6+2 Block Scheduling System
All housestaff participate in the 6+2 block schedule, in which they spend up to 6 consecutive weeks on inpatient services, then spend 2 weeks in the ambulatory setting. This system is designed to introduce regular, predictable breaks from the more intense inpatient rotations, while also allowing separation of inpatient and outpatient responsibilities to allow each skill set to develop with an appropriate focus. It also creates four distinct cohorts within each class that facilitate mentoring and social activity scheduling.
|Ward - General or Subspecialty
|Ambulatory or Elective
General Medicine Services
Residents and interns participate in general medicine rotations at each of our three hospital sites, each sharing the common themes of a generalist service but with distinct flavors at each site. The general medicine rotations all offer excellent opportunities for teaching core clerkship students. At HUP, the Martin teaching service (named for a former program director) cares for a broad range of patients with undifferentiated presentations under the direction of our academic hospitalist group. These patients include some patients followed by HUP specialists who are admitted for unrelated concerns, and may therefore have some more unusual diagnoses along with their active concerns. At Penn Presbyterian, the general medicine teams serve our local West Philadelphia community. Patients typically have a variety of common general medicine diagnoses, and many attendings are from our academic outpatient practices. At the VA, the general medicine services have a focus on intensive teaching, and the VA is the main home of the medicine sub-internship. We are happy to serve the veteran community from the wider Delaware Valley including those needing subspecialty care.
The Medical Intensive Care Unit at HUP is the main site for critical care. This rotation has been our most highly rated for most of the past two decades, and is staffed by pulmonary and critical care attendings who have won many of our most prestigious teaching awards. The MICU often cares for patients receiving other advanced care (solid organ transplantation, cancer chemotherapy or immunotherapy), and features complex multidisciplinary care provided alongside fantastic nurses, clinical pharmacists, and other colleagues.
Housestaff also participate in intensive care for cardiology patients both at HUP (the Cardiac Intensive Care unit) and Penn Presbyterian (the Heart and Vascular Intensive Care Unit). While each unit will have a mix of patients, again each has a distinct curricular focus. At Penn Presbyterian, many HVICU patients are flown in from around the region as part of a large heart rescue program, and a focus is on ischemic heart disease. At HUP, many patients are part of the advanced heart failure and mechanical circulatory support program that coordinates with the heart transplant program.
Categorical and primary care housestaff will spend a total of four weeks in the emergency department, two in the intern year and two later in residency. Early participation in the ED is designed to help housestaff understand processes of care and both opportunities and limitations of care in the acute setting. Later they return in a more senior role and provide care to some of the more severely ill patients.
The geriatrics rotation occurs at Penn Presbyterian, typically during the second year of residency. There is a strong emphasis on interdisciplinary team management and care as part of a caregiver team on the Acute Care for the Elderly unit.
A two-week experience in neurology is required, typically as a junior resident. Some residents participate in an inpatient rotation largely based in stroke care, while sharing responsibilities for other inpatients with neurologic disease. Other residents do a rotating outpatient office-based neurology experience, largely at the VA hospital.
Experience in outpatient care is an important component of our training program. The four cornerstones of the ambulatory experience are the ambulatory block rotations, continuity practices, firm rotation and ambulatory subspecialty rotations.
Ambulatory Block Rotations (Individualized Learning Modules / ILM’s)
Each intern and resident spends the “+2” portions of their schedules in structured rotations with several curricular foci, including:
- Outpatient general internal medicine continuity practice, with 3 sessions weekly as a partner in a faculty / resident outpatient practice;
- Concentrated small-group and outpatient office-based exposure to medicine specialties in the intern year, including endocrinology, rheumatology, infectious diseases, and nephrology;
- Concentrated small-group didactics that are theme-based, sometimes by specialty and sometimes by skill development (e.g. medical education, evidence-based medicine, communication skills) in the second and third years of residency;
- Longitudinal exposure to curricula in quality improvement, including the completion of a group quality improvement project in the second year; and
- One half-day per week for personal wellness
Each trainee has a continuity practice experience in which they serve as the primary care physician for a panel of patients. The patient population consists of patients discharged from the inpatient services, as well as new referrals from the community. Interns and residents practice in firms under the supervision of dedicated faculty members. All faculty are general internists in the Division of General Internal Medicine.
In addition to practicing together, faculty and residents work together to create an ongoing series of weekly conferences based on cases, a curricular framework, and the most recent medical literature. Each resident has a longitudinal relationship with a faculty member who provides summative feedback and mentorship over the three years of continuity training.
This is a two-week block experience in which residents are immersed in their outpatient office practices. The experience includes curriculum in phone triage, urgent care, and sports medicine, in addition to extra sessions with continuity patients and acute care / post-discharge patients
An integrated conference curriculum has been developed to provide interns and residents with broad exposure to the principles and competencies of general internal medicine and its subspecialties. The purpose and format of each conference is slightly different to provide residents with diverse learning venues. The weekly conferences include:
Resident and intern reports
Resident report is a case-based conference held four times each week at all three hospital sites. It is run by the chief residents with faculty support. Content varies, and cases may be derived from inpatient and outpatient cases. Many resident reports highlight traditional topics like advanced clinical problem-solving, differential diagnosis, and complex medical management skills. We also use resident report to review key topics in quality and patient safety, hear evidence-based literature reviews of clinical and investigative medicine, have multidisciplinary conferences with Emergency Department and Pathology colleagues, and more.
At Penn Presbyterian and the VA, interns and residents attend report together. At HUP, two reports weekly are combined, but twice weekly we break out the interns (and students) for separate reports with distinct curricular goals and focus.
2019-2020 Grand Rounds Schedule
Intern ILM: Monday and Friday morning
Monday conferences during the outpatient focused intern ILM introduce interns to key clinical concepts in general medicine and specialties to which they receive less focused inpatient exposure (endocrinology, rheumatology, infectious diseases, and nephrology). On Fridays, a longitudinal conference series focuses on topics that cross specialties such as narrative medicine, wellness, and communications skills.
Resident ILM Thursday Morning Didactic Series
These conferences are devoted to inpatient and outpatient management topics presented by core faculty. These sessions are more advanced, case-based discussions aimed at the resident level. They also incorporate skill-building along curricular themes during the year including communication skills, evidence-based medicine, medical education, and more.
Residents and interns on ILM or elective attend midday ambulatory report at the main outpatient office site. This conference series highlights core curricular and emerging concepts in outpatient medicine.
Nighttime Teaching Series
Roughly 3-4 times weekly at HUP, all night float residents come together for midnight teaching. These conferences are taught by one of the senior residents in house. They focus on teaching scripts designed to highlight management issues.
All HUP inpatient services begin the rounding day with a 30-minute interactive conference room-based session, with topics pertinent to the specific rotation.
All categorical housestaff are required to engage in a scholarly project, which can be broadly defined as participation in clinical or basic science research, critical reviews of the literature, case reports and series, book chapter or community service activities. Residents are encouraged to both publish their work and present at national meetings which is sponsored by the Department of Medicine.