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MEDICINE

Chair
Michael Braffman, MD

Vice-Chair
David Henry, MD

Program Director
Dennis Policastro, MD

Associate Program Director
Leigh Kennedy, DO

About the Program

Pennsylvania Hospital offers a categorical three-year medical residency program as well as a preliminary one-year program approved by the Accreditation Council for Graduate Medical Education and by the American Board of Internal Medicine. The goals of the residency-training program are to provide house officers with outstanding clinical training and didactic educational experiences to produce the highest quality internal medicine physician possible. Our dedicated core faculty of 70 exceptionally well-trained clinician-educators allows our programs to achieve these goals.

In addition, we are now able to offer a 3-year dually accredited Osteopathic Internal Medicine Residency Program. This program was approved by the American Osteopathic Association (AOA) in June of 2007 and is participating in the ERAS and NRMP at this time. In addition to the thorough curriculum of the existent internal medicine residency program, residents of the dually accredited program will have the opportunity to participate in OMT conferences and electives associated with the Philadelphia College of Osteopathic Medicine. Participation in this program will fulfill the Osteopathic requirements for the first year of graduate training and allow you to practice in the states that require an AOA approved first year.

Graduates of the categorical program enter the practice of medicine as accomplished internists or pursue further training as fellows in one of the subspecialties of medicine.

The residency program provides comprehensive education in all areas of medicine including allergy and immunology, ambulatory care, cardiology, emergency medicine, endocrinology, gastroenterology, geriatrics, hematology and oncology, infectious diseases, critical care and pulmonary diseases, renal diseases and rheumatology. Electives are available in all of these specialties as well as anesthesiology, dermatology, gynecology, neurology, pathology, psychiatry and radiology. A research elective may be taken anytime during the three years of training. Faculty mentors for the research project may come from anywhere in the University of Pennsylvania Health System including the Hospital of the University of Pennsylvania and its medical school.

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Program Schedule

The First Year

In cooperation with the National Resident Matching program, Pennsylvania Hospital offers 26 first-year positions in internal medicine. Twelve positions are offered in the Categorical Three-Year-Internal Medicine Program and 14 positions in the Preliminary One-Year Medicine Program. The Categorical Program consists of 36 months of training in internal medicine. During this three-year period each house officer develops the knowledge, skills and confidence that characterize the well-rounded internist.

While some of the programs graduates pursue careers in general internal medicine, the majority join fellowship programs for subspecialty training. The preliminary program is designed to give comprehensive PGY1 training in Internal Medicine for those individuals pursuing specialty residency training in Radiology, Ophthalmology, Anesthesiology, Dermatology and Neurology.

Both programs are approved by the Pennsylvania State Board of Medical Education and Licensure and by the American Medical Association. The categorical training program is dually accredited by the American Board of Internal Medicine and American Osteopathic Board of Internal Medicine.

The PGY-1 schedule includes:

* Preliminary interns have three months of electives
   and do not do the Ambulatory block rotation.

The Second and Third Years

An approved first-year residency must precede the second-year residency at Pennsylvania Hospital. Electives may be taken within the University of Pennsylvania Health System, which includes the Hospital of the University of Pennsylvania, Presbyterian Medical Center and the Veterans Affairs Medical Center. Electives in other cities or in foreign countries, which present unique educational opportunities, may also be taken.

The PGY-2 schedule includes:

  • four months on inpatient general medicine services
  • two months in critical care
  • three months in electives
  • one month night float
  • one month on medical consult service
  • two-week Neurology, two-week swing shift

The PGY-3 schedule includes:

  • four months on inpatient general medicine services
  • one month ambulatory block rotation
  • four months in electives
  • one month Evidence Based Medicine/Clinic
  • One month of critical care
  • One month inpatient Geriatrics

Clinics

Ambulatory Educational Program

Increasingly, the care of internal medicine patients occurs predominantly in the outpatient setting. In keeping with the shifting emphasis toward outpatient care, ambulatory education is an integral part of the internal medicine residency program at Pennsylvania Hospital.

