The Primary Care Program curriculum is shaped by the following principles and values:
- Primary care internists must be well trained in all venues of general internal medicine to lead complex and chronic care management.
- A dedication to our community, health equity and advocacy for our patients.
- An environment that promotes coaching, continuous feedback, and lifelong learning with expert mentorship.
The Primary Care residency is comprised of clinical rotations, outpatient experiences, specialty practice opportunities and dedicated seminars and conferences. Clinical rotations are carefully chosen so as to contribute to the education of well-rounded general internists. The following is a brief explanation of the schedule for each year:
Will I miss out on anything by joining the primary care program?
No!
We are a smaller family within the larger Penn IM program. Inpatient
time and rotations between both programs are the same. We provide more
flexibility with a mix of 2 week full elective blocks and longitudinal
elective that is spread out throughout your ambulatory time. This is to
ensure you become an outstanding outpatinet clinician with longer
stretches of ambulatory time for building patient continutiy and
relationships with your own patients. Our outpatient curriculum is more
intensive and comprehensive as our goal is to created well rounded
physicians who can care for a broad spectrum of outpatient disease
processes for a complex and vulnerable patient care population in West
Philly. We have more built in didactics, small group, and experential
learning than the categorical program to support our LEADER’s curriculum
as well as more broad based outpatient care teaching. – Rani
Nandiawda, MD MSEd (Program Director- but in case you don’t believe me
see below from one of our residents…)
Abby Schmucker, MD – Graduating PGY3:
“Primary care residents feel equally competent to their
categorical peers on inpatient rotations, and much more comfortable than
their categorical peers in the outpatient clinic. So, in my mind its
the best of both worlds. I have been really happy to find
support within the primary care program to pursue my career goal of
being a geriatrician. The schedule has allowed me the flexibility to
have a second clinic in geriatrics, as well as shadowing, mentoring, and
research experiences with geriatricians mixed into my outpatient
schedule. My primary care attendings have encouraged and taught me to be
a great generalist, and have helped me network to find more specialized
mentors and teachers within my field of interest.”
Internship (PGY-1)
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 work side by side with traditional track interns and rotate between all three inpatient sites: The Hospital of the University of Pennsylvania (HUP), Penn Presbyterian Medical Center (PPMC) and the Philadelphia VA Medical Center.
Both the Categorical and Primary Care interns are scheduled in a “6+2” format that allows for six weeks of inpatient rotations followed by two weeks on dedicated ambulatory time. This “block-scheduling” model allows dedicated time in each arena and decreases conflicts between inpatient and outpatient educational time. The two-week ambulatory blocks are spent increasing knowledge and skills in outpatient medicine.
In addition to expanded sessions in their continuity clinic, interns participate in a primary care specific seminar series and participate in a comprehensive program of direct observation and clinical coaching from good to great for all residents.
Junior Residency (PGY-2)
Residents are maintained in the block-scheduling pattern in a “4+4” format. In this model, residents alternate four week inpatient rotations with 4 weeks in the ambulatory setting. In addition to their continuity clinic in the Penn Center for Primary Care (PCPC), all primary care residents select a “second clinic site” in which they spend one half day a week for the next two years. These second clinics are community based clinics in which residents may practice HIV Primary Care, Latino Health, Geriatrics, indigent care at the Philadelphia City Health Centers, Refugee Health and care of patients with opioid use disorder. In addition, PGY-2 residents rotate through ambulatory specialties such as dermatology, musculoskeletal medicine, cardiology, endocrinology, geriatrics and community medicine. The amount of time spent in ambulatory training expands to five months of the year spent on outpatient rotations. Time is also available for residents to design their own clinical or research experiences. Junior residents have 2 weeks of dedicated elective time and elective time dispersed within each outpatient block to individualize their educational experience.
Senior Residency (PGY-3)
During the senior year, there is an increasing emphasis on ambulatory and primary care. PGY-3 residents continue in the “4+4” block scheduling model and have an increased amount of latitude to design and customize their ambulatory experience to include various clinical, administrative and research experiences. Residents also have an opportunity to teach in the “Introduction to Clinical Medicine” Course for the Penn medical students. Senior residents take a more active role in the didactic curriculum and also have the opportunity to function as “junior preceptors” to the interns in continuity clinic. This is also the time in residency when residents can expand their research portfolio and develop projects to improve the effectiveness of the care delivered at the PCPC and in the community. Senior residents have 2-3 half day sessions per week on their outpatient blocks to personalize their own curriculum as elective time. This time can be consolidated into full elective blocks to create individualized experiences based on their clinical and professional interests.
Your outpatient blocks have two dedicated half days focusing on developing a broad array of outpatient skills.
Curriculum Highlights
Community L.E.A.Ders (Leadership, Equity, Advocacy and Disparities) Curriculum
The Community LEADers curriculum is woven throughout the years with a dedicated half day each block focusing on skill development to better the health of our community. This includes experiences going out into the community for health education and advocacy in addition as well as a narrative medicine curriculum focusing on finding your voice as an advocate. Through this curriculum we have engaged with community leaders and the department of health to take a deep dive into social determinants of health, policy issues, and have done city wide trainings with Cease fire PA.
Subspecialty Series
As a future generalist one of the biggest skills is understanding your scope of practice and allowing yourself and consultants to all work at the top of their license. In this vein we have specialists come to reinforce foundational skills as well as a monthly Chat with a Consultant session to review challenging cases we see in clinic. These sessions complement the subspeciality outpatient clinical experience that all primary care residents rotate through.
Joy in Medicine Seminars
Part of a thriving career in outpatient medicine includes finding ways to be present with our patients and remind ourselves of our values and roots. Our joy of medicine series focuses on optimizing your outpatient communication skills, clinic efficiency, documentation, ethics, balint groups, and narrative medicine work. These grounding skills allow you to maximize being in the moment with your patients and help to create work-life boundaries for lifelong wellness.
Medical Education Workshops
A large number of our graduates end up working academic teaching centers and all of our residents love teaching at baseline. In these workshops we develop teaching skills but also think about assessment and productivity as part of a being a clinician educator. We cover an array of topics including coaching, growth mindset, feedback, struggling learners, chalk talks, survey design, curriculum design and much more.
Population Health and Panel Management
As outpatient medicine continues to evolve, the emphasis on population health and panel management has become increasingly important. This is the concept of caring for a group of your patients and being accountable for their health outcomes between office visits. We have a robust curriculum that starts with workshop series to understand panel management strategies and analysis of your own patient dashboards within our electronic medical record system. Every resident has protected time each block to work on population health outreach projects with small group coaching for goal setting and planning built in. We have a large interdisciplinary team who work with our residents to help triage and outreach patients that have been noted as high risk or have uncontrolled chronic diseases.
Addiction Medicine Curriculum
All of our residents are waivered trained in buprenorphine-naloxone. We have an embedded buprenorphine clinic within our clinic that all residents rotate through and some choose to make this their second clinic site for a more intensive experience. Our didactic sessions cover alcohol use disorder, smoking cessation, substance use disorder, person first language and disparities in care.
Scholarly Work & Society of General Internal Medicine Conference
We are fortunate to have funding to send every resident to the Society of General Internal Medicines Annual conference at least once during their time in residency. M any of our residents go a second time to present their work. This past year our residents had 2 workshops, 2 plenary speakers, 1 oral presentation, and 10 posters at the national conference!