General Information
How many PGY-1 positions are available?
There are 44 Categorical, 6 Physician Scientist, 6 Primary Care, 6 Medicine-Pediatrics, 1 Medicine-Dermatology, and 14 Preliminary Year (10 Neuro, 4 Radiation Oncology) positions.
Where do interns come from?
Our house staff come from all over – the current group of residents & interns represents over 50 different medical schools from around the country.
By what criteria are house staff selected?
Our program is built on a shared commitment to outstanding patient care and the desire to nurture the careers of an exceptional group of young physicians. Our primary goal is to identify a group of interns who will be valued team members and additions to the Penn family. We look for applicants who value professionalism and teamwork, and who are eager to embrace increasing amounts of patient care responsibility. Our residents have a strong academic record and a wide range of interests with excellent academic potential.
What types of communication devices are used?
All house staff receive iPhones provided by the residency program. These come loaded with software designed to help access important systems at Penn, including PennChart (our local EPIC), Carelign (a sign out & cross-cover app), and HIPAA compliant texting apps.
What is the 6+2 scheduling model?
6+2 is a block scheduling system that applies to all of our interns, as well as our categorical residents. These house staff spend up to 6 weeks in a row on inpatient services, followed by 2 weeks in the ambulatory setting (called Interactive Learning Modules (ILMs)). This system simplifies scheduling, makes it predictable, avoids burnout, and separates inpatient from outpatient responsibilities. We feel that it increases house staff camaraderie by creating cohorts that travel through the year together. It helps ensure outpatient continuity by making our resident providers available to their patients at regular intervals. Additionally, the regularly scheduled break from more intense inpatient rotations helps to mitigate fatigue and burnout.
Where does clinical training take place?
Our inpatient experiences are based at three hospitals, all within about a mile of one another. They are: The Hospital of the University of Pennsylvania (HUP), The Corporal Michael J. Crescenz Philadelphia Veterans Affairs Medical Center (PVAMC), and the Penn Presbyterian Medical Center (PPMC). Each site has a dedicated faculty site director and a Chief Resident.
Our residents see their own panel of patients within integrated faculty-resident outpatient practices. They are supervised by and develop longitudinal relationships with experienced faculty.
How much time do I spend at each site as a PGY1?
HUP: 8 - 10 months
PVAMC: 1 - 2 months
PPMC: 1 - 2 months
What is the program's approach to duty hour management?
The program takes adherence to the duty hour standards very seriously, and encourages open and honest reporting. All schedules have been designed to promote full compliance. House staff are expected to log their duty hours in MedHub – the institutional GME management system. The program can generate reports by rotations and promptly address any violations.
What is the breakdown of rotations?
Preliminary interns are not required to participate in the ILM curriculum, and typically opt to use most of this time as elective. Some preliminary interns are required to use a small portion of this time for other non-call rotations, as determined by their future programs.
(all numbers represent averages that may vary by 2-4 weeks)
What are the basic team structures on ward rotations?
Our program has a number of different rotation structures, each designed to take maximal advantage of rotation-specific and site-specific factors.
On general medicine services at PPMC, a team is made up of 1 resident and 2 interns. Teams take traditional “long call” together in an extended 24+4 hour shift, with just one of the interns staying overnight with the on-call resident. Interns alternate roles from one call to the next: one intern stays overnight, while the other goes home overnight and returns the next day to round and cover the team post-call. An additional day float intern is brought in to cover the other half of the team.
Night float residents at PPMC arrive in the evening to admit in the overnight hours and allow the long call teams to have time to finish comprehensive admission workups. General medicine services at PPMC have an intern cap of 9, and a team cap of 18. Bedside rounding is emphasized, as are multi-disciplinary rounds.
On the general medicine service at HUP – the Martin service – a team is also made up of 1 resident and 2 interns. The Martin service has an intern cap of 8 and a team cap of 16, but admitting is in a ‘drip’ model. Each team can take a total of 5 patients daily for 4 of the 5 days of their call cycle – this includes night float admissions. On the fifth day, the team is either off or has no admissions. Day off coverage is provided by a day float team consisting of one resident and one intern. The Martin teams admit during the day, and a night float team (2 residents, 2 interns) provides overnight admitting and cross-cover.
On the specialty services at HUP (solid and liquid oncology, infectious diseases, pulmonary, gastroenterology), all residents and interns are on day or night shifts with a maximum of 13 hours of consecutive duty. Liquid oncology teams are made up of 1 resident and 2 interns with team caps of 16, while the other services all have 1 resident and 1 intern per team (2 teams each on pulmonary and gastroenterology) with team caps of 10 per resident-intern duo. The teams alternate days with admitting duties. Overnight admissions and cross-cover are by night float teams.
