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Curriculum

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Curriculum Overview | Rotation HighlightsConferences | Scholarly Activity

The Einstein Medical Center Philadelphia 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.

Breaking News - New Educational Opportunity:

Urban Health Track
The Einstein Medical Center Philadelphia Urban Health Track is designed for those residents who are interested in caring for diverse patient populations and who desire to work towards health equity. The residents will have the unique opportunity to delve more deeply into the concepts of health disparities, social determinants of health, and implicit bias. In addition, they will have the opportunity to engage in community partnerships and health advocacy.

Residents will have the opportunity to:
-Gain insight regarding the roots of social disparities in healthcare and understand how they continue today.
-Develop skills necessary to utilize screening tools relevant to an urban population.
-Understand the particular struggles in achieving the triple aim of modern healthcare in an urban population.
-Gain insight regarding the stigma conferred by: socioeconomic status, race, sexual orientation, gender identity, and behavioral health conditions including substance use disorders.
-Understand the principles of health equity
-Develop knowledge regarding accountable are organizations and their role in an urban population.
-Have exposure to the FQHC model of healthcare and how they sustain care for the underserved.
-Partner with community healthcare stakeholders as well as non-healthcare stakeholders to better serve the community.

What is "6+2"?

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 “6+2” model, where residents will spend 6 weeks on inpatient rotations followed by 2 weeks in the ambulatory setting. This ensures that residents get the best possible education in each setting.

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
  • PGY-1 residents rotate on the general medical floors, through both the medical and cardiac intensive care units, the telemetry and hepatology inpatient units, the emergency department, take part in night float coverage, and do elective rotations
  • All residents are given protected time in the PGY-1 year to begin a scholarly project
  • Ultrasound Curriculum begins in the PGY-1 year

PGY-1

  • General medical floor (wards)
  • Hepatology
  • Stepdown unit
  • Medical Intensive Care Unit
  • Cardiac Care Unit
  • Cardiology Telemetry Unit
  • Night float
  • Electives
  • Ambulatory experience 6+2 model (or 4+1 elective for preliminary year residents)
  • Emergency Medicine

For their PGY-2 and PGY3 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!

PGY-2

  • General medical floor (wards)
  • Hepatology
  • Stepdown unit
  • Medical Intensive Care Unit
  • Cardiac Care Unit
  • Cardiology telemetry unit
  • Neurology
  • Geriatrics
  • Electives (away elective optional)
  • Medicine consults
  • Night float
  • Ambulatory experience 6+2 model and subspecialty clinics

PGY-3

  • General medical floor (wards)
  • Hepatology
  • Stepdown unit
  • Medical ICU
  • Cardiac Care Unit
  • Admitting Resident
  • Electives (away elective optional)
  • Night float
  • Ambulatory experience 6+2 model and subspecialty clinics

Curriculum Overview | Rotation HighlightsConferences | Scholarly Activity

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 and resident, 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 non-teaching service. Patients admitted for routine procedures and those admitted after teams are at capacity are admitted directly to the non-teaching service. The non-teaching 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 non-teaching service.

Critical Care

In the Medical Intensive Care Unit (MICU) and the Coronary Care Unit (CCU), 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 MICU, 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.

Curriculum Overview | Rotation HighlightsConferences | Scholarly Activity

Step Down Unit

The step down, or progressive care unit, is equipped with the technology and staff to manage patients requiring advanced care. Residents will learn to care for patients who 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, chronic obstructive pulmonary disease (COPD) and asthma exacerbation, and gastrointestinal bleeding. Residents are also responsible for patients on chronic mechanical ventilation, working closely with the pulmonary team.

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 (including ultrasound teaching) 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, two interns and a gastroenterology fellow conduct bedside teaching and work rounds daily with a dedicated transplant hepatologist. The team cares 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, they can also become proficient in bedside paracentesis.

Telemetry

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. A team made up of one senior resident, two interns, a cardiology fellow, and cardiology attending round daily 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.

Night Float

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, two 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 admit patients to the hospital from the emergency department. There is also a team that covers the coronary care unit and telemetry floor consisting of one senior resident who performs all the admissions and another senior resident who covers the patient on the floors with one intern. The medical intensive care unit, and the step down unit have night float built into their rotations as this facilitates continuity of care. Interns and residents on this rotation can expect to gain experience in admitting patients, learning how to handle emergency situations (rapid 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. The residents also work hand in hand with the fellows in the units such as in the MICU and CCU.