The ambulatory curriculum is centered around ambulatory blocks spread out during the three years, and a continuity clinic experience which begins in the first year and continues throughout the residency. Residents are exposed to a broad variety of patients under close supervision of faculty with expertise in primary care and preventive medicine.

Continuity Medical Clinics

The core of the ambulatory teaching program takes place in the residency medical practice, the J. Edwin Wood Clinic, located on the hospital campus. Residents build their panel of patients during their three years in the program, seeing patients one half-day session per week over the three years. Residents independently manage their patients with supervision by a faculty member. The experience is organized to provide a supportive environment in which to learn outpatient medicine; support personnel including mid-level practitioners, medical assistants, and a full-time social worker all assist resident physicians in providing quality medical care.

Enthusiastic general internal medicine faculty preceptors are present, with a faculty-resident ratio of 1:4 or less. A full-time medical director of the clinic helps to ensure a rich learning experience. A 45-minute didactic conference on an ambulatory topic is presented on a daily basis by the general medicine faculty.

Ambulatory Block Rotations

Categorical residents have several month-long ambulatory blocks during their training to give each resident focused time in outpatient settings while freed from inpatient responsibilities. Clinical sites for these rotations can be tailored to meet the educational objectives of each resident.

J. Edwin Wood Clinic

During the internship year, each resident spends one month full-time in the Wood Clinic. The focus during this month is on acute/urgent care; interns see a broad range of acute ambulatory problems. Procedural skills, such as the GYN exam, arthrocentesis, and microscopic examination of various body fluids are learned. Housestaff attend four half-day clinics per month exclusively devoted to the outpatient management of patients with HIV infection. This valuable learning experience serves as an introduction to HAART and the diagnosis and management of opportunistic infection in this patient population. A structured curriculum of ambulatory topics is covered during the month, including a written syllabus and daily conference.

During their senior year residents rotate for an additional month at the Wood Clinic. The focus is on ambulatory preoperative evaluation of clinic patients scheduled for surgery as well as polishing skills in outpatient medicine. In addition, during this rotation residents spend a half-day per week in ENT, ophthalmology and dermatology. These are clinical experiences allowing the House officer to become familiar with those aspects of care in each specialty area that can be diagnosed and managed by a general Internist and those that should be referred to other specialties.

Our faculty in General Internal Medicine welcomes residents into their practices for month-long blocks, further preparing residents for careers in primary care. In addition to learning outpatient medicine, the residents will develop practice management skills preparing them for their careers after residency.

Geriatrics

During the third year, each house officer completes one month in Geriatrics at Penn Presbyterian Medical Center. The hospital is located on the main campus of the University of Pennsylvania at 38th and Market.  All of your time will be in the ACE Unit which is supervised by faculty from the Penn Department of Geriatrics. The unit is an experienced, multi-disciplinary unit providing specialized, comprehensive care for the elderly. Rotating through the ACE Unit allows residents to learn and interact with Penn geriatrics faculty, fellows, residents, medical students, therapists, nurses and social workers to provide focused care and create a comfortable environment dedicated to the unique needs of elderly patients and their families. 

Outpatient Subspecialty Clinics

As a teaching institution with variety of training programs, unique opportunities exist to participate in subspecialty clinics. Internal medicine residents may elect time in outpatient clinics such as dermatology, otorhinolaryngology, gynecology/family planning, gastroenterology, rheumatology, endocrinology and neurology.


Section Overviews

Allergy and Immunology

The Section on Allergy and Immunology is active in patient care, teaching and clinical research. Housestaff conferences are presented during the year to provide background in clinical immunology. Electives are available which primarily serve outpatients in areas such as assessment and treatment of asthma, allergic and all types of non-allergic rhinitis; sinus disease; nasal polyp disease; insect sting allergy; urticaria; immunodeficiency (primarily humoral); food allergy; and anaphylaxis.