When are my days off?
All house staff get at least 1 day off in 7 when averaged over a rotation. These days off are preset in the online schedule such that house staff know their days off many months in advance
How is sick call handled?
The program is fully committed to providing prompt coverage for residents who are sick or who have urgent personal or family needs. There are residents assigned as the primary full-time ‘jeopardy’ residents, able to cover for the majority of unanticipated needs. A small fraction (about 1/5) of residents on elective are also designated for “jeopardy” coverage for 1 of their 2 weeks on elective. These residents carry on with normally scheduled elective activities unless needed for urgent coverage.
How does the program teach quality improvement?
Quality Improvement (QI) is taught through a variety of curricular activities. All residents receive clinical data about their own panel of outpatients in semi-annual face-to-face feedback sessions with a clinic preceptor. This resident-specific and practice-specific data helps residents and faculty generate action plans and learning objectives for the upcoming half-year.
All PGY2 residents participate in a team-based longitudinal QI project. They learn QI principles and tools in an experiential manner by working on real problems that impact the quality of patient care within the residency program or department. Each PGY-2 cohort is supervised by a member of the faculty who has expertise in QI. Residents have the opportunity to participate in scholarship related to the project.
Does the program have a patient safety curriculum?
Yes. We have a robust curriculum that begins in the intern year. All interns participate in a two-hour interactive curriculum which teaches practical skills related to patient safety event reporting and root cause analysis of safety events at Penn Medicine. We also have a recurring case-based noon conference which is led by residents and faculty and focuses on patient safety themes or specific safety events. All residents learn and discuss adverse event disclosure skills in their PGY 2 or PGY 3 year.
What are the required ambulatory rotations (ILM’s)?
During intern year there are 12 weeks of ambulatory rotations divided into 2-week Interactive Learning Modules (ILMs) which are theme-based and firm rotations. Individual block themes are focused in general medicine and subspecialty areas while broader longitudinal themes span the curriculum throughout the year. This structure allows interns to focus their learning on specific, high-yield topics that are led by faculty experts in diverse areas of medicine.
Highlights of the ILM's include:
- A standardized curriculum of interactive talks and seminars on physical diagnosis, screening and prevention, common outpatient illnesses, along with topics in professionalism, ethics, safety and wellness.
- Pre-selected high-yield and landmark literature related to the ILM's theme.
- Selected clinics and individual time with faculty in medical subspecialties.
- An increased amount of time building a patient panel in continuity practices.
- Simulated training in procedures at the Penn Simulation Center.
- Standardized patient experience to improve communication skills.
Firm Rotations: Each PGY 1 and 2 has two, and each PGY 3 has one required firm rotation designed to solidify their ambulatory skills. The experience is designed to provide an immersion in their outpatient practice with a focus on in-depth attention to their primary patient panel, acute outpatient medicine, phone triage and quality improvement.
Each resident on the firm rotation will participate in team-based care including:
- Phone Medicine:
- A core curriculum in phone medicine is reviewed, and the firm attending does daily reviews with each resident to insure comfort and facility with phone management of medical issues.
- Panel Management:
- Discuss and implement initiatives to manage chronic diseases or health maintenance at the resident panel level
- Post Acute Care Clinic (PACC):
- Patients of the practice are seen in this clinic by an interdisciplinary team (residents, pharmacists, and social workers) to help the transition after they are discharged from the hospital. Residents on this rotation review key elements in safe transitions of care.
Are there ILMs at the PGY2 and PGY3 Level?
Yes. The implementation of our innovative theme-based curriculum has been met with much positive feedback. This has led us to expand the 2-week ILM’s to the rest of the residency program. The format is similar to the intern ILM’s but the themes are skill-based rather than subspecialty-based. Areas of focus at the PGY2 level include communication skills, academic development, quality & value, evidence-based medicine, and medical education. Residents go to one academic half-day per week while on their ILM block where they participate in interactive talks focusing on the themes above. In addition to the focus on these skill-based themes, we have a 2-year curriculum that includes additional teaching from subspecialty experts on topics not covered in the intern year or on inpatient rotations. In addition to having ILMs every 6 weeks, residents have additional elective time.
Is there flexibility in choosing how elective time is spent?
