Division of General Internal Medicine and the Residency
The interactions of the Division of General Internal Medicine and the internal medicine residents over their three-year program is continuous and in depth. The Division provides year-round coverage for three of the general internal medicine inpatient teams during which the daily care of both critically and chronically ill hospitalized patients is shared.
Inpatient Teams and Call
General internal medicine teams at the Hershey Medical Center are comprised of 2 interns and 1 senior resident, with the team size capped at 14 patients per team.
VA medical center teams consist of 1 senior paired with 1 intern, with the team size capped at 10 per team.
Team are on call every 3rd to 4th day, with the call team responsible for admissions from 2 PM to 7PM. Admissions from 7 AM to 2 PM, are triaged based on complexity and distributed to the teaching or hospitalist services based on patient load. After 7 PM a night team of House Officers and Nigh Floats take over all admission and cross cover responsibilities.
PGY 1 (Categorical)
• On the inpatient service, the first year resident physician functions as the patient's primary physician.
• Interns work under the supervision of a senior resident and an attending physician on the general internal medicine, cardiology, critical care, and hematology/oncology inpatient services.
• PGY-1 rotations: categorical PGY-1 residents complete an average of:
o 3-4 blocks of inpatient general internal medicine
o 1 block inpatient cardiology
o 1 block ICU
o 1 block GI/ Hematology / Oncology
o 4 weeks of night medicine
o 4 blocks ambulatory medicine
o 2 weeks basic clinical skills
PGY 2/PGY 3
• The second and third year residents complete and average of:
• 2-3 blocks per academic year as a supervisory resident inpatient general internal medicine
• 1-2 blocks per academic year as ICU senior
• 1 block each in cardiology, hematology/oncology and hepatology
• 2-4 weeks per year on night medicine as House Officer
• 4- 8 blocks ambulatory medicine.
• The senior residents interested in hospitalist medicine have the opportunity to rotate through Lancaster General Hospital (LGH), a large community-based hospital. The resident will function as a hospitalist for the internal medicine inpatient service with flexible roles as admitting physician, inpatient rounding and night medicine physician.
Electives can be selected from a wide variety of inpatient and outpatient subspecialty and general medicine rotations including: Endocrinology, Rheumatology, Sports medicine, pulmonary medicine (including further specialization in Cystic fibrosis, interventional pulmonology/bronchoscopy), cardiology (with opportunities for further specialization for interested residents in EP, Echocardiography, interventional cardiology), gastroenterology (endoscopy, inflammatory bowel disease etc. for interested residents), hepatology, benign and malignant hematology, oncology, Infectious disease, allergy-immunology and more.
Additional electives such as research electives and electives in faculty development, medical education, epidemiology and preventative medicine, quality improvement etc. can be tailored to the individual resident's interests.
Research Activities and Scholarly Pursuits
With the inception of our "Residents Research Forum", Research Pathway, and the support of our faculty, the scholarly pursuits of our residency program have expanded considerably. Over the last 3 years, the vast majority of our residents are completing their training with multiple achievements in the areas of research, publication, and podium/poster presentation at the regional, state, and national level.
Led by the Chief residents, morning report is held on most weekdays from 7:30 to 8:30 AM. About half of the time is dedicated to board preparation using the ACP's MKSAP question back. The second half is reserved for resident case presentations where the group develops differential diagnoses, diagnostic workup and treatment for interesting cases seen on service, or fresh cases of patients admitted by the night team that same day.
Held on weekdays from 12 to 1PM, and following a monthly theme(i.e. General Internal Medicine during the month of July, GI in the month of August and Pulmonary medicine in September), this is an informal seminar series where dedicated faculty present high yield topics or important research developments of their subspecialty.
Academic Half Day
New since the introduction of the block schedule, the academic half day has been introduced in ambulatory blocks. One day a week residents are free from clinical and patient care responsibilities for an entire morning and spend their time in small group teaching sessions. Resident feedback has been overwhelmingly positive and we plan to incorporate the academic half day into the inpatient curriculum as well.
As part of our Evidence-Based Medicine (EBM) curriculum Journal Club is held once a month during noon conference and introduces critical appraisal concepts, specific for each session. Senior residents and attending physicians facilitate small group discussions, where each resident engages actively in critical study appraisal.
Tuesday mornings are reserved for Department of Medicine Grand Rounds. Here, invited guest speakers and our own experts present new research developments, updates on best clinical practice and other topics of interest from the broad realm of internal medicine. In addition to expert panelists, residents have to opportunity to present research results or challenging case presentations during resident grand rounds.
Morbidity and Mortality (M&M) Conference
This conference is monthly peer-protected conference to evaluate cases with unexpected complications, medical errors or mortality. Focusing on education, system based practice and multidisciplinary quality improvement the M&M conference provides a forum for residents, faculty, nursing and administrative staff to explore the details cases with unexpected outcomes in a blame free environment. Most cases are identified by residents, presented by the chief residents and integrated directly into quality improvement projects. This conference has been very well received throughout the department and provides great opportunities for residents to learn and get involved in quality improvement, often with an immediate positive impact on patient care and clinical practice.
Basic Clinical Skills - Each categorical intern will participate in the Basic Clinical Skills course. This is a two-week course on the instruction and standardization of advanced physical diagnosis skills, epidemiology, evidence-based medicine and bedside procedures. Basic skills such as interpretation of chest x-rays, EKG's, PFT's and blood smears as well as extensive simulation training for ultrasound guided beside procedures and CODE-Blue scenarios. Using computer-based instruction, interactive small group sessions, didactic lectures, direct patient care, as well as simulation the Basic Clinical skill course is a great opportunity for interns to gain valuable hands on experiences in the safety of a simulation environment, before applying their skill in clinical practice.