Cardiovascular Diseases

The Section on Cardiovascular Diseases offers a full range of services including an active Coronary Care Unit, a Cardiac Step-Down Unit, and Outpatient clinics. The Non-invasive Imaging Program includes Transthoracic Echocardiography, Transesophageal Echocardiography, Stress Echocardiography, and Dobutamine Echocardiography.

A range of nuclear cardiology techniques is offered by the Radiology Department. The Coronary Intervention Program includes diagnostic Cardiac Catheterization and Percutaneous Transluminal Coronary Angioplasty Techniques including conventional Balloon Angioplasty, Coronary Stent Placement, and Rotational Atherectomy. The Electrophysiology Program includes Diagnostic Electrophysiologic Studies, Radio Frequency Ablation, and Device Implantation. The Section includes a busy Cardiac Rehabilitation Program as well as a risk factor intervention program. Residents are welcome to participate in Cardiology Electives which would include exposure to any and all of these areas.

Critical Care Units

Residents rotate in the cardiac care and intensive care units. To maximize the learning experience, comprehensive teaching rounds are held daily with both a full-time pulmonary-critical care specialist and a cardiologist. Residents are actively involved in treating patients with acute myocardial infarction and other ischemic syndromes, congestive heart failure, cardiogenic shock, rhythm disorders, sepsis, and acute respiratory failure from a myriad of causes.

Emergency Department

Approximately 80% of the patients on the medical services are admitted through the hospital's emergency department where 26,000 patients are evaluated and treated annually. The diverse patient population provides an excellent mix of disease entities for housestaff training. Interns are responsible for evaluating all patients under the direct supervision of full time attending faculty.

Diabetes and Endocrinology

The Section on Diabetes and Endocrinology offers residents an opportunity to develop skills in evaluating and treating patients with pituitary, adrenal, gonadal, pancreatic, bone, parathyroid and thyroid disorders. In addition to this training, an endocrine elective allows residents the opportunity to evaluate every variety of endocrine problems while learning the intricacies of endocrine testing and the use of such techniques as fine needle aspiration of thyroid nodules. Monthly conferences help crystallize this knowledge, which include morning report cases and interactive didactic talks covering the full range of diseases in adult Endocrinology.

Gastroenterology

The section's endoscopy laboratory and facility has four fully staffed procedure rooms and offers the latest video equipment to facilitate observation, learning and teaching.   Interns and residents are provided the opportunity to learn basic endoscopic procedures under the direction of staff physicians. Residents will participate on the inpatient consultation team as well as see patients in the outpatient faculty practice.

General Medicine

Residents acquire in-depth experience in general internal medicine during the ambulatory and inpatient rotations. Four of the 8 inpatient floors are led by a hospitalist attending. These faculty members are talented clinician educators who provide high quality, academic teaching rounds. The hospitalist oversees a resident, 1-2 interns and medical students from the Perelman School of Medicine at the University of Pennsylvania, Philadelphia College of Osteopathic Medicine and The Royal College of Surgeons in Ireland.  Each team demonstrates a multidisciplinary approach involving pharmacists, nurses, and social workers. House staff also have ample opportunity to teach junior members of this diverse team. In addition to the general medicine faculty, specialists serve as outstanding role models for the house staff and provide advice and mentoring for career goals.

Hematology and Oncology

The section of Hematology and Medical Oncology treats patients with a variety of hematologic and oncologic problems. Residents will participate with the inpatient consultation team as well as with staff in the outpatient area. Hematologic training will include exposure to the evaluation and treatment of cytopenias, coagulation disorders, and hematologic malignancies, including the use of high dose chemotherapy with peripheral stem cell transplantation. There will also be instruction in the interpretation of morphology of the peripheral blood and bone marrow. Pennsylvania Hospital hematologists are actively involved in the Center for Bloodless Medicine and Surgery, which provides a unique opportunity to manage complex hematologic and general medical issues in this patient population who choose not to receive blood product transfusion.

