department of medicine

Internal Medicine Residency Program

Frequently Asked Questions

Outpatient Continuity Practice

Emergency Department

Research

International Experiences

Living in Philadelphia

Q: What changes has the program made in order to be 100% compliant with work hour reform?
A: The ACGME recently enacted new work hour guidelines, effective July 2011.  We have reviewed these in detail and are 100% compliant. We were previously a traditional overnight call structure and are now following a shift system for our inpatient floors and ICUs.  Our new non-call cystem was successfully implemented in January 2011 at our affiliate institution, Fox Chase Cancer Center, and in April 2011  at Temple Hospital.  Our new system ensures ACGME compliance and has gotten great feedback from the residents.  Our non-call system maximizes resident education, minimizes patient handoffs and ensures outstanding quality of patient care.  The typical weekly schedule is described in detail below.  Nonteaching services and hospitalists augment the resident services in the hospital. 

We have a no-tolerance policy regarding work hour violations. Any duty hour violations are acted upon to ensure that problems do not recur. 

Q: Do you have any overnight call?

A: There is no overnight call during the medical wards or ICU rotations as an intern.  Sporadic (every 8th day) overnight, traditional calls do occur as a resident when you are cross-covering the CCU. 

Q: Do you have an Electronic Medical Record (EMR)?

A: Yes!  Temple uses the EPIC EMR in all its primary care and most of its subspecialty clinics. All of the subspecialty practices will be integrated by the end of 2011. The inpatient services already have electronic order entry systems in place.  The Emergency Department uses Medhost EMR.

Q: Can you please describe the 4+1 Block structure that you use?
A: Temple utilizes an innovative ‘4+1’ block structure that debuted in June 2011. The year is organized into ten 5-week blocks consisting of 4 weeks of a core residency rotation (electives, medicine wards, ICU, etc.), followed by a 1 week Ambulatory block. This repeats throughout the year.

During the 4-week section of the block, you will have no continuity practice sessions. All urgent clinical matters will be managed by you through the EMR or with the help of your colleagues who are in Ambulatory.

Alternatively, the 1 week Ambulatory block is divided in the following proportions: 5 half-days devoted to your general medicine continuity practice (one of urgent care), 1 to 2 half-days devoted to an ambulatory subspecialty experience, 1 half-day to work on your Quality Improvement project and 2 half-days learning to manage urgent ambulatory issues in the practice. Every morning from 8 a.m. to 9 a.m. you will meet for Ambulatory didactics and small group learning.

We believe that this innovative structure improves the overall real-world education of our residents and provides a clear separation between everyone’s inpatient and outpatient duties. It also makes trainees more comfortable with working and managing patients in the Ambulatory setting, which is where most of medicine takes place today anyway. This system allows for less fragmentation in care in the hospital since you do not have to leave to attend clinic, while maintaining continuity of care in the continuity practice.

Q: How do your residents do in obtaining fellowships?

A:  Extremely well.  In the past decade our residents have consistently matched to extremely competitive fellowships, with greater than 95% getting one of their top choices. They have matched to outstanding programs all over the country.  Our web site lists the fellowship choices of our residents over the past decade.

Q: What are the opportunities for research?

A: There are many opportunities to get involved in research.  Temple’s faculty are involved in many research projects and very much enjoy involving the residents in their projects.  Temple receives significant funding from the NIH for research both in the basic sciences, as well as for clinical research.  Many residents successfully published and presented their work in the past year .

Q: What percentage of your graduates go into primary care?

A: For the past three years, about a third of our graduates have gone into general internal medicine with the majority entering outpatient primary care practices.   The remainder have become hospitalists, or gone onto another generalist career such as palliative medicine, geriatrics or general internal medicine fellowships.  As a result, our graduates post-residency plans are quite diverse when compared with many other large urban residency programs. 

Q: Does Temple have non-housestaff covered services?

A: We have continually expanded our non-teaching services in order to decrease the housestaff work load and keep the focus on education on the housestaff team.  At Temple Hospital we have non-teaching services in Pulmonary and Gastroenterology.  Patients who are expected to require a 24-48 hour admission are triaged to the Clinical Decision Unit (CDU). This unit is staffed solely by our hospitalists.  In addition, we have a general medicine non-teaching service that is staffed by our hospitalist which do not require housestaff coverage. At Fox Chase Cancer Center, there is also a non-teaching service utilized.

