internship: 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 5 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). Every intern has 2 one-month ambulatory care block rotations. These months are spent increasing knowledge and skills in outpatient medicine; interns spend extra sessions in their own practice, rotate through specialty clinics, and have seminars and conferences dedicated to physical diagnosis, prevention, patient-doctor communication, and office practice. Finally, one month 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: 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 specialty practices necessary for office practice of general internal medicine, dermatology, orthopedics, cardiology, endocrinology,, etc. Time is available for residents to design their own clinical or research experiences.

During the block rotations, there is a specific curriculum of didactic topics taught by attendings and by the residents themselves. Topics include outpatient orthopedics, women's health, physical exam and psychiatry.

A one-month block rotation is spent at Independence Blue Cross headquarters, the region's largest managed care organization, learning about managed care and health economics first-hand.

Residents continue to practice together, and have clinic conferences and an ongoing seminar series.

Senior Residency: 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 and selectives. Residents are expected to design and complete a scholarly project; DGIM faculty are available to serve as advisors and mentors. 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 standard 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.

Specific inquiries about the primary care program can be addressed to:

Matthew Rusk, M.D.
Program Director, Primary Care Residency
Department of Medicine
Presbyterian Medical Center
39th and Market
Philadelphia, PA 19104-2699
(215) 662 9233
matthew.rusk@uphs.upenn.edu