Extensive exposure to general medical oncology will be provided. Aspects of care for patients with solid tumors will include instruction in the diagnosis, staging and treatment of common malignancies. Residents will learn general principles for treating cancer-related complications including management of symptomatic metastatic disease, infectious and metabolic complications, pain management and palliative care. Multiple site specific Tumor Boards are held each week for multidisciplinary treatment planning for patients with cancers of the head and neck, breast, lung, gastrointestinal tract, bone and soft tissues.

Pennsylvania Hospital's Joan A. Karnell Cancer Center is actively involved in a wide variety of clinical research protocols with the University of Pennsylvania Cancer Center, the Eastern Cooperative Oncology Group, and many pharmaceutical trials, so residents may be exposed to principles and procedures involved in the design and performance of clinical trials.

Infectious Diseases

Residents rotating in the ID elective are exposed to a broad range of learning experiences because of Pennsylvania Hospital's diverse patient population. Infections routinely treated at the hospital include those requiring or resulting from surgery; special infection problems related to high-risk obstetrical patients and patients with total joint replacement; immune deficiency from malignancy or chemotherapy; and patients with AIDS. In addition, residents work closely with patients who have fevers of unknown origin, unusual cases of endocarditis and other difficult treatment or diagnostic dilemmas.

All section members are actively involved in the teaching process and work closely with the residents at all levels of providing care. The section offers a specific elective for residents and medical students interested in infectious disease, and is very active in clinical research. House staff on this rotation can attend a weekly infectious disease conference at the Hospital of the University of Pennsylvania where the faculty and fellows discuss challenging cases in infectious disease.

Pulmonary Diseases and Critical Care Medicine

The Section on Pulmonary Diseases and Critical Care Medicine provides training on a wide variety of respiratory ailments including emphysema, asthma, bronchitis, pneumonia and lung cancer. Training in acute respiratory failure and critical care is emphasized. Residents also learn sophisticated pulmonary physiologic testing such as Pulmonary Function Tests (PFT) and Sleep Studies. The section has modern bronchoscopy facilities including laser bronchoscopy for both diagnosis and therapy. Faculty provide a comprehensive consultative service to the medical and surgical services of the hospital, and are responsible for medical directorship and supervision of the intensive care unit.

Renal Diseases and Hypertension

Residents work closely with section members to receive in-depth exposure to the diagnosis and care of patients with both acute and chronic renal disease and hypertension. Under proper supervision, residents actively care for acute medical and surgical patients, providing diagnostic consultation, patient management support and acute dialysis, including hemodialysis and peritoneal dialysis. In addition, residents are involved with therapeutic plasmapheresis for treating a variety of conditions including Guillain-Barre syndrome, myasthenia gravis, thrombotic thrombocytopenic purpura and hyperviscosity syndromes. A chronic outpatient dialysis unit provides hemodialysis therapy as well as a variety of ambulatory peritoneal dialysis and at-home peritoneal dialysis techniques.

Rheumatology

Members of the Section on Rheumatology evaluate common arthritic disorders as well as a broad array of other rheumatic conditions, especially as they pertain to general internal medicine. Since much of the care is delivered to outpatients, residents and medical students are encouraged to participate in the activities of the section's office practice. Daily rounds are also held on inpatients with staff attending physicians. A monthly rotation in rheumatology provides residents and students with knowledge in the following areas: extra-articular manifestations of rheumatic and other systemic diseases; differential diagnosis of rheumatic diseases, especially polyarthritis and monoarthritis; crystal-induced arthritides; connective tissue diseases and systemic vasculitides; regional rheumatic disorders such as bursitis, tendonitis, low back pain and spinal stenosis; interpretation of serologic testing, synovial fluid analysis and use of the polarizing microscope; radiographic features of bone and joint diseases; and use of anti-rheumatic agents.

The flexibility of the above experiences allows the house officer to tailor an inpatient and ambulatory educational program that suits their post-residency needs.


