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Curriculum

  • Curriculum

    Years | RotationsConferences | Research

    The Einstein Medical Center Internal Medicine Residency Program is structured to provide a comprehensive core curriculum in internal medicine. This is accomplished through supervised daily patient care activities as well as an extraordinary number of high-quality didactic educational experiences.

    The residency program is structured to ensure that each resident has the opportunity to acquire the knowledge, clinical and interpersonal skills, professional attitudes and behaviors, and experience required to become an outstanding general internist or subspecialist.

    For each required and elective rotation a written curriculum defines the educational purpose, training objectives, principal teaching and educational methods, educational content, and evaluation process one can expect from that rotation.

    Our didactic curriculum covers the full range of general internal medicine and all its subspecialties. These lecture series give structure to training in medical ethics, behavioral science, continuous quality improvement, medical informatics, legal medicine, preventive medicine, environmental and occupational medicine, cost-conscious care, and patient safety as well as financial planning for the resident, contract negotiation, and other career development topics.

    What is "4+1"?

    Medicine 4 + 1 chart

    The Einstein Internal Medicine Residency Program is organized such that the core and elective inpatient rotations and ambulatory educational experiences, including continuity clinic, are separate.  We operate in a “4+1” model, where residents will spend 4 weeks on inpatient rotations followed by 1 week in the ambulatory setting.  This ensures that residents get the best possible education in each setting with minimal interruptions.

    Curriculum Overview

    The PGY-1 year focuses on fundamentals of differential diagnosis and clinical problem solving. Residents in the first year master the techniques of history-taking and physical examination, gain expertise in the care of patients in a variety of inpatient and ambulatory settings, and develop competence in basic procedural skills. At the conclusion of the PGY-1 year, residents are prepared to supervise patient care and provide leadership for a medical team. PGY-1 residents rotate on the general medical floors, through both the medical and cardiac intensive care units, the telemetry and oncology inpatient units, the emergency department, take part in night float coverage, and do an elective rotation.

    For their PGY-2 and PGY-3 years, the curriculum provides for ongoing, excellent training in general internal medicine, ambulatory care, subspecialty medicine, and medical consultation as well as a variety of advanced procedural training opportunities. Experience on the medical consult service ensures that residents develop expertise in the clinical and interpersonal skills essential to the practice of internal medicine. Specific to the second year, residents rotate on the geriatric and neurology services. Third year residents spend time as the admitting resident, coordinating care of patients as soon as they are admitted.  Clinical and didactic teaching is integrated into a core curriculum that focuses on the competencies expected of practicing internists. Internal medicine residents have the opportunity to design the elective portion of their curriculum to focus on primary care or a specific subspecialty, depending on their unique career aspirations and needs. Our curriculum offers a wide range of elective opportunities in all specialties. In addition, senior residents have the option during either their second or third years to do an elective at an outside institution including an international experience!  All residents are given protected time in the PGY1 year to begin a research project. Protected research time is also available in the second and third years, and many of our residents have taken advantage of this opportunity to gain advanced experience in research methodology, the institutional review process, statistical analysis, and manuscript preparation.

    Medicine Example Schedule

    Years | RotationsConferences | Research | Top

    Rotation Highlights

    GENERAL MEDICINE

    General medicine services are the core of our residents’ inpatient experience. Because Einstein Medical Center Philadelphia is a referral center for area hospitals, medical residents receive hands-on training in the care of patients with the full spectrum of complex illnesses.

    General medicine services are organized into teams. Each team typically includes one to two medical students, a pharmacy student, two PGY-1 residents, one senior resident, and a full-time teaching attending. Each teaching attending is a full-time hospitalist who supervises patient care activities on each team and conducts daily bedside teaching rounds.  The team approach extends to include nurses, social workers, pharmacists, and care managers allowing residents to establish collaborative and continuous partnerships with all.

    PGY-1 residents on the general medicine service have primary responsibility for up to eight patients and receive close supervision and extraordinary teaching. PGY-1 residents learn to become excellent teachers of medical students. Senior residents can care for up to 16 patients, and play the most significant role in leading the team.

    In order to ensure that the residency program remains focused on its educational mission, the Department of Medicine sponsors a nonteaching service. Patients admitted for routine procedures and those admitted after teams are at capacity are admitted directly to the nonteaching service. The nonteaching service guarantees that residents have responsibility for an appropriate number of patients, ensures an appropriate workload, and guarantees the educational value of each patient on a resident’s service. Physician assistants and dedicated physicians provide full-time coverage for the nonteaching service.