Resident Research Forum – Led by Core Faculty Member, Dr. Cynthia Chuang, the resident research forum is designed to connect residents with the ample resources and research opportunities available at Penn State Hershey. In a series of monthly formal and informal meetings as well as regular office ours residents have the opportunity to get involved with ongoing research projects, find faculty support for new ideas and get support with ongoing projects, case reports, poster presentations and more. The resident research forum also hosts regular informal sessions immediately prior to large regional and national meetings to help our residents prepare submissions and finalize poster and oral presentation for accepted projects.
The Jeffries Educational Mentor and Scholar (JEMS) Program - Initiated in the 2013-2014 academic year, the JEMS program – named in honor of the first Chair in our Department of Medicine, Dr. Graham Jeffries – was developed to support and enhance the selection and professional development of Internal Medicine Residents through the creation of a dedicated group of faculty with advanced skills in medical education and mentorship. These clinical educators will 1.) Serve as leaders in the implementation of the Next Accreditation System (NAS) through meaningful, proactive, longitudinal monitoring and guidance of our residents, 2.) Provide consistent, focused support for the resident selection process, and 3.) Serve as a valuable resource in medical education and accreditation for other members of the department. It is anticipated that this group of engaged faculty will have a significant impact on the culture of education and professional development in the Department of Medicine and enhance the overall success of the education programs for both residents and faculty.
Selected JEMS faculty will serve as mentor, focused-educator, and evaluator for three to four residents over the entire course of their medical residency training. These mentors will meet with residents for direct observation of clinical skills, review of self-assessments, discussion of progress in the milestones and entrustable professional activities, feedback to the competency committee on resident progress, career guidance, and participation in re-mediation of residents as needed. JEMS faculty will also participate in the interview and selection process of all applicants to the residency training program in the department.
Expected Outcomes of the JEMS program include a more comprehensive understanding for faculty and residents of the ACGME core competencies and the Next Accreditation System (NAS) - milestones in training, and entrustable professional activities (EPA's); higher quality teaching, direct observation, and assessment of our residents in training in the context of the NAS; formal longitudinal mentorship for each resident; and enhanced culture of education and educational scholarship in the Department of Medicine.
Evidence-Based Medicine (EBM) - Our program places a unique emphasis on the EBM training of residents. We have developed a multi-faceted curriculum, which goes beyond the traditional Journal Club:
1. EBM scripts during academic half day enable our residents to discuss important EBM concepts such as surrogate outcomes, without being limited to a single research article. EBM scripts are based on clinical scenarios and teach such concepts in an interactive and enjoyable manner.
2. Journal Club is held once a month during noon conference and introduces critical appraisal concepts, specific for each session. Senior residents and attending physicians facilitate small group discussions, where each resident engages actively in critical study appraisal.
3. EBM consults during academic half day, are short (10-15 min) presentations from our senior residents, each tasked with answering a clinical question. Residents practice formulating a question, searching and appraising the literature and finally discussing findings with their peers. This allows residents to become familiar with sources of original research studies but also of pre-appraised information such as the PIER modules, TRIP database etc.
4. EBM mini-CEX allows our residents to practice EBM in real time, while caring for their patients
In short, EBM scripts and Journal Club provides our residents with the necessary foundations of EBM and lifelong learning behavior, while the EBM consults and EBM mini-CEX ensure that our residents practice EBM in a format that can be easily integrated into a busy clinical setting.
Primary Care Track
The Division of General Internal Medicine was honored as a past recipient of the Robert Wood Johnson Generalist Physician Initiative Grant along with the Departments of Family Medicine and Pediatrics. This grant was one of only 14 awarded nationwide. Our residency program provides primary-care-oriented residents with complementary clinical, administrative, and research experience as part of our primary care track. This track combines the academic rigor and strong subspecialty experience of a university teaching hospital with the enhanced ambulatory and primary care experience afforded by our affiliation with a community teaching hospital and private practice groups. The major objective of this program is to respond to the increased need for well-trained general internists to serve in practice as well as academic positions. The primary care track residents are additional time for ambulatory rotations including outpatient general internal medicine in Lancaster, as well as additional subspecialty and general medicine electives such as health evaluation sciences and epidemiology, preventative care, geriatrics etc. Residents are also paired up with a dedicated primary care faculty member to serve as a mentor throughout residency.
Hospitalist medicine is one of the most rapidly growing and highly demanded areas of internal medicine. With a focus on the acutely ill, hospitalized patient, along with consultative medicine and perioperative management, residents on the hospitalist track will experience different care delivery, and management models. Additional rotations include Hospitalist Medicine rotations at Lancaster General Hospital, medicine consultation service, and pre-operative clinic as well as educational and elective opportunities such as quality improvement and systems based practice.
Intended for those physicians interested in pursuing a career in basic, clinical or translational sciences, the research track offers dedicated residents protected time during their residency training to complete research with a dedicated research mentor. There are ample opportunities for basic and clinical research through the academic resources of the medical center, Heart and Vascular and Cancer Institutes as well as the Penn State University Collage of Medicine. In addition to research opportunities during residency training we support the designated extended research tracks offered and supported through the ABIM
Internal Medicine Research Pathway - The ABIM Research Pathway is an integrated program that combines training in research with training in clinical internal medicine. This pathway is intended for physicians who intend to pursue a career in basic science or clinical research.
Subspecialty Research Pathway - The ABIM also offers residents a ‘Subspecialty Research Pathway' requiring 24 months of Internal Medicine and a further 12 – 24 months in sub-specialty training, after which a subspecialty or added qualification (AQ) examination may be taken in the fall of PGY-6 or 7 (dependent on specialty).