department of medicine

Internal Medicine Residency Program

Primary Care Program

Overview and Goals

General Internal Medicine Outpatient Practice

Mentoring

Participation in Categorical Residency Curriculum

Primary Care Program Specific Conferences

Community Medicine Experience

Ambulatory Block

Outpatient Block

Online Curriculum/Self-Directed Learning

Applying to the Program

Contact Information

Thank you for your interest in our Primary Care Program!  The program is an option within the Temple University Internal Medicine Program to serve the needs of residents who have a strong interest in pursuing a career in primary care after residency. We are excited to provide these residents with both the rigorous, hospital-based training of the internal medicine residency and an intensive primary care training experience based on the principles of continuity, mentorship, and small group learning. The primary care program offers residents all the resources of a traditional urban internal medicine program with a focus on the core skills necessary to function as a practicing outpatient physician after residency.

The goal of the Primary Care Program is to provide residents interested in general internal medicine with an intensive primary care experience throughout their residency. The structure of the program provides a longitudinal primary care training experience that simulates small group practice as well as exposure to community general internal medicine outside of the academic center setting. In addition, the program fosters an environment in which trainees engage each other regularly concerning issues relevant to their future careers. The components of this training program include:

• Weekly outpatient continuity practice in a traditional faculty general internal medicine practice

• Intensive mentoring and career advice by general internal medicine faculty

• Year round small group longitudinal conference series facilitated by general internal medicine faculty

• Beginning in the second year of residency, a second outpatient clinical site during non-call months with a community general internist preceptor

• Extensive opportunities for dedicated ambulatory training during all three years.  These consist of primary care practice, outpatient subspecialty experiences, and intensive resident-led conference sessions.  Residents will also have the opportunity to participate in non-traditional clinical experiences including palliative care, rehabilitation medicine, community health centers, health care financing, nutrition, correctional health, and acute care.

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All residents in the Primary Care Program have practices based in the General Internal Medicine faculty practice at Jones Hall (categorical residents have their outpatient practice based at the Medicine Group Practice, 4th Floor Outpatient Building). Residents practice together during their one weekly continuity practice on Friday afternoon. Residents are expected to function as partners in a group practice with their co-residents and faculty supervisors. They are responsible for coordinating care with support staff, following up on results of laboratory and other studies they order, and answering messages from their primary care patients. The Primary Care Program director, who also practices in the Jones Hall practice, is the designated faculty preceptor for these patient care sessions.

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The Primary Care Program director meets regularly with all residents in the program to discuss outpatient clinical skills, post residency career planning, and research interests. In addition, efforts will be made to match residents with other faculty who share interests with the resident. The assigned community general internal medicine physician will provide each resident with another mentor as they consider their future careers.

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Residents attend all educational activities organized for internal medicine residents, including the weekly ambulatory care conference on Mondays and the pre-clinic case conferences.

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Approximately every other week, program-specific conferences occur Fridays from 12:30 p.m. to 1:30 p.m. prior to the Friday practice session. These conferences serve as a space to experiment with non-traditional resident-driven educational models for primary care training. One resident is assigned to lead each of these sessions with faculty facilitation. The Primary Care Program director will facilitate conferences with additional participation from the primary care chief resident, interested general internal medicine faculty, and other invited guests.

Clinical Case Conference

Resident presents a case based on an encounter from their office practice. Discussion is focused on approach to chief complaint, brief review of the relevant literature, and practical clinical decision-making based on both evidence and patient values. The conference provides an opportunity for residents to formally discuss the process of learning from patient encounters, using evidence to guide patient care, and make practical clinical decisions.

Psychosocial Issues in Primary Care

Resident presents a difficult patient encounter or personal issue regarding the practice of medicine; preceptor(s) facilitates discussion of relevant psychosocial issues along with review of available literature. This conference provides residents with an opportunity to discuss difficult psychosocial issues common in clinical practice and to learn strategies to approach them. Co-facilitators from the department of psychiatry, nursing, social work and other disciplines will be invited to these sessions as possible. The longitudinal nature of the conference series will allow for the group to return to specific issues over many weeks and months. Issues discussed by residents have included resident burnout, the impact of poverty on health care, prayer in medicine, and end-of-life care.

All materials from above conferences are posted to an accessible web site (Temple University Blackboard). In addition, residents and faculty are encouraged to post interesting cases, articles or concerns for review throughout the year.

Systems-Based Practice and Health Systems Conference

Resident presents and leads a discussion of a system issue or problem he or she identifies, either from the perspective of their outpatient practice or the global health care system. He or she may present the issue as a topical review, a practice improvement initiative, or a recent study or review article from the literature. This conference provides residents with an opportunity to explore the many systems issues that serve as barriers to effective patient care and improve skills in designing and evaluating solutions. Issues discussed by residents have included cost-effectiveness of the health care system as a whole, residency training redesign proposals, recent Pennsylvania health reform proposals, and “pay for performance” initiatives.