Work Hour Rules and Call Responsibilities

The Department of Medicine at Pennsylvania Hospital is in compliance with all ACGME work hour rules.  As of July 2011, there are no longer any overnight in house calls for ANY house officers.

There are 8 floor teams; 4 Hospitalist teams and 2 non-Hospitalist teams, a Cardiology team and a Hematology/Oncology team.

For the Hospitalist teams, there is a long call every 4th night until 9pm. The weekends for the Hospitalist teams include one golden, one black and 2 "grey" weekends (where you work one day and have one day off).

For the other 4 floor teams, all team members leave at 5:30 pm since there is no long day until 9pm.  Weekends for the Cardiology and Hematology/Oncology team include 2 black and 2 golden weekends. For the other 2 non Hospitalist floor teams, there are 4 "grey" weekends.

For the ICU, shift length varies between 8-14 hours. Each house officer will work 3 weeks of day shift, one week of night shift and have one black, one golden and 2 grey weekends.


Rounds and Conferences

A wide variety of conferences are held throughout the week, each with a different format and purpose to provide residents with diverse learning environments. A review of the weekly schedule follows. The highlight three  days a week  is morning report, a patient-based interactive conference led by a group of faculty members known for their prowess at teaching, and chosen by acclamation of the housestaff. Noon conferences on Monday, Wednesday and Friday are specialty conferences in Allergy and Immunology, Cardiology, Endocrinology, Gastroenterology, General Internal Medicine, Hematology and Oncology, Infectious Disease, Intensive Care, Pulmonary Diseases, Renal Diseases and Rheumatology. The curriculum for noon conference is designed to present a comprehensive syllabus of medicine in lecture format for the house-staff.

Medical Grand Rounds is the premier didactic conference of the week with visiting faculty presenting clinically relevant topics; many speakers function as "visiting professors" and spend several hours with the housestaff.

Journal Club is an evidence-based conference where residents and faculty members discuss key articles from the literature. The other Thursday Noon conference is a multidisciplinary conference. The format alternates weekly, including a clinicopathology conference (CPC), Morbidity and Mortality, and Infectious Disease Professor Rounds. This conference is attended not only by the medicine faculty and housestaff, but also the Radiology and Pathology faculty and housestaff. The cross-pollination among specialties that occurs at these conferences adds considerable breadth to the educational experience at Pennsylvania Hospital. Attending Rounds with a senior staff member are held on all services. These teaching rounds are for a minimum of 4 - 1/2 hours per week and include bedside physical diagnosis.

Every Tuesday evening, 5:30 – 7 pm, there is Board Review in preparation for the ABIM certifying examination. This format involves review of MKSAP questions with faculty members.

The department also has subspecialty conferences which are on the schedule.

Conference Schedule

Monday

8:30 am

Attending Rounds

11:30 am

Morning Report

12:30 pm

Core Conference

Tuesday

8:30 am

Attending Rounds

Noon

Medical Grand Rounds

Wednesday

8:30 am

Attending Rounds

11:30 am

Morning Report

12:30 pm

Core Conference

Thursday

8:30 am

Attending Rounds

Noon

Multidisciplinary Conference/Journal Club

Friday

8:30 am

Attending Rounds

11:30 am

Morning Report

12:30 pm

Core Conference


Non-Teaching Service

To maximize the learning experience and to reduce stress and fatigue on residents, Pennsylvania Hospital maintains a non-teaching service. This service cares for patients with limited active medical issues. Residents do not round or write notes on these patients. By placing patients onto the appropriate service, residents are assured of an optimal learning experience.


Eligibility

Individuals are eligible to begin the medical residency upon completion of medical school.

How to Apply

We will only be accepting applications through the Electronic Residency Application Service (ERAS). Deadline for submitting applications is October 1st.

For additional information about the Internal Medicine residency training program, please contact:

Joy Robinson
Program Coordinator
jorobi@pahosp.com
215-829-5410
1-866-827-0413



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