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Frequently Asked Questions

Q: Describe the 4+1 Block structure.

A: Temple utilizes a ‘4+1’ block structure that debuted in June 2011. The year is organized into ten 5-week blocks consisting of 4 weeks of core residency rotations (electives, medicine wards, ICU, etc.), followed by a 1-week Ambulatory block, where residents spend the week in their continuity clinic and do not have inpatient responsibilities. This repeats throughout the year.

We believe that this structure improves the overall real-world education of our residents and provides a clear separation between residents’ inpatient and outpatient duties. It also makes trainees more comfortable with working and managing patients in the Ambulatory setting, where most of medicine takes place today. This system prioritizes the ambulatory experience and does not fragment the inpatient rotations (and patient care) by asking residents to leave the hospital once per week to go to clinic. Rather, when residents are on the floors, they can follow up outpatient labs and studies through the EMR, and when in the clinic, they can focus their time and attention on their patients, arrange appropriate follow up appointments, and make necessary phone calls without feeling hurried to return to their busy floor service. Residents maintain their continuity panel for all three years of their training and will accumulate patients as they progress as well.

Q: Do you have an Electronic Medical Record (EMR)?

A: Yes. Temple uses the EPIC EMR in all its primary care and subspecialty outpatient clinics.  EPIC was introduced to the inpatient side in 2016.  You can look up patients from either inpatient or outpatient from either location.

Q: How do your residents do in obtaining fellowships?

A: Extremely well. In the past decade, our residents have consistently matched to extremely competitive fellowships, with greater than 95% getting one of their top choices. You can see where our residents have matched here.

Q: What are the opportunities for research?

A: Research opportunities for residents abound at Temple. Our program brings together a robust research infrastructure with faculty who are approachable and eager to bring residents onto their teams. Residents can find research projects within the Department of Medicine or do work with one of the medical school’s several research institutes. Research opportunities run the spectrum from bench and translational research to clinical investigation, to medical education.  Many residents have successfully published and presented their work in the past year.  Residents are encouraged to attend local, regional, and national conferences to present, and as part of the house staff benefits package, there is a $1500 stipend which can be used on expenses related to these conferences (travel, registration, hotel, etc.).

Q: What percentage of your graduates pursue primary care?

A: Each class’s percentage is a little different. For the past several years, about a third of our graduates have gone into general internal medicine with some entering outpatient primary care practices and the remainder becoming hospitalists or going onto another generalist career such as palliative medicine, geriatrics or general internal medicine fellowships. As a result, our graduates’ post-residency plans are quite diverse when compared with many other large urban residency programs.

Q: Does Temple have non-house staff covered services?

A: We do. With our ever-quickening work pace, and increasing patient complexity, we have continually expanded our non-teaching services in order to allow the house staff to focus their energy on learning from our most complex patients and their pathologies. At Temple, our hospitalist attendings are full time faculty and spend their time rounding on both the teaching and non-teaching services. Patients who are expected to require a short, straightforward admission are triaged to the Observation Unit, staffed exclusively by our hospitalists. In addition, we have general medicine non-teaching services that are staffed by our hospitalist faculty without house staff. There is a hospitalist present overnight to manage the patients not under resident care, and this person also does admissions to the observation unit.  Additionally, in September 2017, a moonlighting position was created to assist with night time admissions, enhancing the 24-hour admitting support for our house staff.  Admissions done by the moonlighting physician are transitioned to hospitalist-only services in the morning. This position has enhanced the educational quality of the medicine teaching teams.

Q: Where do residents live?

A: Our residents live in many different places around the city and the nearby suburbs.  Many choose to live in downtown Philadelphia (Center City).  Compared to other major metropolitan areas on the east coast (such as Boston, New York, or Washington, D.C), Philadelphia has a lower cost of living and offers more affordable housing, which allows residents to enjoy the perks of living downtown.  Philadelphia has many different neighborhoods and each has a different feel and flavor.  If you are new to the area, this website may be helpful.

Downtown Philadelphia is not the only option, however.  We have residents that have lived in other enjoyable areas of Philadelphia outside the hustle and bustle of downtown, such as Manayunk, Mt. Airy, and Germantown.  These are also vibrant communities with their own unique feel.  The New Jersey and Pennsylvania suburbs are other great options.  

If you plan to drive to work, we have some good news for you: garage parking is free for residents and fellows.

Q: Is safety a concern around Temple Hospital?

