The inpatient clinical and teaching activities at Temple University are centered around rotations on the General Medical Service and the intensive care units. Each Medicine team is staffed by two second- or third-year residents, two first-year residents, and one to three medical students, who work with one attending. We are dedicated to our 1:1 ratio of resident to intern because we believe that it delivers the most comprehensive and individualized education possible.
The activities of each service are supervised by full-time teaching attending physicians who conduct daily teaching rounds. Residents may be assigned to subspecialty units in Congestive Heart Failure, Cardiology, Nephrology, Pulmonology, and Hepatology, which are supervised by their respective specialist attendings.
In March 2014, Temple successfully transitioned to a q4 call schedule, which involves an overnight call every 8 nights or an average of 3-4 overnight calls during a month of general medicine floors. The system works based on a hemi-team structure where one half of the team (1 resident and 1 intern)is present during the day on a call day. The other half of the team comes in during the evening of the call day and admits patient overnight. Both hemi-teams reconvene in the morning, round on all of the patients and the overnight team signs out to the other hemi-team when their patients have been wrapped up. (Typically around Noon). Non-call days or “Short call days” consist of a maximum of two redistributed patients in the morning and 3 new admissions spread throughout the day, all coming before 4pm. Reviews of this system have been shown to help decrease hand-offs, improve continuity of care and increase resident ownership of their patient.
Rotation PGY-1 (wks) PGY-2 (wks) PGY-3(wks)
General Medical Services 12-18 16-22 10-16
Elective Rotations 4-6 6-8 9-10
Fox Chase Cancer Center 0 0-4 9-10
Intensive Care Services 4-8 4-8 0-4
Emergency Department 2 0-2 0-2
Medical Admitting Resident/Housechief 0 0 2
Intern Cross-Cover Night Float 2-4 0 0
Medical Consult 0 0 2-4
Geriatrics 0 1 3
Vacation Weeks 4 4 4
Night Admitter 0 2-4 2-4
Ambulatory 10 10 10
Note: The above chart may add up to over 52 weeks due to variability in schedules.
The role of the medical house officer is characterized by direct and extensive responsibility for the care of patients. Therapeutic decisions are primarily based on evidence published in the medical literature rather than personal anecdote. An intellectually stimulating environment is fostered on the services by the close one-to-one relationships between the second/third-year resident and the first-year resident and unobtrusive supervision is provided by clinically adept faculty.
Hospitalists are playing an increasing role in health care nationally, and this is true at Temple University Hospital as well. We have an expanding core of full-time hospitalists who specialize in managing complex inpatient cases. The majority of general medicine services are staffed by these academic hospitalists. Subspecialists also participate in inpatient floor care by staffing the subspecialty services mentioned above.
The program's philosophy is one of graduated responsibility and independence paralleling professional growth.
The physician who completes the Internal Medicine Residency Program at Temple University Hospital will have participated in a program that is at the forefront of contemporary medicine. It includes thoughtful, efficient and effective care of sick patients, stimulating education, and productive clinical investigation. Emphasis is placed on the development of comprehensive skills in clinical problem-solving situations that the internist is likely to confront now and in the future.