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 implemented an X+Y (6+2) curriculum in 2021 for our intern class, and this will move through each class annually; the junior class will start X+Y in 2022, and the whole program will follow an X+Y schedule in 2023. The X+Y curriculum has allowed our program to expand our outpatient education, and has standardized resident diastole whereby each person has a break from inpatient services at least every 6 weeks.
Ambulatory Medicine
The J. Edwin Wood Clinic 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 Clinic, 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.
General Inpatient Medicine
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.
Consultative Services
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.
Cardiovascular Medicine
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.
Hematology and Oncology
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. 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.
Medical Intensive Care Unit
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.
Emergency Department
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.
Geriatrics
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.
Neurology
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, Women’s Health, 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
The program offers daily noon conferences in a variety of formats outlined below. Our didactics are not only an opportunity for residents to learn from the presenter, but also offer opportunities for our residents to build their skills as educators when they lead their own reports for the program.
Resident Noon Conference
A case conference is held for all residents each week. In this presentation, a resident presents an interesting case from the wards, and the faculty or chief resident leads a discussion focusing on patient evaluation skills and advanced clinical reasoning.
Intern Report
Interns have the opportunity to showcase their medical passion, whether that be a case presentation, a discussion of an interesting research topic, or a journal article.
Clinicopathological Conference
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.
Morbidity and Mortality Conference
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.
Journal Club and EBM Club
Starting with “Stats Bootcamp” in the summer, this resident-led bi-weekly conference emphasizes the skills necessary to analyze and implement information conveyed in the medical literature. As junior residents, the focus is a traditional journal club where a new article is appraised and contextualized into clinical practice. As senior residents, a challenging clinical scenario is proposed and the senior resident reviews guidelines and primary literature supporting their decision in the hypothetical case.
“Cornucopia” Fridays
On Friday’s, our program hosts a variety of longitudinal curricula which span the course of the year. These curricula include Point-of-Care Ultrasound (POCUS) facilitated by our faculty and POCUS fellows, medical jeopardy led by our chief residents, imaging review sessions led by our Radiologists, and a Medical Education series led by our program director.
Wednesday Morning Small-group Learning
As part of our X+Y curriculum, every Wednesday on the outpatient block is reserved for protected small group didactic sessions. These talks are focused on group activities such as EKG workshops, Narrative Medicine exercises, and POCUS. We also provide didactic sessions on topics relevant to outpatient medicine such as Sleep medicine, healthcare screening, and Geriatrics.