A: Much less than you might think. Like any large city, Philadelphia has its share of safety concerns. Temple police are very visible in and around the Temple Health Science Campus. As a result, safety in areas around Temple hospital is excellent. All walkways to the parking garages and subways are well-lit and patrolled. Our advice to anyone, in any city, is to use common sense and your best judgment. If you are leaving at any time on your own and prefer extra security, the Temple Police are on campus and available for escort at all hours. Finally, there are over 500 residents and fellows across all of Temple’s training programs that choose to train at Temple each year, in addition to hundreds of faculty and staff.  We all feel safety is important, and we feel safe and secure coming to work each day by car, bike, or subway.

Q: How many PGY-1 positions are available?

A: There are 34 categorical positions, 5 general preliminary positions, 4 neurology preliminary positions, and 2 anesthesia preliminary positions available.

Q: What is the salary?

A: Next year’s salary has not been announced. For information on this year's salary, please visit the House Staff Stipends page.

Q: How many clinical training sites are there?

A: At Temple, we are proud that our residents are all scheduled for the majority of their time, at Temple University Hospital (TUH). This minimizes additional travel obligations and allows for all residents to easily attend all conferences. While PGY-1s spend 100% of their time at TUH, during their second and or third year, residents may spend time doing an outpatient Geriatrics rotation in Roxborough (a 15-minute car ride from Temple) and also have opportunities to pursue electives at Fox Chase Cancer Center. International experiences through the Global Health elective are also available.

Q: How much time do I spend at each site as a PGY-1?

A: As an intern, you will spend all of your time at Temple University Hospital, unless you choose to do elective rotation at affiliate hospitals.

Q: What is the breakdown of rotations during the first, second, and third year of residency?





 

PGY-1 (weeks)

PGY-2 (weeks)

PGY-3 (weeks)

General Medical Services

Subspecialty floors

20

 4

8

10

12

 4

Elective Rotations

4

8-10

10-12

Intensive Care Services

4-8

4-8

0-4

Emergency Department

2

0-2

0-2

House Chief

0

0

2

Intern Cross-Cover Night Float

2-4

0

0

Medical Consult

0

0

2-4

Geriatrics

0

2-3

0

Night Admitter

0

2-4

2-4

Ambulatory

10

10

10

Vacation

4

4

4

Note: schedules may vary slightly depending on resident career goals.

Q: When are my days off?

A: All house staff on admitting services get a minimum of 4 days off per month. During ambulatory weeks, there is no evening or weekend call.  This means that categorical residents are guaranteed every 5th weekend off!

Q: What is a typical day on ward service like as an intern?

  • 6:30 AM - 7:00 AM Pick up sign-out from Night Float

  • 7:00 AM- 9:00 AM Work rounds with the resident or round on new patients with full team from overnight call.

  • 9:00 AM - 11:30 AM Attending Teaching rounds

  • 11:30 AM - 12:00 PM Work Rounds

  • 12:00 PM - 1:00 PM Didactic Conferences

  • 1:00 PM- 4:00 PM: Admit patients

  • 5:00 PM - 6:00 PM Sign-out to Night Float

Q: Do you have any overnight call?

A: Yes, we do, and the residents and students overwhelmingly report they value this part of the call cycle! We moved back to an overnight call system in March 2014 in an effort to maximize our residents’ patient continuity experience. The system has been refined recently, and now involves a 5-day call cycle. On the call day, all team members are present for morning rounds.  One intern admits patients in the early evening, supervised by the team’s resident.  The other intern begins admitting in the later evening, working with a night admitting resident, whose only overnight role involves overseeing the admissions of one intern and providing teaching along the way. All team members round the next morning with the attending for teaching rounds. This system minimizes the number of redistributed admissions (which are traditionally handed off from a night admitting team to the day team) and allows residents and interns to admit the majority of their own patients and follow them to discharge. This system complies with all ACGME duty hour rules. We take resident feedback seriously at Temple, and when polled about this system change, residents continue to report that overnight call is a valuable experience, that they know their own patients better, and that they are able to do more of the admissions from start to finish.  

Q: What is the call cycle on general medicine floors?

A: The call cycle is designed around a five-day call model. The entire team is on call every fifth day, but interns alternate overnight call, which comes out to every tenth night.  Over the course of the intern year, this works out to 10-14 call nights.

  • On-Call day: One intern is on evening call and the other intern is on overnight call.  The evening call intern and resident admit between 4:00 p.m. – 7:00 p.m.

  • Post Call - No admissions or redistributions

  • Short Call 1 - Team gets up to two redistributed patients from overnight (though typically 0-1), and can take up to 3 admissions from 7:00 a.m. - 4:00 p.m.

  • Short Call 2 - Team gets up to two redistributed patients from overnight, and can take up to 3 admissions from 7:00 a.m. – 4:00 p.m.

  • Pre-Call – No admissions or redistributions

  • On-Call Day - as above, but interns switch evening call and overnight call.

Q: How much autonomy is given to residents to make clinical decisions?

