Internal Medicine Residency Program
Frequently Asked Questions
Q: What changes has the program made in order to be 100% compliant with work hour reform?
Q: Do you have any overnight call?
A: Yes we do. We recently moved to an overnight call system in March 2014 in an effort to maximize our residents’ patient continuity experience. As many admissions come in overnight, we restructured the general medicine teams with two residents and two interns on each. On the call day, one resident-intern pair (half the team) rounds during the day, and stays until their sister team (the other resident-intern pair) arrives in the evening to start their overnight call. The resident-intern pair admit new patients overnight to their own team. All four resident team members round the next morning with the attending for teaching rounds. This system minimizes the number of redistributed admissions (which are traditionally handed off from a night admitting team to the day team), allows residents and inters to admit the majority of their own patients and follow them to discharge. This system complies with all ACGME duty hour rules. We take resident feedback seriously at Temple, and when polled about this recent system change, residents report that they know their own patients better, and are able to do more of the admissions from start to finish, where we think much of the valuable clinical reasoning is learned.
Q: Do you have an Electronic Medical Record (EMR)?
A: Yes! Temple uses the EPIC EMR in all its primary care and subspecialty outpatient clinics. The inpatient services already have electronic order entry systems in place, but charts are still on paper. The Emergency Department uses Medhost EMR. Inpatient EMR will be fully implemented in Fall 2016.
Q: Can you please describe the 4+1 Block structure that you use?
During the 4-week inpatient section of the block, residents will have no continuity clinic sessions. All urgent clinical matters will be managed by residents through the EMR or with the help of their colleagues who are on the Ambulatory block.
The 1 week Ambulatory block is divided in the following half day sessions: 5 half-days devoted to your general medicine continuity practice, with one of those half days spent in our urgent clinic, 1 half-day devoted to an ambulatory subspecialty experience (of the residents’ choosing) 1 half-day to work on an annual Quality Improvement project, 1 half-day triaging ambulatory phone calls or issues that arise in the practice, and 1 half-day doing outreach work to your patient panel to ensure they are up to date, and 1 half-day session for your own academic/administrative time. Each morning during the ambulatory week begins with didactics at 8AM.
We believe that this innovative structure improves the overall real-world education of our residents and provides a clear separation between residents’ inpatient and outpatient duties. It also makes trainees more comfortable with working and managing patients in the Ambulatory setting, where most of medicine takes place today. This system prioritizes the ambulatory experience and does not fragment the inpatient rotations (and patient care) by asking residents to leave the hospital once per week to go to clinic. Rather, when residents are on the floors, they can follow up outpatient labs and studies through the EMR, and when in the clinic, they can focus their time and attention on their patients, arrange appropriate follow up appointments, and make necessary phone calls without feeling hurried to return to their busy floor service. Residents maintain their continuity panel for all three years of their training, and will accumulate patients as they progress as well.
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. In 2013, our program had a 100% fellowship match rate and in 2014 we had a 96% fellowship match rate. They have matched to outstanding academic 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: Research opportunities for residents abound at Temple. Out program brings together a robust research infrastructure with faculty who are approachable and eager to bring residents onto their teams. Residents can find research projects within the Department of Medicine, or do work with one of the medical school’s several research institutes. Research opportunities run the spectrum from those focused on bench and translational research, to clinical investigation, to medical education.
For those applicants interested in a career as a physician scientist, and or established research interests, Temple offers several positions in fellowship-specific physician scientist tracks. Please see our page devoted to this track for more information.
Many residents have successfully published and presented their work in the past year.
Q: What percentage of your graduates pursue primary care?
A: For the past several years, about a third of our graduates have gone into general internal medicine with some entering outpatient primary care practices and the remainder becoming hospitalists, or going 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-house staff covered services?
A: We do. With our ever-quickening work pace, and increasing patient complexity, we have continually expanded our non-teaching services in order to allow the house staff to focus their energy on learning from our most complex patients and their pathologies. At Temple, our hospitalist attendings are full time faculty and spend their time rounding on both the teaching and non-teaching services. This allows for better communication between residents and attendings when patients are transferred between services, etc. Patients who are expected to require a 24-48 hour admission (observation stay) are triaged to the Clinical Decision Unit (CDU), staffed exclusively by our hospitalists. In addition, we have general medicine non-teaching services that are staffed by our hospitalist faculty without house staff. There is a hospitalist present overnight as well to cross-cover the non-teaching patients and do admissions to the observation unit.
