Chair
R.
Michael Buckley, MD
Program Director
Dennis
Policastro, MD
Associate Program Directors
Alison
Leff, DO
David
H. Henry, MD
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.
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. The research elective maybe 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.
Program Schedule The First Year
In cooperation with the National Resident Matching program,
Pennsylvania Hospital offers 23 first-year positions in internal
medicine. Ten positions are offered in the Categorical Three-Year-Internal
Medicine Program (C-16) and 13 positions in the Preliminary
One-Year Medicine Program (C-15). 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
half the programs graduates pursue careers in general internal
medicine, the other half join fellowship programs
for subspeciality training. For a list of the fellowship
training programs entered by our graduates, please see the
appendix.
The Preliminary Program, which has the same first year as
the Categorical Program, will lead into other specialty residencies
such as dermatology, neurology and ophthalmology.
A candidate may apply to either or both of these programs,
however, a separate application must be completed and submitted
for each program. Candidates applying to the Categorical Program
may rank both the C-16 and the C-15 (Medicine Preliminary)
on the rank order lists; however, candidates wishing to have
one year of training should rank C-15 only. Both programs are
approved by the Pennsylvania State Board of Medical Education
and Licensure and by the American Medical Association.
The first year is spent as follows:
* (3 months of electives for Preliminary Interns)
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 second year is spent as follows:
The third year is spent as follows:
During the three-year program, residents spend 34 percent
of their time in ambulatory rotations, including a weekly continuity
medical clinic, five ambulatory block rotations and the emergency
room. For residents interested in practicing as a generalist
physician upon graduating from the program, the time spent
in ambulatory rotations can be increased to 50 percent by substituting
additional ambulatory block rotations for electives.
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. Each resident receives an ambulatory
care manual upon which the core curriculum is based.
Ambulatory Block Rotations
Categorical residents have five 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 basic suturing, are learned. Housestaff attend two halfday
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. A
CD-ROM
library is also available.
During their senior year residents rotate for an additional
month at the Wood Clinic. The focus is an 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 non-operative orthopedics. These are clinical experiences
allowing the Houseofficer to become familiar with those aspects
of care in each speciality 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.
Adolescent Medicine
During their training, residents may elect to rotate through
the University of Pennsylvania Student Health Service. This
valuable experience will allow the house officer to develop
the unique skills needed to care for this patient population
in a supervised environment.
Geriatrics
During their third year house officers completes a one month
rotation in a designated geriatrics unit. The Fountains
at Logan Square is located in Center City Philadelphia. This
rotation spans the spectrum of geriatrics experiences from outpatient
visits to assisted living patients and rounds on inpatient floors. During
the rotation, the house officer will also get the opportunity
to work with an audiologist, a physiatrist, a podiatrist and
ophthalmologist who also serve the geriatric population at the
Fountains. There is a weekly interdisciplinary skin care
conference and home visit program which the resident will have
the opportunity to participate in.
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
in the region's only fully digital Lab.
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 half the patients on the medical services are
admitted through the hospital's emergency department where
24,000 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, focusing specifically on thyroid disease concepts.
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,
residents and fellows 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.
The gastrointestinal clinic is staffed by fellows as well as
staff physicians. During clinic time, interns and residents
have the opportunity to learn how to perform flexible sigmoidoscopy
procedures on their patients under proper supervision of fellows
and staff gastroenterologists.
The section is currently involved in several research programs
dealing with biliary manometry, Endoscopic Retrograde Cholangio-Pancreatography
(ERCP), and a clinical trial on altering the natural history
of Barrett's esophagitis.
General Medicine
Internists within the Section on General Medicine are actively
engaged in clinical practice and education. The section's members
serve as teaching attendings on inpatient units, consult services
and in the medical clinic. In addition to providing training,
section members also serve as advisors and preceptors.