    Medicine Rounding

    CRITICAL CARE

    In the Medical Intensive Care Unit and the Coronary Care Unit, medical residents learn to manage patients with multi-system failure and a variety of life-threatening illnesses. The critical care units offer a challenging patient mix and exceptional learning opportunities. Each unit team includes PGY-1 residents, senior residents, a subspecialty fellow and the teaching attending.In the Medical Intensive Care Unit, our designation as a Level I Regional Resource

    In the Medical Intensive Care Unit, our designation as a Level I Regional Resource Trauma Center and participation in a helicopter transport program ensure a broad experience for medical residents. Active programs in cardiovascular, pulmonary, oncology, hepatobiliary and infectious disease, as well as transplantation, also ensure outstanding learning opportunities for medical residents.

    Daily teaching rounds and conferences supplement the clinical experience for medical residents in the critical care units. The core curriculum ensures that residents achieve competency in a variety of procedural skills, including ventilator management, ECG interpretation, arterial and central line placement and advanced cardiac life support. A nurse facilitator coordinates patient transfers in and out of the units, freeing residents to concentrate on learning and patient care.                                                                                                     
                                                                  

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    Years | RotationsConferences | Research | Top

    STEP DOWN UNIT

    The step down, or progressive care unit, is a 24 bed unit equipped with the technology and staff to manage patients requiring advanced care. Residents will learn to care for patients that need very close monitoring as well as learning the principles of patient triage.

    The case mix is diverse so the learning opportunities are vast. Typical problems include diabetic ketoacidosis, sepsis, drug overdose, COPD and asthma exacerbation, and gastrointestinal bleeding. Residents are also responsible for patients on chronic mechanical ventilation, working closely with the pulmonary team in weaning efforts.

    The unit is staffed by full time hospitalist attendings that are part of the core faculty of the residency program. Work and teaching rounds occur every morning, and frequently additional didactic sessions in the afternoon are held to review topics that pertain to the current patients on the service.

    Opportunities for procedures, such as paracentesis or central venous catheter placement, exist and there is always sufficient supervision.  Residents will also gain experience in the management of non-invasive positive pressure ventilation in patients that are stable enough to be managed outside of the critical care unit.

    HEPATOLOGY

    The hepatology service at Einstein Medical center is an active transplant service.  A senior resident, an intern, and a gastroenterology fellow conduct bedside teaching and work rounds daily with a dedicated transplant hepatologist and care for patients on both the general medical floor and step down unit.  Residents have a unique opportunity to learn about a wide variety of liver pathology from experts in the field, and also can experience in bedside paracentesis.

    ONCOLOGY

    On this service residents will care for patients with all stages of malignancy, in both solid organs and hematologic malignancies.  A team made up of a senior resident, an intern, and a medical student round daily with a board certified hematologist/oncologist.  Residents learn to care for every kind of oncology patient from stable patients receiving chemotherapy infusions to those with oncologic emergencies.  In addition to daily rounds, residents receive extra didactic sessions and the opportunity to attend various tumor boards. They also gain exposure to skilled end-of-life decision making

     

    Years | RotationsConferences | Research | Top

    Conferences

    A full and robust schedule of conferences contributes to the active learning environment for medical residents.

    Summer Conference Series

    • July and August feature the summer conference series, in which the fundamentals of clinical decision-making and patient management are reviewed.  View a sample of last year's schedule

    Curriculum Conference

    • These interactive, case-oriented lunchtime conferences begin in September and continue through May. They take place two days per week and focus on a core curriculum in general internal medicine, internal medicine subspecialties and related specialties.

    Benjamin Gouley, MD, Medical Grand Rounds

    • Wednesdays feature Benjamin Gouley, MD Medical Grand Rounds, at which visiting professors and guest lecturers share their expertise with medical residents and faculty.

    Firm Conference

    • Weekly firm conferences provide an informal group setting and serve as the perfect venue for journal club, morbidity and mortality review and medical ethics case conference. 

    Evidence-Based Medicine and Research Conferences

    • Residents have an opportunity to present their research in progress at these monthly conferences.  In addition, journal articles are reviewed and critical appraisal of the literature skills are taught. Lunch is provided at these conferences.

    Regional and National Meetings 

    • Residents are encouraged to present their scholarly activity at  regional and national meetings of the American College of Physicians and the subspecialty societies. The Department of Medicine offers time off and conference stipends to help residents take advantage of these opportunities.

    Years | RotationsConferences | Research | Top

    Research

    The Department of Medicine’s commitment to resident education is reflected clearly in the opportunities, encouragement and support provided for resident research.

    The PGY-1 research rotation includes supervised experience in computer-assisted literature searching, an introduction to epidemiology and biostatistics and instruction in critical review of the medical literature. Residents select an area of interest and present their findings at the annual Department of Medicine Resident Research Symposium.

    A number of research projects initiated in the PGY-1 year have culminated in presentations at national meetings or publications in peer-reviewed journals.

    The Department of Medicine encourages all residents to participate in scholarly activity and we are especially proud of their research achievements.