Last year, we developed a new rotation for our third year residents, during which time they rotate one-on-one with one of the hospitalist faculty to learn some of the more practical aspects of “being an attending”. During this block, the senior resident is the primary decision maker, admitter, and discharger, but has the teaching attending of ask questions and from whom to fine-tune the ins and outs of running an inpatient team. This rotation is specifically directed at our residents interested in Hospitalist medicine, but allows all senior residents the opportunity to get the experience of running their own service.
Q: Is safety a concern around Temple Hospital?
A: Much less than you might think. Like any large city, Philadelphia has its share of safety concerns. North Philadelphia is an urban underserved neighborhood, so Temple police are very visible in and around the Temple Health Science Campus. As a result, safety in areas around Temple hospital is excellent. All walkways to the parking garages and subways are well-lit and patrolled. Our advice to anyone, in any city, is to use common sense and your best judgment. If you are leaving at any time 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?
Q: By what criteria are house staff selected?
Q: What is the salary?
Q: How many clinical training sites are there?
A: At Temple, we are proud that our residents are all scheduled for the majority of their time, at Temple University Hospital (TUH). This minimizes additional travel obligations and allows for all residents to easily attend all conferences. While PGY-1’s spend 100% of their time at TUH, during their second and or third year, residents will spend one month at the Fox Chase Cancer Center, Temple’s primary oncology campus. 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.
Importantly, when living in Philadelphia, transportation to Temple University Hospital is easily accessed through the city’s subway system. For residents without a car, special arrangements can be made for the Fox Chase rotation.
Q: How much time do I spend at each site as a PGY-1?
Q: What is the breakdown of rotations during the first, second, and third year of residency?
Note: The above chart may add up to over 52 weeks due to variability in schedules.
Q: When are my days off?
Q: What is a typical day on ward service like as an intern?
Q: What is the call cycle?
The call cycle is designed around a four day call model. The entire team is on call every fourth day, but as there are two upper years and two interns on every team, each of these upper year and intern pairs take overnight call every eighth night.
On-Call day: One hemi-team is on evening call and the other hemi-team is on overnight call. Evening call hemi-team arrives at 7 a.m., rounds like a normal day on the old patients and begins admitting new patients from 4:00 p.m. - 7:00 p.m., and the overnight call hemi-team arrives at 6 p.m. and admits patients from 7:00 p.m. - 5:00 a.m.
Post Call - No admissions or redistributions
Short Call 1 - Team gets up to two redistributed patients from overnight, and can take up to 3 admissions from 7:00 a.m. - 4:00 p.m.
Short Call 2 - Team gets up to two redistributed patients from overnight, and can take up to3 admissions from 7:00 a.m. – 4:00 p.m. (After all Short Call 1 teams have hit their admit limits)
On-Call Day - as above. . . . Repeat
Q: How much autonomy is given to residents to make clinical decisions?
A: Quite a bit. The importance of resident autonomy is often cited as one of the most valued aspects of this program. As residents advance through their years at Temple, more autonomy is afforded to them. As a third year, the residents take on sub-interns (fourth year medical students) and act as the junior attending on the team. Though we pride ourselves on resident autonomy, attendings make it a priority to be present and available to their teams at all times for questions or guidance.
A: The ancillary services are robust and allow residents to focus on patient care without having to spend valuable time doing less medically oriented tasks. To support the medicine teams, there are phlebotomy "rounds" throughout the day and night to ensure that patients can get their lab draws throughout the day (and STAT if needed). There are also IV teams available during the day to place IV lines. EKG’s are performed by EKG techs and or nurses. Additionally, the transport personnel take excellent care to coordinate the moving of our patients between rooms, studies, and labs.
Q: Are there required ambulatory rotations?
Q: Is there a Night Float System?
Q: How are additional Night Admissions done?
Q: How many people are on a team?
Q: What is the patient mix?
Q: Who are the attendings that provide inpatient care? Are there private attendings?
Q: Is food provided at work? Are white coats provided?
Q: Is there an educational stipend?
Q: Where will I have clinic?
Q: What is the faculty to resident ratio in clinic?
Q: Is there a separate Primary Care Program?
A: Yes. We have a dedicated Primary Care Track. Each year, two interested interns (and at times, PGY-2s depending on space availability) join the program.
Residents in the Primary Care Program have clinic in the General Internal Medicine faculty practice at Jones Hall (adjacent to TUH). Residents are expected to function as partners in a group practice with their co-residents and faculty supervisors. There are specific 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. Paul Williams at Paul.Williams@tuhs.temple.edu
Q: What is the experience like in the ED?
Q: Is there a research requirement?
Q: Are there research electives?
Q: How can I get involved in research?
Q: Are there opportunities for international rotations?
Q: Where will I live?
Q: What about transportation to and from work?
Q: What is there to do outside of work?
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