Curriculum Overview | Rotation HighlightsConferences | Scholarly Activity

Ambulatory Experience

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 and streamlined evidence-based care. It is now clustered into 2-week blocks alternating with the 6-week in-patient rotations. This facilitates better continuity of care especially for patients needed to be followed up more closely within the next 14 days.

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 and milestone skills throughout the course of their three years of training. This supervision is provided by four full time attending physicians whose scope of practice is centered in the resident continuity clinic. Residents also get the opportunity to rotate to various outpatient medicine and non-medicine subspecialty clinics. This is for residents to have concrete and fulfilling experiences that can give them a glimpse of the dynamic nature of these medicine specialties of which they might want to go into in the future.

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 one patient at a time but for potentially thousands of patients. 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 Community Practice Center (CPC) caters to the underserved population in North Philadelphia. We have a newly established Medication-Assisted Treatment (MAT) program to help treat opioid dependence. We have streamlined diabetes management clinic to foster better adherence to medical therapy, follow up and screening. Pre-exposure prophylaxis (PrEP) options are also integrated in the management of high-risk patients to prevent transmission of HIV. The CPC has a dedicated refugee clinic supplemented by assistance from social work, psychiatry and complemented by the inherent diverse Einstein resident roster to bring about the most culturally sensitive care possible for this special population.

Our patients face every conceivable social, economic, political, and cultural barrier to healthcare. 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.

Residents are also given the opportunity to participate in community outreach initiatives that include educational series at several community partners as well as health fairs and other community activities. In addition, residents are partnered with other care team members including community health workers, patient navigators and social workers for home visits and social determinants of health assessments through these visits and assessments they learn about available resources to help our patient population.


GME Internal Med - Phila Curriculum

Conferences

Multiple conferences are provided each day to supplement bedside learning. A description of our most common conferences can be found below.

SUMMER LECTURE SERIESreinforces the fundamentals of internal medicine

NOON CONFERENCE

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

MORNING REPORT

AMBULATORY ACADEMIC HALF DAY - a mixture of didactics and case presentations centered on ambulatory medicine 

MOCK CODE/SIMULATION TRAINING

BOARD REVIEW

RESIDENT RUN CONFERENCE


GME Internal Med - Phila Conferences


Curriculum Overview | Rotation HighlightsConferences | Scholarly Activity

Scholarly Activity

Our training program provides a formal integrated curriculum to support resident research or scholarly activities. The practical component of the curriculum consists of designing and implementing a research project or scholarly activity under the guidance of a faculty research mentor and the Resident Scholarly Committee. From the start of their residency, residents are provided with protected research time in the form of half days during their ambulatory clinic blocks so their projects can steadily progress.

In addition to frequent informal meetings with their research mentors, all residents will meet formally with members of the Resident Scholarly Committee to discuss any progress, challenges and timelines. Residents are also required and encouraged to discuss about their research experiences openly informally during their ambulatory week blocks. This helps to establish a network of mutual interests between residents and mentors which increases collaboration and support to help achieve their research milestones. The goal is for every resident to present their research at any local, national or international conference and or to publish a manuscript to a peer-reviewed journal prior to completing residency.

This practical component is supplemented with a structured didactic curriculum which gives the residents background on basic methodology and study design, data analysis, and data presentation. There are also separate Evidence Based Medicine (EBM) lectures which deals with the critical appraisal of medical literature. 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. This also provides them with the necessary tools to be self-directed lifelong learners.

Scholarly Activity Resources

Einstein’s IRB application process has been refined further to facilitate easier processing of paperwork all of which can now be done online. It is now simplified with a step by step process with tutorials available on how to navigate the system. Einstein also has support available to assist with both basic and advanced statistical analyses. The Einstein Luria Library also provides access to software for statistical analyses and management of references. Funding for research can be applied for and sponsored by the Albert Einstein Society (AES) Seed Grants. Some of the categories include Early Career Researcher, Quality Improvement and Healthcare Disparities grants.

We are incredibly proud of the diverse high-quality scholarly work produced by Einstein residents. A summary of our most recent graduates' accomplishments can be found here. A summary of the recent scholarly activity during the COVID-19 pandemic can be found here.

Ultrasound

Our program provides formal ultrasound training making certain that residents have both cognitive and technical competency in many areas of Point of Care Ultra Sonography (POCUS). This equips residents with an essential skill set to keep up with the growing demands and pace of modern medical practice.

Residents will have various opportunities to apply these conceptual ultrasound knowledge and skills in the actual clinical setting under direct attending, fellow or senior resident supervision during all of their rotations.

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