The Program Director's Overview of the Residency Program
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Mary Lynn Sealey, MD, FACP
Program Director,
Internal Medicine Residency Program
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The Western Pennsylvania Hospital is the western Clinical Campus of Temple University School of Medicine, one of the nation's premier medical institutions.
The ultimate goal of the Internal Medicine Residency Training Programs at The Western Pennsylvania Hospital is to produce an excellent internist - one who is proficient in the basic clinical skills of data gathering, clinical reasoning, differential diagnosis, planning diagnostic studies, managing clinical care, and in continuing to acquire new knowledge and apply it effectively to the care of patients.
The internal medicine residency program is directed by a full-time program director, three associate program directors, several full-time general medicine physicians, and five intensivists who are full-time key faculty. Full-time division chiefs and full-time and part-time faculty support the teaching program in general internal medicine and the Department of Medicine's approved fellowships. In addition, nearly 100 part-time faculty and voluntary staff assist with residency program training.
During their three-year residency, physicians in training are given gradually increasing responsibility for patient care. First-year residents are scheduled for rotations in general internal medicine, coronary care, medical intensive care, emergency medicine, and electives. Ambulatory care includes a one-half-day continuity clinic in the resident-faculty practice office, which continues throughout the three-year residency, and a one-month block rotation, which includes office experience in surgical subspecialties.
Second-year residents rotate as supervising residents in general medicine and coronary care and serve rotations in geriatrics, hematology/oncology, neurology, and pulmonary medicine. A second one-half day per week ambulatory care experience, in a private physician office, begins in this year and may continue through year three. An ambulatory care block month includes office orthopedics, managed care, and rehabilitation medicine. Electives may include cardiovascular diseases, dermatology, endocrinology, gastroenterology, infectious diseases, nephrology, rheumatology, pulmonary medicine, and sports medicine.
In the third year, the internal medicine resident plays a supervisory role in general medicine and medical critical care services and serves as a medical consultant and as an admitting resident in the emergency room. Responsibilities in ambulatory medical care are expanded to include visits to homebound patients. An ambulatory care block month includes an adolescent medicine experience in a high school clinic and a clinic in a homeless shelter. Electives in medical subspecialties, including subspecialty care in the office setting, are other options.
During the three-year program, the internal medicine resident spends increasing time serving as the primary care physician, under the supervision of attending faculty members, to general medical service patients.
Residency Organization
Each year, the Department of Medicine accepts 15 postgraduate year 1 (PGY1) physicians into the three-year program in internal medicine and 10 PGY1 physicians into a one-year Transitional Program. The Department of Medicine has accredited fellowships in cardiology, interventional cardiology,hematology/oncology, and pulmonary medicine, and residents in training programs at The Western Pennsylvania Hospital are given preference for these highly competitive fellowships. In addition, the Department of Medicine has an outstanding record for placement of graduates in highly respected fellowship programs at other institutions.
Curriculum
The following table provides an overview of the Internal Medicine Categorical/Primary Care curriculum.
Year One Rotations
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| Inpatient General Medicine |
5 months |
Inpatient General Medicine |
3 months |
Inpatient General Medicine |
2 months |
| Medical Intensive Care Unit |
1 month |
Cardiac Care Unit |
1 month |
Medical Intensive Care Unit |
1 month |
| Cardiac Care Unit |
1 month |
Ambulatory Block/Selective |
2 months |
Emergency Room |
1 month |
| Emergency Room |
1 month |
Geriatrics |
1 month |
Ambulatory Block |
2 months |
| Ambulatory Block |
1 month |
Hematology/ Oncology |
1 month |
Medical Officer of the Day |
1 month |
| Elective |
1 month |
Neurology |
1 month |
Consult Service |
1 month |
| Elective |
1 month |
Elective |
2 months |
| Continuity Experience 1/2 day each week |
Continuity Experience 2 1/2-days each week
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Continuity Experience 1 or 2 1/2-days each week |
| Night Float |
1 month |
Night Float |
1 month |
Night Float |
1 month |
| Vacation |
3 weeks |
Vacation |
3 weeks |
Vacation |
3 weeks |
| Research |
1 Week |
Conference |
1 week |
Conference |
1 week |
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There is a tropical medicine rotation available through West Virginia University School of Medicine. Up to two residents per year may apply for this elective with the approval of the program director.
Daily Schedule
The average day for a resident at The Western Pennsylvania Hospital begins at 7:15 a.m. with sign-in rounds. First-year residents see their patients plus any new admissions from the night-float team. At the same time (7:30 to 8:30 a.m.), the second- and third-year residents on the teaching service are at morning report, which is directed by a faculty member.
Work rounds take place between 7 and 8:30 a.m. daily. Residents see all patients, including new admissions from the previous night, follow up on routine laboratory tests, and formulate treatment orders.
