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department of medicine

Internal Medicine Residency Program

Frequently Asked Questions

 

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Outpatient Continuity Practice

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Q: What changes has the program made in order to be 100% compliant with work hour reform?
A: In 2011, the ACGME enacted new work hour guidelines, with which we quickly compiled by re-evaluating and redesigning our resident schedule. We continually review these in detail to ensure continued compliance. We have a no-tolerance policy regarding duty hour violations. Any duty hour violations are acted upon to ensure that problems do not recur.

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 2015.

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 consecutive weeks of a core residency rotation (electives, medicine wards, ICU, etc.), followed by a 1 week Ambulatory block, where residents spend the week in their continuity clinic and do not have inpatient responsibilities. This repeats throughout the year.

 

During the 4-week inpatient section of the block, residents will have no continuity practice 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 your annual Quality Improvement project, 1 half-day learning to manage urgent ambulatory issues in the practice, mainly over the phone, and 1 half-day doing outreach work, 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 2014, our program had a 100% 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 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 a large percentage 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-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.

 

This 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 whom to ask questions and from whom to learn the ins and outs of running an inpatient team. This rotation is most 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-lighted 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?
A: There are 33 categorical positions, 5 general preliminary positions, and 4 neurology preliminary positions available. We also have 2 ABIM physician scientist positions per year.

 

Q: By what criteria are house staff selected?
A: We look for applicants who are well-rounded, value teamwork and collaboration, bring a strong sense of professionalism 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 $53,310.40. Click here to view house staff stipends for July 1, 2014 - June 30, 2015.

 

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?
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 the first, second, and third year of residency?

 

Rotation

PGY-1

(wks)

PGY-2

(wks)

PGY-3

(wks)

General Medical Services

12-16

22-26

12-18

Elective Rotations

7-9

7-9

11-13

Fox Chase Cancer Center

0

0-4

0-4

Intensive Care Services

4-8

4-8

0-4

Emergency Department

2

2

0

Medical Admitting Resident/Housechief

0

0

4

Intern Cross-Cover Night Float

4

0

0

Medical Consult

0

0-4

4

Geriatrics

0

0-4

0-4

Vacation Weeks

3

4

4

Night Admitter

4

2

0-2

Ambulatory

10

10

10

 

Q: When are my days off?
A: All house staff on admitting services get a minimum of 4 days off per month. This is a full calendar day in addition to the day when you come in the evening for overnight call. 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?

 

6:30 AM - 7:00 AM

Pick up sign-out from Night Float

7:00 AM- 8:30 AM

Work rounds with the resident or round on new patients with full team from overnight call.

8:30 AM - 11:30 AM

Attending rounds

11:30 AM - 12:00 PM

Work Rounds

12:00 PM - 1:00 PM

Didactic Conferences

5:30 PM - 6:30 PM

Sign-out to Night Float

 

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.

 

Pre Call - Team gets up to two redistributed patients from overnight, but does not take admissions during the day.

 

On-Call day: One sister team is on evening call and the other sister team is on overnight call. Evening call admits patients from 4:00 PM - 7:00 PM, and Overnight call admits patients from 7:00 PM - 5:00 AM.

 

Post Call - No admissions or redistributions

 

Short Call –Team gets up to two redistributed patients from overnight, and can take admissions from 7:00 AM - 4:00 PM

 

Pre Call - 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 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.


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

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. As well, the transport personnel take excellent care to coordinate the moving of our patients between rooms, studies, and labs.

 

Q: Are there required ambulatory rotations?
A: Every 5th week, all categorical residents spend a week entirely devoted (immersed?) to outpatient medicine. Many ambulatory-based electives are available including all medicine sub-specialties, HIV, Primary Care, Orthopedics, 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. Night Float is a four week rotation (Sunday - Thursday night) where interns cross-cover floor patients. Interns on this rotation do NOT do admissions. A second and a third year resident are in-house and assigned to supervise the Night Float interns and help them with procedures or complex management decisions. Night Admitters is a two week block (Sunday - Friday night) where interns and residents do overnight admissions and redistribute them to General Medicine ward teams on rounds the following morning. We do have academic hospitalists in-house overnight for times when additional guidance is necessary.

 

Q: How are additional Night Admissions done?
A: There are additional upper year residents, in house during the evening, to handle the admissions which come in overnight beyond the capacity of the overnight call teams. This is an upper year only rotation, where residents ONLY admit patients; they do not cross cover patients who have already been admitted by the day teams. The patients which these upper years admit are distributed to the non-call teams in the morning.