Yes. Our goal is to provide all house staff with sufficient flexibility to explore and develop their future careers while providing a robust base curriculum that all internists need. At the PGY2 level, residents are able to focus elective time in potential areas of career interest, which allows for easier career decision-making. Additionally, this provides extra time for resident to get to know faculty in their area of interest. At the PGY3 level, our residents create an Individualized Learning Plan (ILP). This allows our residents a large amount of flexibility, with the goal of making elective time most useful for each resident’s career development. They are able to choose how they spend their elective time including: the selection of a “longitudinal preceptor,” with whom they can schedule regular attendance in his or her outpatient practice; reserved time to develop and implement research projects; the choice of inpatient and outpatient electives; and reserved time for board preparation.
How often do I work in the Emergency Department?
Each PGY1 resident spends 2 weeks in the HUP ED. Experiences on this rotation range from low-intensity urgent care up to critical care and resuscitation.
How will I eat?
Residents receive credit at hospital cafeterias for inpatient rotations. In addition, lunch is served at Resident Report, Intern Report, Ambulatory Report, and Grand Rounds.
Are white coats available?
Free laundering and simple tailoring (mending) is available through the department. We provide 3 white coats; 2 in intern year and another one in 2nd year.
What Retirement Benefits are available to residents?
An employer (UPHS) non-elective contribution of 4% of your salary will be made annually on your behalf once the initial eligibility period ti satisfied (Internal Medicine Residents who start as interns and complete 3 years of training here meet eligibility).
UPHS will also match any contribution residents make (up to legally allowable limits) to your 403(b) account up to 2.5% of your salary.
Does the program support professional society membership and Step 3 costs?
Yes. The program pays for an Associate level membership for all senior residents to the American College of Physicians. The program buys MKSAP for all senior residents. In addition, the program will reimburse the cost for Step 3.
What do most of your residents do after completing the program?
A large portion of our residents go on to train in a subspecialty fellowship, including general medicine fellowships. Increasingly, we are seeing more of our residents enter general medicine practice.
Hospital Sites and Continuity Clinics
Are there non-house staff covered patients?
Yes. There are non-house staff services at HUP in general medicine, cardiology and oncology. The total number of patients managed by non-house staff services is about 120/day. Recent health system investment in non-house staff services has helped our program maintain an appropriate balance of volume and educational opportunity on our services.
What is the patient mix?
HUP serves a diverse patient population that varies somewhat by service. On many ward medicine services, quite a few of our patients come from the surrounding West Philadelphia and University City areas, which comprise a very diverse urban population. Our more specialized services also care for the local community while simultaneously drawing referrals from the region of the Delaware Valley and many states in the Mid-Atlantic region.
Are there private attendings?
No. Each teaching service has 1-2 attendings for each 2-week block. For example, the infectious diseases division has 1 faculty member on the primary house staff service for each 2-week block. Any infectious diseases attending who admits a patient will admit to that attending and service. Thus, there is only 1 infectious diseases attending for all infectious diseases admissions.
What are the hospitalist services?
We have had hospitalists since 1999. They staff some of the general medicine services at PPMC and the PVAMC, and at HUP they staff the Martin Service – named after a beloved former Program Director at Penn. All unassigned admissions and admissions from many of the Penn Medicine general medicine practices come to these services. These individuals are the teaching attendings as well as the attendings of record for their services.
Our program is fully committed to a rigorous training experience that fits within the duty hour regulations. The past few years have seen a significant expansion of support systems, a few of which are:
• Web-based patient identification and sign out system.
• 24-hour blood culture and phlebotomy services.
• Dedicated clerical support to make post discharge appointments and obtain outside hospital records.
• Telemetry transport services.
• Ultrasound-guided IV placement team
• PICC placement team
Where is the VA Hospital located?
An 8-minute walk across campus from HUP, on University Avenue.
How much time will I be spending there?
On average, each intern and resident spends 1 month per year at the VA.
What is the structure of the VA service?
The inpatient service at the VA was remodeled in July 2012 to be the site of our Intensive Teaching Service. The experience has been designed to optimize the resident’s opportunity to teach and supervise students. A teaching curriculum is embedded in this rotation with the goals of enhancing bedside teaching, feedback and evaluation. The VA team structure consists of 4 medicine teams, each with an attending, 1 resident, 2 sub-interns (or 1 resident and 1 intern during the months without sub-interns), and a clerkship student. Each team takes extended long call every fourth day, and is capped at 10 patients.
Where is PPMC?
A 15-minute walk through campus from HUP.
How much time will I spend there?