Q: Is safety a concern around Temple Hospital?

A: Like any large city, Philadelphia has its share of safety concerns.  North Philadelphia is an economically disadvantaged area so Temple police are very visible in and around the Temple Health Science Campus.  As a result, your safety in areas around Temple hospital is excellent.  Our advice to anyone, in any city, is to just use common sense and you should be fine.  If you are leaving at anytime on your own and prefer extra security, the Temple Police are on campus and available for escort at all hours.

Q: How many PGY-1 positions are available?
A: There are 32 categorical positions and 11 preliminary positions available for 2012.

Q: By what criteria are house staff selected?
A: We look for applicants who are well-rounded, value professionalism and teamwork and possess a strong academic record.

Q: What is the salary?
A: Next year’s salary has not been announced. The current PGY-1 salary is $49,337.60.

Q: How many clinical training sites are there?
A: Two: Temple University Hospital and the Fox Chase Cancer Center.  However, there are opportunities to work in other hospitals and facilities across the region as part of electives or away rotations. International experiences through the Global Health elective are also available.

Q: How much time do I spend at each site as a PGY-1?
A: As an intern, you will spend all of your time at Temple University Hospital, unless you choose to do elective rotation at affiliate hospitals.

Q: What is the breakdown of rotations during intern year?

Q: What is the breakdown of rotations during the PGY-2 year?

Q: What is the breakdown of rotations during PGY-3 year?

Q: When are my days off?
A: All housestaff on admitting services get a minimum of 4 days off per month. During electives, interns typically have 2 weekends off and 2 weekends with reserve duty or guest float (see below).

Q: What is a typical day on ward service like as an intern?

Your team can receive admissions between 7:00 am and 3:00 pm on non-call days. When you are on call, your team begins receiving admissions at 3:00 pm and end at 7:00pm.  The medical admitting team starts taking admissions at 8:00pm.

Q: How much autonomy is given to residents to make clinical decisions?

A: As residents advance through the years at Temple, they are given more autonomy. As a third year, the residents take on sub-interns (fourth year medical students) and are essentially the junior attending on the team. Though we pride ourselves on resident autonomy, attendings are available at all times while on service for questions and guidance.

Q: What are the ancillary services like at Temple University Hospital?

A: The ancillary services have improved significantly over the years. There are phlebotomy "rounds" all throughout the day to ensure that pt's can get their lab draws throughout the day, and IV therapists also available during the day to place IV lines. After midnight, the IV therapist is also available to do blood draws (blood cultures, etc.) Nurses in the ICU and telemetry floor do all admission ECGs, and all nurses will do ECGs for acute clinical changes in patients (i.e., chest pain).

Q: Are there required ambulatory rotations?
A: Every 5th week, all residents spend a week entirely devoted to ambulatory, outpatient medicine.  Many ambulatory-based electives are available including all medicine sub-specialties, HIV, Primary Care, Healthcare Finance, Palliative Medicine and Dermatology.  We have a dedicated Associate Program Director and Chief Resident who help direct ambulatory education during your residency.

Q: Is there a Night Float System?
A: Yes. Interns do one month of night float and one month of night owl admitting.  One month (Sunday-Thursday night) is spent as a Cross-Coverage night float at TUH taking care of patients whose teams are not on call.  Interns do NOT do admissions during this rotation. Overnight, a second year resident and a third year resident are in-house to serve as resources in the event of questions or complex management decisions.   Additionally, once as an Intern and once as an upper year, residents work as a team for one month (Sunday-Thursday night) doing admissions, and then rounding with the General Medicine ward team and attending the next morning.

Q: How many people are on a team?
A: A typical general medicine team is made up of one attending, one resident, one intern (1:1:1 ratio) and two 3rd year medical students.

Q: What is the patient mix?
A: Located in North Philadelphia, TUH cares for an underserved urban population. In addition, TUH is a tertiary care center with well-respected subspecialty departments. We receive many referrals from the surrounding suburban region resulting in a diverse patient population.