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Each resident in the Primary Care Program will be assigned a second outpatient preceptor experience in addition to their weekly continuity practice. The attending preceptors are practicing general internists in the community invited to participate because of their interest in teaching and mentoring. Residents will be expected to attend one half-day clinical session per week with their community internist in addition to their weekly Jones Hall continuity practice when on non-call months. This experience provides another opportunity to learn clinical general medicine, to interact with a mentor, and to gain experience with the operations of a community primary care practice. If specific requests are made regarding a preferred practice type for the second continuity experience, all efforts will be made to fulfill the request.

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Frequency:  One block during internship year and second year, two blocks third year

During the ambulatory block, residents have continuity clinic sessions 3 times per week and attend subspecialty experiences 2 to 3 times per week. Residents attend all medicine residency-wide conferences including morning report, clinical pathologic conference, and grand rounds.

Two half-days are dedicated to primary care program resident-led conferences as described above.

During the internship ambulatory block, the resident is exposed to the General Internal Medicine practice as a “health care system” through interviews with administration and clinical support staff. He or she is expected to consider a system-based practice issue to work on as a project over the next two years of residency. Subsequent ambulatory blocks serve as opportunities to continue work on issue and develop a system-based solution to improve care.

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The outpatient block consists of two separate intensive two-week experiences in clinical settings not traditionally taught in medicine residency but directly relevant to outpatient medical practice. All categorical residents participate in the outpatient block once during the second year. Primary care program residents are required to participate in 2 outpatient block experiences during each of the second and third years. For additional information, please check our Ambulatory Curriculum site.

• Palliative health - Keystone Hospice, Wyndmoor, PA

• Community health - City of Philadelphia Health Centers (city funded health centers providing care for uninsured patients) and Esperanza Health Center (a federally qualified health center serving predominantly Spanish speaking population)

• Physical Medicine and Rehabilitation - Temple University Hospital

• Health care financing – Temple University Health System and Aetna Managed Care

• Nutrition – Temple University Hospital

• Acute Care – Temple University Hospital Emergency Department “Fast Track”
  
  

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The program has a course listing through the Temple University “Blackboard” program. The site includes an extensive reading list of clinical topics related to general internal medicine, medical literature focused on specific clinical questions that arise in practice, and all previous resident presentations. First year residents can use the resources as a source for study as time allows and more formally, during the ambulatory block. Second year residents are expected to carefully study and master materials labeled “Core Topics in Outpatient Medicine.” Third year residents are expected to continue their independent study. In addition, they are expected to create folders with relevant literature and initiate online discussions on clinical policy and ethical questions that arise in the course of their training.

All primary care program residents participate in the residency’s Primary Care Interest Group – devoted to providing support and mentoring for all Temple residents interested in primary care. Primary Care Interest Group activities include online discussions relevant to primary care and workshops focused on career opportunities in general internal medicine.

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The Primary Care Program is fully integrated with the Temple University categorical internal medicine residency. Beginning in 2009 it will also have its own Match number with two slots available for participation each year. If you are at all interested in participating in this program, please let Maria Cruz know when you are contacted for an interview so we may better match you with a faculty interviewer. We recognize that career plans can change during residency and offer complete support for whatever career path participating residents ultimately choose. For this reason, although we encourage it, participation in the Program does not require you to be certain that Primary Care is your career path.

Although you may learn about the Primary Care Program and be interviewed for admission on any interview day, visiting on a Friday will give you an additional opportunity to meet the current primary care program residents during their continuity practice session at the end of your day.

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If you are interested in the Primary Care Program, please feel free to contact us for more information:

Shiva Chandrasekaran, MD
Temple University Hospital Internal Medicine Residency
Primary Care Program Director
shivanandh.chandrsasekaran@tuhs.temple.edu

Lawrence Ward, MD, MPH, FACP
Temple University Hospital Internal Medicine Residency
Associate Program Director for Ambulatory Education
lawrence.ward@tuhs.temple.edu

Primary Care Chief Resident

Gina Simoncini, MD
gina.simoncini@tuhs.temple.edu
Completed Primary Care Program, June 2009

Current Third Year Residents

Rachel Rubin, MD
rachel.rubin@tuhs.temple.edu

 

Heather Silver, MD
heather.quigley@tuhs.temple.edu

Current Second Year Residents

Diana Chan, MD
diana.chan@tuhs.temple.edu

 

Vishnu Kulasekaran, MD
vishnu.kulasekaran@tuhs.temple.edu

 

Current First Year Residents

 

Maureen Clarke, MD

maureen.clarke@tuhs.temple.edu

 

Patrick Dostal, MD

patrick.dostal@temple.edu

 

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