Approximately 1-2 months per year.
What teaching services are at PPMC?
General Medicine, Acute Care for Elderly (ACE), and Cardiology Care Unit (CCU). All attendings are Penn Medicine faculty, including many outstanding Penn general internal medicine physicians on the general medicine service who also attend in the office practices.
Are there non-house staff covered patients?
Yes; there is a large non-teaching service for peri-procedure Cardiology patients and for private specialty and general medicine admissions.
Where will I practice?
House staff practice in groups at one of three sites: PVAMC, 3701 Market Street or Penn Center for Primary Care. You will practice as a member of your firm for all three years.
When will I have outpatient office hours?
There are no outpatient practice responsibilities during inpatient clinical rotations. This allows house staff to focus on inpatient care while simultaneously enhancing the outpatient experience when it takes place. Interns on ILM have 3 office sessions (half days) every week, with a few extra when on an immersion (or ‘firm’) rotation. Residents on ILM also have 3 office sessions weekly, while those on elective have 1 session weekly in order to support a more in depth experience for the elective rotations. Residents who are considering primarily outpatient-based careers have the option to do more outpatient clinic time
What is the faculty preceptor to resident ratio in the office practice?
At most the faculty preceptor to resident ratio is 1:3, though it is often 1:2.
What is a firm? And a Resident Care Team (RCT)?
Those residents that practice at 3701 Market Street belong to one of 4 firms that are run by a faculty firm chief with 2-3 core faculty preceptors. Each resident has their own panel of patients within the practice that they keep throughout the three years of residency. Each resident is part of a longitudinal RCT (within the larger firms) along with 3 other residents and a longitudinal preceptor. When a resident is on ILM, they cover the patients belonging to their RCT colleagues, all of whom are also known to the longitudinal preceptor.
Mentoring and Wellness
Is there career counseling?
Yes, there is extensive counseling by the Program Director, Chair and Division Chiefs of each subspecialty. There are also identified faculty in each division for this purpose. Residents get help with preparing their CV's and personal statements.
All residents are assigned a "Program Mentor" as soon as you start the program. The Program Mentor is an Associate Program Director or Core Faculty with close knowledge of the residency program. Through the early part of internship, they help to guide your clinical development and focus on maintaining wellness. After interns have adjusted to their new roles, they start having conversations with their Program Mentor about career interests, and the Program Mentors introduce them to other faculty in their areas of interest who can serve as clinical and academic mentors. This mentorship team - the Program Mentor, clinical mentors, academic mentors, and the Program Director - all help guide residents on the path towards their next career step.
Is there a Wellness Program?
Absolutely – there is an extensive and ever-growing wellness program here. Our program recognizes the stresses of residency and is fully committed to supporting house staff through both successes and challenges that come during the training process.
We are excited to note that we recently built a cozy Wellness Room at HUP that is used by our residents exclusively as a peaceful site for reflection. The Wellness Room also has a coffeemaker and healthy snacks. This past year, our wellness program has expanded even further, coordinating events like happy hours, exercise, group trips and more outside the hospital. There are now various Social Clubs that housestaff can join and each club has a certain amount of money which they can use throughout the year for their activities.
Now in its 4th year, there is also a longitudinal Resilience Curriculum for interns. The goals of these sessions, which are distributed longitudinally throughout intern year, delivered during each ILM block, are to provide safe space for interns to process the challenges and successes of their year; highlight various evidence-based physician wellbeing strategies (e.g. Mindfulness, Finding Meaning, Positive Psychology); and normalize a multi-modal approach to self-care (physical, emotional and spiritual) as an expectation of residency training and beyond. A new session developed by the wellness committee in 2016 features a facilitated “standardized participant” workshop that helps rising second years recognize and address burnout in peers and learn team management techniques to prepare them for their new role as team leaders. This past year, these sessions were extended into to 2nd and 3rd year ILM blocks. The wellness committee also organizes skills-building content for the retreats which interns and residents participate in during the year.
Lastly, we’d like to highlight the philosophy of our residency program: we very much recognize that the wellbeing of each physician is a shared responsibility. The greater US medical system, the UPHS health system, the residency program itself and each of us as individuals contribute to our own wellbeing. Many of this residency program’s leadership are working at the national level to bring about much needed change. At the program-level, our mission is to support each member of our community to thrive, not just survive, residency. The wellness committee, through the Resilience Curriculum and beyond, seeks to provide each individual with wellbeing strategies to implement for themselves and to encourage each of us to be active participants in our health and wellness.