Residents
acquire in-depth experience in general internal medicine during
the ambulatory care and inpatient rotations. Residents are
exposed throughout the three-year curriculum to a unique blend
of learning experiences such as medical ethics, medical economics,
geriatrics, occupational health, and sports medicine.
Sports Medicine Fellowship
This one-year, ACGME accredited fellowship is led by the
Program Director for Sports Medicine, Gary
W. Dorshimer, MD and
coordinated
with Arthur
R. Bartolozzi, MD, Chief of Sports Medicine in
the Department of Orthopaedics. Graduates of three-year residencies
are eligible to apply. Heavy emphasis on the muscoskeletal
system and evaluation and non-operative treatment of sports
injuries is complemented by a broad overview of medical aspects
of care for athletes.
Clinical Exposure is extensive, including
care of adolescent and adult athletes at amateur, college
and professional levels of sports. At least one research project
is required during the fellowship year. The Internal Medicine-Sports
Medicine Fellow will be actively involved in the teaching of
muscoskeletal and sports medicine topics to the medical
housestaff through didactic sessions,
training room experiences and serving as a preceptor at a monthly sports
medicine clinic in the Wood Clinic. Upon completion of the
fellowship, the graduate
will be eligible to take the Board Examination in Sports Medicine.
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. Currently, inpatient
and outpatient studies on new therapies for a variety of infections
are being conducted including national multi-center drug trials.
Housestaff 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 allow the house officer to tailor an inpatient
and ambulatory educational program that suits their post-residency
needs.
Call Responsibilities
Overnight on-call responsibilities occur every 12th night
for interns on inpatient floors. When staying overnight, interns
leave the next day by 1:30 pm. In the intensive care unit night
call is every fourth night for interns. There is no night call
on elective or outpatient rotations. Senior residents on inpatient
floors are relieved by the night float resident at 9:30 pm
and therefore do no overnight calls. To ensure the maximum
learning experience when on overnight call, house officers
continue to follow all patients they have admitted. To further
reduce workload and stress when on call, a night float provides
all cross coverage for those patients not on the admitting
team's service.
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 of each day 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 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. The department also has subspecialty conferences which
are on the schedule.
Conference Schedule
| Monday |
7:30 am
|
Work Rounds
|
|
9:00 am
|
Attending Rounds
|
|
11:00 am
|
Morning Report
|
|
Noon
|
Noon Conference
|
|
3:00 pm
|
Pulmonary Case Conference
|
| Tuesday |
7:30 am
|
Work Rounds
|
|
9:00 am
|
Attending Rounds
|
|
11:00 am
|
Morning Report
|
|
Noon
|
Medical Grand Rounds
|
|
4:00 pm
|
Interdisciplinary Breast Conference
|
| Wednesday |
7:30 am
|
Work Rounds
|
|
9:00 am
|
Attending Rounds
|
|
11:00 am
|
Morning Report
|
|
Noon
|
Noon Conference
|
| Thursday |
7:00 am
|
GI/Surgery Conference
|
|
8:00 am
|
Work Rounds
|
|
9:00 am
|
Attending Rounds
|
|
11:00 am
|
Morning Report
|
|
Noon
|
Multidisciplinary Conference
|
| Friday |
7:30 am
|
Work Rounds
|
|
9:00 am
|
Attending Rounds
|
|
11:00 am
|
Journal Club
|
|
Noon
|
Noon 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). ERAS can be contacted
through your medical school's Dean's Office. International
Medical Graduates must use the ECFMG as their Dean's office.
Applications through ERAS will be accepted starting mid-August
with a deadline of January 1st.
Documents which must be submitted through ERAS include:
For additional information about the Internal Medicine residency
training program please contact:
Dennis
Policastro, MD
Residency Program Director
Department of Medicine
Pennsylvania Hospital
800 Spruce Street
Philadelphia, PA 19107
Telephone: 1-866-872-0413
E-mail: jorobi@pahosp.com
See also: List of Fellowships obtained by Graduates
of Pennsylvania Hospital Internal Medicine Residency Program
(by years)
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