Core clinical curriculum
Our program follows a 2-week block schedule for clinical rotations, and each house-officer rotates thought a variety of clinical settings to broaden their foundational training in Internal medicine. We follow an X+Y (6+2) curriculum, which allows for continuous longitudinal growth in primary care, and sets consistent resident diastole from inpatient services at least every 6 weeks. For preliminary interns, rather than Y blocks being spent in the primary care clinic, these are elective opportunities to explore an individual’s areas of interest.
Core clinical curriculum areas of interest
The J. Edwin Wood Practice is the primary care outpatient continuity practice for the Internal Medicine Residents. It is located an easy walking distance from Pennsylvania Hospital. Our residents care for patients in our community with multiple chronic conditions and complex social needs. Working as primary care physicians in their clinics, residents address chronic and acute medical issues, health maintenance topics, and social determinants of health. Residents manage a clinical team, including a social worker, clinical pharmacists, a lab, and support staff. The clinic also performs outpatient procedures such as Pap smears, wet mounts, joint injection and incision and drainages.
Outside of the Wood Practice, each resident has dedicated time from the Y schedule to explore our outpatient subspecialty clinics. Interns rotate through outpatient subspecialties such as Rheumatology, Endocrinology, Pulmonology, and Gastroenterology. Residents will be able to explore deeper topics in primary care, such as gynecology or sports medicine, or residents may develop a longitudinal relationship with an outpatient subspecialist in their fellowship of choice.
Residents rotate through the inpatient Cardiology Service learning in-depth management of patients with primary cardiovascular diseases. Patients on this service have conditions ranging from heart failure, to arrhythmias, or acute coronary syndromes. The service is staffed by a Cardiology attending who supervises a team of 1 resident and 2 interns; the attending runs daily teaching rounds, and hosts didactic sessions outside of rounds. Our Cardiovascular service may manage patients in the Cardiovascular Critical Care Unit, and those on the rotation may also have the opportunity to join procedures in the cardiac catheterization laboratory.
Our house-officers provide consultative services in Infectious Disease, Nephrology, and General Medicine. These consultative services allow our residents to change their perspective for complex cases and see management through a specialist’s eye. Additionally, particularly with the medicine consult service, our residents have the opportunity to co-manage patients on surgical and psychiatric services, again broadening our perspective on care within the hospital.
Approximately 80% of patients on the medical service are admitted through the Emergency Department, which highlights the need for our medical house-staff to understand the basics of Emergency Medicine. While on the Emergency Department rotation, residents gain a foundation in first-pass clinical decision making, rapidly-evolving care, procedures, and bedside ultrasound.
Residents acquire in-depth clinical training during the inpatient Hospitalist rotation, and our hospital’s broad case-mix provides the grounding for a well-rounded educational experience. Each team is led by a Hospitalist attending who provides high quality, daily academic teaching rounds. The Hospitalist oversees a resident, 2 interns and medical students from the Perelman School of Medicine of the University of Pennsylvania, The Philadelphia College of Osteopathic Medicine, the Royal College of Surgeons (Dublin, Ireland) and University College Dublin School of Medicine (Dublin, Ireland). Each team utilizes an interdisciplinary approach to patient care involving pharmacists, nurses, social workers, and case managers.
Third year residents complete dedicated inpatient geriatrics training in the Acute Care for Elderly (ACE) Unit at Penn-Presbyterian Medical Center. During this rotation, residents are exposed to a variety of unique medical and social issues commonly affecting our aging population. This rotation also provides our residents a unique opportunity to collaborate with residents from other internal medicine and family medicine programs within our health system.
Residents rotate through the inpatient Hematology and Oncology service where they have the opportunity to treat a variety of hematologic and oncologic problems, including the evaluation of patients with cytopenias, coagulation disorders, and hematological/oncological malignancies. Our inpatient Oncology services offer advanced treatment option such CAR-T and Bone Marrow Transplant. The service is staffed by an Oncology attending who supervises a team of 1 resident and 2 interns; the attending runs daily teaching rounds, and hosts didactic sessions outside of rounds. Lastly, Pennsylvania Hospital is also home to the Center for Transfusion-Free Medicine, and our inpatient Hematology service will often treat who do not accept blood products and require specialized care to support an acute anemia.
Consistently rated as one of the best rotations in the program, our MICU rotation includes a broad range of critical care exposure, and allows residents the autonomy to grow their clinical judgement. In addition to advanced problem-solving, residents also learn and execute many bedside procedures, including central line and arterial line placements, dialysis catheter placement, thoracenteses and paracenteses.
Third year residents rotate on our hospital’s Neurology service where they are exposed to the management of primary neurologic conditions and participate in stroke alerts in the Emergency Room. During this time, our residents also visit the movement disorders outpatient clinic.
Electives
Electives are each resident’s opportunity to explore medicine, discover their interests, and build the skills necessary for the next steps in their career. We offer a variety of electives ranging from Cardiology consults to electrophysiology, Palliative Care, POCUS, and board preparation. Our residents also have the opportunity to participate in electives at the Hospital of the University of Pennsylvania if they would like to broaden their clinical exposure to unique specialties like lung transplant. Lastly, each house officer is entitled to 1 month of vacation per academic year, and part of this vacation is selected by the house-officer from their elective time.
Didactic curriculum
Our program has two main curricular venues – a fully protected academic half day on Tuesday mornings and a traditional noon conference. The academic half day is time taken during the clinic blocks (for categorical interns) or electives (for preliminary interns). Each curricular venue includes the following components:
Noon conferences
Through the summer, all noon conferences are dedicated to getting the new intern class up to speed on high priority topics. Each section in the department presents how to approach the most common emergencies relevant to their field such as DKA, ARDS, ACS, and Neutropenic Fever. This is one of the most highly regarded curricula in the program and supports our interns as they grow into their new roles.
This conference series is a discussion of an unknown case presented by the senior residents. The resident, with faculty mentorship, will review the case and present a differential diagnosis and discussion of the final diagnosis.
This is a department-wide lecture series where national leaders present innovative topics relevant to internal medicine.
Junior residents pose a challenging clinical question from their clinical experiences and present how they digested clinical guidelines and/or literature to develop an appropriate plan of care.
On Wednesday’s, residents and interns present active cases on their service, and attending physicians teach on high priority clinical topics relevant to the cases.
This conference is presented monthly by senior residents. In this talk, a resident presents a case that highlights a weakness in our system that led to an undesirable outcome. These conferences allow for a multidisciplinary discussion amongst faculty and residents with the goal of identifying process-improvements that better our hospital’s clinical care.
Each month the program meets to discuss operational changes and upcoming events. Residents also have the opportunity to raise concerns or ask questions about ongoing initiatives.
Tuesday morning academic half day
Led by attending physicians, each section presents core topics relevant to the ABIM Board exam and our daily clinical practice. This curriculum spans two years such that, over the 3 years of training, there is a variety of talks, and a broad set of content is covered.
In this curriculum, two respected attendings lead writing and reflection exercises focused on helping residents process their experiences in training. This is a highly regarded and unique opportunity, and one which has become foundational to the Pennsy experience.
Woven into our Tuesday academic half day, we are glad to provide education on unique topics like Mock Code, POCUS, Financial Health, and Quality Improvement.