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 four 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 1 senior resident and 1 intern with a team size of 10-12 patients.
The Lebanon VA Medical Center teams consist of 1 senior paired with 1 intern, with the team size capped at 10 per team.
At the Hershey Medical Center, teams are on call every 4th day, responsible for admissions from 12-7PM. Admissions from 7AM to 2PM are triaged based on complexity and admitted by the short call team or hospitalist services based on patient census. After 7 PM a night team of House Officers and Nightfloats take over all admission and cross cover responsibilities.
At the Lebanon VA Medical Center teams are on call every 3rd day. After 6PM a nightfloat is responsible for all admission and cross cover
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.
• 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. 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.
Academic Half Day
The academic half day was inintially introduced in the ambulatory blocks. Due to it's success we have transitioned the academic half-day into our inpatient curriculum as well. In lieu of a daily noon conference, one half-day a week is reserved for lectures from various departments presenting board-relevant topics.
As part of our Evidence-Based Medicine (EBM) curriculum Journal Club is held once a month 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 a 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.
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 traditional Journal Club:
- EBM scripts during academic half day enable our residents to discuss important EBM concepts such as surrogate outcomes and hierarchy of evidence, without being limited to a particular research study. EBM scripts are based on clinical scenarios and teach such concepts in an interactive and enjoyable manner.
- Journal Club is held once a month during our academic half day and introduces different critical appraisal concepts for each session. Senior residents and attending physicians facilitate small group discussions, where each resident actively engages in critical study appraisal. We utilize a debate format and other interactive methods to engage our residents in the process.
- 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 pre-appraised information such as the PIER modules, TRIP database etc.
- EBM mini-CEX allows our senior residents to practice the application of EBM principles in real time, while caring for their clinic patients.
In short, EBM scripts and Journal Club provide our residents with the necessary foundations of EBM and lifelong learning behaviors, while EBM consults and EBM mini-CEX ensure that our residents practice EBM in a format easily integrated into a busy 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 our 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.
Basic Clinical Skills - During early ambulatory blocks 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.
Primary Care Track
Our primary care track enables residents with an interest in primary care to obtain more experience in the outpatient setting. In addition to their own clinic, primary care track residents spend additional time working one to one with experienced primary care physicians. They also receive protected time to participate in our longitudinal outpatient quality improvement projects, as well as a two week experience as Junior Faculty. This block rotation allows our residents to work closely with the ambulatory training director, organizing educational activities such as the academic half day and improving on our outpatient curriculum. Finally, primary care track residents spend 2-4 weeks at a community based outpatient practice where they function with a high level of independence, managing common ambulatory conditions.
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).