Management rounds begin at 8:30 a.m. and last until 10:30 a.m. The management attending physicians take part in management rounds. Teaching rounds take place from 10:30 a.m. until noon on Monday, Wednesday, and Friday; during this time on Tuesday and Thursday, chief rounds are conducted by either the program director or chairman of the Department of Medicine. All five general medical services teams attend chief rounds. Some Tuesday sessions are set aside for mini-courses. From 11 a.m. until 1 p.m., an attending radiologist conducts rounds in the Radiology Department.
There is a didactic conference daily at noon, on core curriculum topics in internal medicine. The core curriculum also includes weekly Grand Rounds, Morbidity and Mortality conferences, clinical patient care conferences, medical ethics conferences, Journal Club, a monthly residents' meeting, and a residents' Continuous Quality Improvement committee meeting. There is a board review course for senior residents starting in January of each year.
Residents' afternoons are reserved for inpatient and outpatient care. The day concludes with medical sign-out rounds at approximately 4:30 p.m., when house staff review the day's admissions and alert the night-float team to any potential problems.
Medical On-Call Schedule and Working Conditions
Resident work loads are arranged to maximize educational experience and on-call schedules conform to the Work Duty Hours of the Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME). On-call time averages less than 72 hours per week at the PGY1 level and is significantly less at the PGY2 and PGY3 levels. Each resident has at least one 24-hour period off per week. There are no extended periods of call without rest.
Intensive care and coronary care unit call is every fifth night for interns.
A night-float system is used for resident coverage from 8:30 p.m. until 8:30 a.m. Sunday through Thursday, and each resident spends one month each year on the night-float service.
Coverage from 7 p.m. Friday through 7 p.m. Sunday is provided in 12-hour shifts by the five teams on the inpatient medical service, which results in each resident having a maximum of four 12-hour weekend calls each month.
When residents are on an elective rotation, they will have three or four calls for the month, from Sunday through Thursday.
Clinical support services, including phlebotomy and intravenous infusion teams, are staffed 24 hours a day by an IV team.
Supervision and Evaluation
To ensure excellent patient care and a superior academic experience, the Department of Medicine makes every effort to ensure that house staff have appropriate supervision and guidance while they act as primary care providers for their patients.
Supervision begins at the team level, where each PGY1 is responsible to a more senior house officer. The team, in turn, is supervised by the chief medical resident who is trained in internal medicine and interacts with the house staff on a daily basis to provide academic, clinical, and personal support. A directing physician also oversees each house staff team.
The patient's private attending physician or the assigned management attending physician supervises patient care. Guidance is provided by the directing physician of the house staff team, and daily teaching rounds are led by an assigned teaching attending physician, the program director, or another senior faculty member.
The Department of Medicine uses a web-based evaluation system, "New Innovations" for the convenience of the residents and attending staff to complete evaluations on-line.
Rounds and Conferences
Residents are expected to attend a number of rounds and conferences.
Morning Report
Senior residents meet each day with the department chairman, program director, or a senior faculty member to review admissions from the previous evening. The setting is informal, and discussion is focused on interesting cases and difficult patient management problems.
Work Rounds
Work rounds take place daily. Residents see all patients, including new admissions from the previous night, follow up on routine laboratory tests, and formulate treatment orders.
Management Rounds
Each work team (one PGY2 and two PGY1 residents, one fourth-year medical student, and one third-year medical student) makes morning rounds, during which team members review new admissions, discuss patient management, perform bedside examinations, and experience didactic teaching. One PGY3 resident has oversight responsibility for two work teams. The management attending physician participates in work rounds.
Teaching Rounds
Formal teaching rounds are held with an attending physician assigned to each team. These physicians are carefully selected from both the full-time and voluntary faculty for their teaching abilities. Daily teaching rounds include bedside case presentations with patient interviews and reviews of physical findings. Multiple aspects of the patient's care are discussed, including medical problems, psychosocial problems, ethical issues, and cost-effectiveness of care.
Morbidity/Mortality Conference
Our Morbidity and Mortality Conference provides the basic structure for a broad performance improvement program that relates to multiple competencies including medical knowledge, clinical skills, communication skills, system-based practice and practiced-based learning. The conference is attended by all internal medicine residents including subspecialty fellows, unit nursing directors, risk management, key department administrative staff and all core faculty. The entire medical staff is invited to participate. This conference meets for 2 hours each twice monthly. Residents on the floor teams and from block ambulatory rotation present mortalities but most of the conference is given over to resident presentation of morbidities.
Radiology Conferences
Radiology conferences are held two Tuesdays per month. House staff submit a list of films to be reviewed with a radiology attending physician or senior resident, who teaches the reading of plain x-rays, computed tomography scans, magnetic resonance images, radionuclide scans, angiography studies, and sonograms.
