MCMC IM Clinical Experience

• Attending Rounds: Teaching rounds are held five times per week for 1½ hours. Medical students and interns present cases for an in-depth discussion of differential diagnosis and management. Bedside teaching is integrated into daily rounds. The team resident assists the teaching attending by reviewing aspects of the case using an evidenced-based approach. Teams are organized so that the teaching attending has clinical responsibility for the majority of patients cared for by the team. Thus, rounds advance education and clinical care simultaneously.
• Interdisciplinary Rounds: Inpatient floor residents meet daily with attendings, case managers, social workers, discharge planners and others to discuss the ongoing care of patients.

6:30 – 7 a.m. Arrive, get sign-out from night float team 
7 – 8:30 a.m. Pre-rounding and bedside rounds with student/intern/resident/nurse when possible with focus on targeted physical exam, daily patient plans, and writing daily orders 
8:30 – 11 a.m. Interdisciplinary rounds and teaching rounds with floor team intern(s), resident(s), student(s), and teaching attending 
11 a.m. – 12 p.m. Daily Work: Write progress notes, follow-up on tests, labs/procedures, work up new patients, do procedures under supervision when indicated.
12 – 1 p.m. Noon conference. 
1 – 2:30 p.m. Daily Work: Write progress notes, follow-up on tests, labs/procedures, work up new patients, do procedures under supervision when indicated, antibiotic and subspecialty rounds, re-round on floors and check in with nursing & patients 
2:30 – 3:30 p.m. Intern or Resident Report (1x/week) or continue daily work 
4 – 4:30 p.m. Prepare sign-out as a Team. Sign-out rounds with long shift team. 
7 p.m. Long shift team signs out to night float team.

In the Intensive Care Unit, residents work in teams of 3-5 under the supervision of board-certified intensivists. Critical care is a dynamic and challenging specialty, in which we care for the sickest of patients. Working knowledge of all organ system pathologies and basic medical physiology is highlighted in order to provide high quality patient care in the Intensive Care Unit.

The ICU rotation offers a breadth of clinical learning to foster your management of patients with complicated medical diagnoses. Patients are admitted to the Intensivist team and managed in conjunction with the other subspecialists. The resident team will also help co-manage surgical patients in the ICU under the supervision of the intensivist as a consultant. This exposes the residents to how a critical care consult service operates on non-medicine-based patients. Residents will be co-managing, with the intensivist, medicine-based issues and problems in critically ill patients. This will emphasize teamwork, interdisciplinary care, and evidence-based care.

• Daily Work/Teaching Rounds: These rounds are held daily with the ICU team of residents, interns, students, and the Attending Intensivist making rounds on patients that day. Bedside teaching is combined with didactic sessions to enhance understanding of the management of critically ill patients. Residents are expected to actively participate in rounds and present new patients admitted to the ICU service. An emphasis on procedural skills is a cornerstone of this rotation experience.
• Supplemental education: Provided via the Society of Critical Care Medicine’s Virtual Critical Care Rounds, which offers our residents access to over 20 online education modules, from basic to advanced topics, in critical care medicine.
• Weekly Ethics Conference: with skilled ethics team.
• Directly-Supervised Procedures: All procedures are done by residents under the direct supervision of the Intensivist and/or a certified resident. This includes training in the use of ultrasound to place central and arterial lines and perform venipuncture. Through small group hands-on sessions with an Intensivist and Chief Resident, the trainee is able to practice on life-like models in addition to real time procedures in the ICU.

Pictured above: Chair of Medicine and Board Certified Intensivist, Dr. Rotem Friede teaches residents how to perform an Internal Jugular Vein Central Venous Access procedure on a simulator.

The ambulatory curriculum at MCMC occurs in an X+Y System, where X (inpatient) rotations are 4 weeks long, and Y (outpatient( rotations are 2 weeks long.

During Y Blocks, residents attend multiple sessions in their continuity clinic where each resident is assigned to a hospital-based resident practice. Residents will follow patients in the practice throughout the three years of residency. Our hospital-based clinics feature an integrated electronic health record and they collaborate with major insurers in unique programs of case management. During a clinic session, each patient is reviewed with faculty preceptor. Through continuity clinic sessions, residents will gain experience in chronic disease management of a panel of patients. They also gain proficiency in acute and episodic care of patients primarily followed by other resident providers.

“Y Blocks” are also dedicated to teaching residents the principals of outpatient and specialty medicine.

Once a week, residents participate in a formal Academic Half Day. This 4 hour session consists of case-based discussions about topics in ambulatory medicine, quality improvement, concepts of high-value care, concepts of health care disparities, unconscious bias training, and more.

Residents have ample elective time during their training. Residents focus their elective time in core internal medicine electives (Cardiology, Endocrine, GI, Hematology-Oncology, Pulmonary, Infectious Diseases, and Nephrology). The remaining elective time can be done in other internal medicine electives or, on occasion, non-IM electives (psychiatry, radiology, and anesthesia). Electives are a mix of inpatient and ambulatory clinical work. During electives our residents work side by side with attending physicians. Clinical learning is enhanced by formal and informal didactic learning. Residents may also do one “away” elective outside of MCMC. Many residents take advantage of this opportunity to gain experience with medical care in one of the University Hospitals in the Philadelphia area.

Residents have ample elective time during their training. Residents focus their elective time in core internal medicine electives (Cardiology, Endocrine, GI, Hematology-Oncology, Pulmonary, Infectious Diseases, and Nephrology). The remaining elective time can be done in other internal medicine electives or, on occasion, non-IM electives (psychiatry, radiology, and anesthesia). Electives are a mix of inpatient and ambulatory clinical work. During electives our residents work side by side with attending physicians. Clinical learning is enhanced by formal and informal didactic learning. Residents may also do one “away” elective outside of MCMC. Many residents take advantage of this opportunity to gain experience with medical care in one of the University Hospitals in the Philadelphia area.

All residents participate in a geriatric selective. During this experience, residents are guided by a board-certified geriatrician in a variety of experiences with elderly patients including:

• Long-Term Acute Care: Medical Residents see patients in Long-Term Acute Care, participate in wound care rounds, and work with a nutritionist.
• Nursing Home: Residents round with a faculty member in a nursing home.
• Hospice Visit: The residents spend time with a hospice nurse doing home visits.

All residents participate in a consultation rotation during their third year. During the rotation, the resident will:

1. Perform in-house medical consults required by other services (i.e., Ortho/Surgery/GYN/Neurosurgery/ Physical Medicine and Rehab).
2. One half–day each week, the resident will have an opportunity to review topics in consultative medicine assigned by the preceptor.
3. Learn important concepts of hospitalist medicine including billing and coding.

Residents rotate in the busy emergency room at MCMC. Residents train under emergency department physicians, focusing especially on patients presenting with acute complaints not likely to require admission. Residents are also assigned as the admitting officer of the day (AOD) as a rotation. The AOD is a first-contact physician for admitted patients and helps facilitate triage and management of the patient while in the process of being admitted. In addition, the AOD acts as a liaison between ED and inpatient teams.