Q: Who are the attendings providing inpatient care? Are there private attendings?
A: There are 12 inpatient general medicine services staffed by GIM faculty or hospitalists. Each team has one dedicated attending. Your attending performs teaching rounds and didactics daily. On occasion, one or two patients on your service may be staffed by an attending other than your general medicine attending. However, this is the exception and not the rule. There are also 4 inpatient subspecialty services each staffed by a subspecialty attending.

Q: Is food provided at work?  Are white coats provided?
A: Meal money is placed on your TUH ID card for overnight calls. Snacks are provided in the resident lounge. Lunch is usually served at Noon Conference 3 days per week.   The Department provides 2 long white coats to all house staff annually.  Scrubs and lockers are also provided.

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OUTPATIENT CONTINUITY PRACTICE:

Q: Where and when will I have clinic?
A: The Medicine Group Practice is the resident-run clinic located on the 4th floor of the Outpatient Building which is attached to the hospital. The practice has dedicated faculty who oversee your educational experience.

Q: What is the faculty to resident ratio in clinic?
A: 1:4.

Q: Is there a separate Primary Care Program?
A: Yes. We have a dedicated Primary Care Program. Each year, 2 interested residents (PGY-1 or PGY-2 depending on space availability) join the track.

Residents in the Primary Care Program have clinic in the General Internal Medicine faculty practice at Jones Hall (adjacent to TUH). Residents work together during their continuity clinics. Residents are expected to function as partners in a group practice with their co-residents and faculty supervisors. There are specific weekly primary care program conferences with a focus on psychosocial issues in primary care, systems-based practice and clinical case conferences. Each resident in the Primary Care Program is assigned to a second community preceptor experience in addition to their weekly continuity practice.

For more questions, please contact Dr. Gina Simoncini at gina.simoncini@tuhs.temple.edu.

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EMERGENCY DEPARTMENT:

Q: What is the experience like in the ED?
A: During your 4 week ED rotation, you function as a member of the ED team, triaging all types of patients who present for care including fast track, general medicine, neurology, OB/GYN, surgery, and trauma patients. Upper year residents may spend additional time in the ED by request.

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RESEARCH:

Q: Is there a research requirement?
A: No. However, all residents are offered the opportunity to and are strongly encouraged to complete a scholarly project during their residency. Scholarship is broadly defined and includes reviews of clinical topics, original work resulting in abstracts or manuscripts and laboratory experience. Many residents actively engage in research. The list of this year’s conference presentations and publications is available elsewhere on this website.

Q: Are there research electives?
A: Yes. Residents may choose to do up to 3 research blocks during their residency.

Q: How can I get involved in research?
A: There is an annual research day at the start of the year. Dr. Moyer and representatives from each division present information on the many options for research that are available at TUH and FCCC.

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INTERNATIONAL EXPERIENCES:

Q: Are there opportunities for international rotations?
A: Yes. Our residents are increasingly involved in international work through the Global Health elective and have experienced medicine across the globe including Nicaragua, Korea, India, Bolivia, Peru, and Botswana. You can organize your own trip or rotate at a site affiliated with Temple University School of Medicine. For more information please see the web site at:

http://www.temple.edu/medicine/education/mdprograms/medical_education/

international_health.htm

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LIVING IN PHILADELPHIA:

Q: Where will I live?
A: Most residents live in Center City or in areas just outside downtown including Rittenhouse, Bella Vista, Old City, Queen Village, Fairmont, East Falls, Roxborough, Manayunk, and Conshohocken. Compared with other large east coast cities, the cost of living in Philadelphia is very reasonable.

Q: What about transportation to and from work?
A: Most residents travel by car and park for free in Temple's parking garages.  Residents who live in Center City can take the subway to Temple Hospital which has a stop two blocks away.

Q: What is there to do outside of work?
A: Philadelphia is a multi-cultural city, full of history, and offers something for all tastes. Attractions include the Philadelphia Museum of Art, Fairmont Park, Independence Mall, The Kimmel Center, Franklin Institute, Academy of Music, Walnut Street Theatre and the World Champion Philadelphia Phillies Major League Baseball team. Philadelphia also has a wide variety of eateries for every budget with several nationally acclaimed five star restaurants as well as countless BYOBs. Philadelphia is centrally located with easy access to New York, Baltimore, Washington, D.C., the Poconos, Atlantic City and the Jersey shore.

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