Journal Club/Evidence-Based Medicine
A Resident Journal Club meets monthly to discuss current trends in therapy and the science of medicine as drawn from their critical readings of the literature. There is a complete curriculum on Evidence-Based Medicine, overseen by full-time faculty and a statistician.
Lecture Schedule
A noon lecture series provides house officers with a coordinated, planned curriculum of lectures on a variety of important issues. Lectures during the first two months concentrate on medical emergencies and commonly encountered problems. Several days a month are set aside for special presentations. Medical Grand Rounds are held at noon once weekly. Morbidity and Mortality conferences and subspecialty conferences are also scheduled regularly.
Board Review
Beginning in January of each year, a formal Internal Medicine Board Review Course is held that includes didactic material, patient problems, and MKSAP questions; the Department of Medicine covers the cost of MKSAP for all PGY2 and PGY3 residents.
Medical Library
The Richard M. Johnston Health Sciences Library at West Penn Hospital contains more than 11,000 volumes, maintains subscriptions to 166 journals, and offers all major indices and citation retrieval services on-site to support clinical, educational, and research activities of residents and medical staff members.
The library is supervised by a full-time medical librarian. An interlibrary loan service is provided through West Penn Hospital's participation in the National Network of Libraries of Medicine (NN/LM) program, a network of eight regions with approximately 3,000 libraries that are coordinated through the National Library of Medicine in Bethesda, Maryland. West Penn's library offers on-line bibliographic services and individualized literature searches. The medical librarian provides individualized teaching and assistance to residents for Medline searches and general information retrieval.
In addition to the Richard M. Johnston Health Sciences Library, house officers in the Department of Medicine may use the departmental library, which contains reference material recommended by the American College of Physicians and personal computers that are available 24 hours a day, seven days a week, for use by residents in conducting on-line literature searches.
The Western Pennsylvania Hospital has made a major commitment to the development of high-quality laboratory and clinical research. As evidence of this commitment, The Western Pennsylvania Hospital Foundation has purchased a building and invested more than $5 million in renovating it as a basic science research center for the use of West Penn faculty and house staff. This building houses an accredited animal research facility, modern laboratory space, and a number of internationally respected research programs. The Department of Medicine and the Foundation provide support for resident research. Funds are available for poster, abstract, and paper presentations at local, regional, and national meetings.
The Department of Medicine has more than $1 million in external grant support and major research programs in cardiology and cardiac electrophysiology, gastroenterology, geriatrics, hematology/oncology, pulmonary medicine, renal/endocrine medicine, and rheumatology. The Division of General Internal Medicine has active research in osteoporosis, healthcare delivery, and medical education. Residents and fellows participate in many of our present research programs. Several house staff have submitted papers for publication or abstracts for presentation at regional and national meetings. All residents and fellows are expected to participate in one or more laboratory or clinical research projects. At the end of the first year the residents present their research project to the Research Committee for approval. In the second year the residents actively meet with their Research Advisors and begin to formulate a question, search the literature and write an abstract. In the third year the final project is presented to the Research Committee. All completed projects are presented at The Western Pennsylvania Hospital's Resident Research Day.
Resident Support Services
Residency is a stressful experience for both the physician and his or her family. While filled with excitement and growth, this time also brings added frustration, confusion, and fatigue. The extra pressures can both exacerbate normal life stress and create special problems. Most residents have huge financial burdens; many have spouses and children as well. Added to all these stresses are heavy demands, expectations, and long hours in the residency program.
To help residents and their families cope with stress, West Penn Hospital has an Employee Assistance Program through which residents and their families can receive problem-solving services. The services are strictly confidential and may be accessed by contacting the nurse practitioner in Employee Health. The Department of Medicine also has a resident stress monitoring program.
Medical Student Activities
The Western Pennsylvania Hospital is the western Clinical Campus of the Temple University School of Medicine. The Department of Medicine is also a major affiliate of the Lake Erie College of Osteopathic Medicine and the University of Pittsburgh School of Medicine. Required internal medicine and subspecialty elective rotations are also offered at The Western Pennsylvania Hospital for third- and fourth-year students from Lake Erie College of Osteopathic Medicine and for University of Pittsburgh medical students.
In conjunction with the universities and various schools in the Philadelphia and West Virginia areas, senior elective rotations are offered in all subspecialties of internal medicine, including an acting internship.
Moonlighting Opportunities
On-site moonlighting opportunities, which are incorporated into the educational experience, are available for third-year residents and fellows. All hours are counted toward the 80 hour work limit.
Contact Information
Mary Lynn Sealey, MD , FACP
Program Director, Internal Medicine Residency Program
The Western Pennsylvania Hospital
4800 Friendship Avenue
Pittsburgh PA 15224
(412) 578-6937 or 1-800-545-4WPH
email