 

Q: How many people are on a team?
A: A typical general medicine team is made up of one attending, two residents, two interns, and two 3rd year medical students. Each team can accommodate up to 20 patients at a time.

 

Q: What is the patient mix?
A: The patient mix at Temple is perhaps one of the strongest aspects of our training program. As a tertiary referral center in an inner city urban environment, Temple’s patients come from all walks of life. While the majority of the General Medicine ward patients are from the local community, the subspecialty services add in the referral patients from the suburbs, who bring different pathology and learning opportunities. The residents care for and learn from some of our health system’s most complex patients; those without the luxury of easy access to care. While this presents residents with a challenge, they get to learn how to treat complicated illness, and often have to balance and prioritize several illnesses in the same patient. While serving as the front line for many of our community’s patients, our residents learn how to workup pathologies from scratch and often follow patients they have taken care of on the inpatient service in their continuity clinic. This care spectrum not only provides residents with some of the best hands-on clinical training available, but also provides a great deal of reward when residents care for patients from diagnosis, through treatment, and into follow up for one, two, or three years.

 

Q: Who are the attendings that provide inpatient care? Are there private attendings?
A: All attendings who round with residents are full time faculty of the medical school. There are eight General Medicine teaching services, one staffed by our GIM faculty, a Chief Resident service, and six services staffed by Hospitalist faculty. There are five inpatient primary subspecialty services, staffed by a resident and an intern and attended by the subspecialty faculty. These include Nephrology, Hepatology, and Advanced Heart Failure (all with transplant patients), as well as General Cardiology and Pulmonology.

 

Q: Is food provided at work?  Are white coats provided?
A: It would be tough to work without food and a white coat. The Graduate Medical Education office generously provides residents with money on their employee ID card to use in the cafeteria. This money varies with your call cycle, so residents on elective will get less than those staying overnight for call. Lunch is provided at three of the five noon conferences each week. And yes, white coats are of course provided. Residents will get two long white coats, embroidered with their name, at the beginning of their intern year, with an additional new white coat each subsequent year. After so many hours spent caring for patients, and earning battle wounds, these white coats are the residents’ to keep. Residents also each get their own hospital locker to use for all three years.

 

Q: Is there an educational stipend?
A: Yes. We understand how important conference travel can be to our residents’ education, and work to support residents in their endeavors to present their work at meetings, both locally and nationally. Each resident gets a $1500 educational stipend to use during one of their three years. This funding can be distributed over two separate disbursements, and includes travel, conference registration fees, and hotel and meal expenses, and board review courses.

 

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OUTPATIENT CONTINUITY PRACTICE:

 

Q: Where will I have clinic?
A: The resident continuity clinic, known as the Medicine Group Practice, is located on the first floor of the Medical Office Building (MOB), across the street from the main hospital. We recently moved there in Winter 2014 to allow for more clinical space, larger patient rooms, better work flow, and more academic space for the residents while they are in clinic.

 

Q: What is the faculty to resident ratio in clinic?
A: No more than 1:4.

  

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. 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. The ED is a terrific opportunity for residents to not only learn how to begin patient workups from scratch, but also to better understand and get an appreciation for all that our ED colleagues do, in addition to beginning the workup for patients bound for inpatient admission.

 

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RESEARCH:

 

Q: Is there a research requirement?
A: There is not a formal research requirement. However, all residents 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. Each year there is a department-wide symposium showcasing the research done by residents and fellows, including posters and oral presentations.

 

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

 

Q: How can I get involved in research?
A: The opportunities to get involved in a research project begin early on during our residents’ training. During our Intern Summer Conference Series (a daily didactic of protected time for the interns), given by junior and senior faculty, the residents get to meet many of the subspecialty attendings. Each fall, during intern year, our department organizes an Intern Research Day, when all of the section chiefs (from each medicine subspecialty) meet with the interns and discuss the ongoing research projects within their division. This morning and afternoon session is protected time for our interns, when their residents hold their pagers. This conference allows the interns to hear about all of the ongoing research projects within each division, and provides them easy access the section chief who can put them in contact with faculty members whose research is of interest to the intern or resident.

 

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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, and Manayunk. 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: About half of our residents take the subway from Center City, and the other half drive to work from one of the suburbs convenient to the city. Each resident, whether they drive every day or not, can park their car for free in one of the hospital parking garages

 

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, Fairmount Park, Independence Mall, The Kimmel Center, The Franklin Institute, The 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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