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Curriculum Overview| Rotation Hightlights |Conferences | 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.
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.
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.
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.
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.
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.
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.
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
Patients admitted to Einstein Medical Center with acute coronary syndromes, heart failure exacerbations, arrhythmias, and other cardiac pathologies are admitted to our telemetry unit and receive continuous heart monitoring. Teams made up of two senior residents, three interns, and a cardiology fellow round daily with a cardiologist to develop appropriate plans of care for their patients. Residents will learn in depth about all types of cardiac pathology and receive one on one instruction from cardiologists. Residents will also master interpretation of EKGs, learn the basics of echocardiography, and how to coordinate continued care of these patients after discharge.
The Einstein Internal Medicine residency program operates on a strict night float system which eliminates overnight “call” and is 100% compliant with ACGME duty hour requirements. At night, three senior residents and two interns are responsible for the continued care of the patients under the care of the general medical teams, the hepatology team, and the oncology team, and also admit patients to the hospital from the emergency department. The medical intensive care unit, telemetry and coronary care units, and the step down unit have night float built into their rotations, and continue to care for their patients. Interns and residents on this rotation can expect to gain experience in admitting patients, learning how to handle emergency situations (raid responses), and how to lead a code blue team. All of this is accomplished under the direct supervision of a night chief medical resident who is a credentialed attending and part of the teaching hospitalist group. In addition to supervising care, the night chief resident will supervisor procedures, attend code blues and rapid responses, and provide a structured educational experience for the residents.
With the evolving complexity of healthcare in the United States, it is becoming more apparent that primary care is the necessary foundation for the delivery of high quality medical care. Recognizing this, the Einstein Internal Medicine residency program has taken a proactive position to prepare residents for the challenges of outpatient internal medicine tomorrow. At our on-site resident continuity clinic, our residents learn to manage both common and complex conditions in the outpatient setting. Furthermore, they are trained to navigate the intricacies of local and national healthcare delivery systems to ensure patients receive cost conscious, streamlined, evidence-based care.
As an extension of Einstein Internal Medicine Associates, Einstein Medical Center-Philadelphia’s flagship academic primary care provider group, our faculty provides the ultimate balance of supervision and autonomy necessary for the mastery of outpatient practice. Our system of graded supervision allows for close support and guidance of residents as they begin their training. This oversight is carefully and appropriately scaled back proportionate to individualized resident needs as they attain clinical competency milestone skills throughout the course of their three years of training. This supervision is provided by three full time attending physicians whose scope of practice is centered in the resident continuity clinic.
Our residents are given instruction not only relevant to the clinical skills necessary to provide care for primary care patients, but are also provided a framework within which they may develop the skills to become the healthcare leaders of tomorrow. With focus on patient safety and quality improvement our residents have the opportunity to improve care not only to one patient at a time but potentially thousands of patients at a time. The role of the primary care physician is changing to that of a population health manager and our residents finish our program fully prepared for the challenges inherent to this demanding position.
Perhaps most importantly, our residents learn to touch the lives of patients other medical systems may be unable or unwilling to reach. We embrace the Einstein mission of providing high quality compassionate care for as many as we can reach. Our patients face every conceivable social, economic, political, and cultural barrier to health care. While others view such barriers as an avoidable hindrance, we view them as opportunities. They are opportunities to teach. They are opportunities to learn. They are opportunities to improve the quality of life of those overlooked by society and in turn better ourselves. Indeed, every day of work in our continuity clinic brings with it all the rewards of community service while at the same time meeting all the educational needs of ambulatory internal medicine training.
Multiple conferences are provided each day to supplement bedside learning. A description of our most common conferences can be found below.
SUMMER LECTURE SERIES- reinforces the fundamentals of internal medicine
MEDICAL GRAND ROUNDS
CLINICOPATHOLOGIC CONFERENCE - case based instruction that illustrates the logical, measured consideration of a differential diagnosis used to evaluate patients.
JOURNAL CLUB - in-depth examination of recent high profile studies and discussion about their application to clinical practice
CRITICAL APPRAISAL OF THE MEDICAL LITERATURE - classic articles are used to teach residents how to evaluate different types of studies and other fundamentals of evidence based medicine
MORBIDITY AND MORTALITY CONFERENCE
SUBSPECIALTY ROUNDS - clinical case discussion mediated by a specialist attending
AMBULATORY ACADEMIC HALF DAY - a mixture of didatics and case presentations centered on ambulatory medicine
MOCK CODE/SIMULATION TRAINING
Our training program provides a formal integrated curriculum to support resident research. The practical component of the curriculum consists of designing and implementing a research project under the guidance of a faculty research mentor and the Resident Research Committee. Beginning at the start of their residency, residents are provided with protected research time so their projects can steadily progress advance. In addition to frequent informal meetings with their research mentor, all residents will meet formally with the research committee to discuss any challenges and ensure they have the appropriate support to achieve their milestones. The goal is for every resident to present their research at a national conference and submit a manuscript to a peer-reviewed journal prior to completing residency. This practical component is supplemented with a structured didactic curriculum which trains residents on basic methodology and study design, data analysis, and data presentation. We feel it is critical for residents to gain an understanding of the research process so they can better appreciate the strengths of limitations of the medical literature. We are incredibly proud of the diverse high quality scholarly work produced by Einstein residents. A summary of our most recent graduate’s accomplishments can be found here.
James Cosentino explains what has made his Einstein learning experience so valuable through his first year of the Internal Medicine residency at Einstein Healthcare Network.