A: Quite a bit. The importance of resident autonomy is often cited as one of the most valued aspects of this program. As residents advance through their years at Temple, more autonomy is afforded to them.  Interns always have someone to back them up, typically a second- or third-year resident. As a third year, the residents take on sub-interns (fourth year medical students) and act as the junior attending on the general medicine team. Though we pride ourselves on resident autonomy, attendings make it a priority to be present and available to their teams at all times for questions or guidance, in person and by phone.

In the Medical ICU, there are pulmonary fellows present during the day and night.  Additionally, there is always at least one Critical Care attending in house overnight who is available for troubleshooting, discussing admissions, helping with procedures, and more.  

Sometimes the word “autonomy” can be taken as a euphemism for being left alone.  As you can see, this is not what we mean.  To us, the culture of autonomy starts with critical thinking.  We ask our interns to not only identify and report problems, but also to explain what the most likely cause is and what they would suggest as next steps.  We provide autonomy to make the first assessment and later autonomy to lead and teach the medical team, all with attending back-up.

Q: What are the ancillary services like at Temple University Hospital?

A: The ancillary services are robust and allow residents to focus on patient care without having to spend valuable time doing less medically oriented tasks. To support the medicine teams, there are phlebotomy "rounds" throughout the day and night to ensure that patients can get their lab draws throughout the day (and STAT if needed). There are also IV teams available during the day to place IV lines. EKG’s are performed by EKG techs and or nurses. Additionally, the transport personnel take excellent care to coordinate the moving of our patients between rooms, studies, and labs.  In 2017, the hospital dedicated resources to enhance pharmacy capabilities- Temple now has pharmacists that are dedicated to handling medication prior authorizations.  There is also a delivery service in place that allows residents to prescribe medications to patients around the time of discharge which the pharmacy will then deliver to the patient’s bedside.  

Q: Are there required ambulatory rotations?

A: Every 5th week, all categorical residents spend a week entirely devoted to outpatient medicine. Many ambulatory-based electives are available including all medicine sub-specialties, HIV, Primary Care, Orthopedics, Palliative Medicine and Dermatology. We have a dedicated Associate Program Director and Chief Resident who help direct ambulatory education during your residency.

Q: Is there a Night Float System?

A: Yes. Night Float is a two-week rotation (Sunday - Thursday night) where interns cross-cover floor patients. Interns on this rotation do not do admissions. A senior resident (the House Chief) is in-house and assigned to supervise the Night Float interns and help them with procedures and management decisions. Night Admitter is a two-week block (Sunday - Friday night) where upper year residents admit and cross cover subspecialty patients (cardiology, nephrology, pulmonary, and hepatology).  They also may admit General Medicine patients depending on the night.  Patients are then transitioned to daytime teams in the morning.  As mentioned in prior questions, we do have academic hospitalists in-house overnight for times when additional guidance is necessary.

Q: How many people are on a team?

A: A typical general medicine team is made up of one attending, one resident, two interns, and two 3rd year medical students. Each team can accommodate up to 16 patients at a time.

Q: What types of patients do you see at Temple?

A: The patient mix at Temple is one of the strongest aspects of our training program. As a quaternary referral center in an inner-city urban environment, Temple’s patients come from all walks of life. While the majority of the General Medicine ward patients are from the local community, the subspecialty services add in referral patients who live throughout the region, who bring different pathology and learning opportunities. The residents care for and learn from some of our health system’s most complex patients; those without the luxury of easy access to care. Residents quickly learn how to treat complicated illness, and often have to balance and prioritize several illnesses in the same patient. While serving as the front line for many of our community’s patients, our residents learn how to workup pathologies from scratch and often follow patients they have taken care of on the inpatient service in their continuity clinic. This care spectrum not only provides residents with some of the best hands-on clinical training available, but also provides a great deal of reward when residents care for patients from diagnosis, through treatment, and into follow up for one, two, or three years.

Q: Who are the attendings that provide inpatient care?

A: All attendings who round with residents are full time faculty of the medical school. There are ten General Medicine teaching teams, with one staffed by our GIM faculty, one run by Chief Residents, and the rest staffed by Hospitalist faculty. There are three inpatient primary subspecialty teams; these include Pulmonary, Nephrology/Hepatology, and Advanced Heart Failure.

Q: Is food provided at work? Are white coats provided?

A: It would be tough to work without food and a white coat. The Graduate Medical Education office generously provides residents with money on their employee ID card to use in the cafeteria. This money varies with your call cycle. Lunch is provided at the noon conferences each week. And yes, white coats are of course provided. Residents will get three long white coats, embroidered with their name, at the beginning of their intern year, with an additional new white coat each subsequent year. After so many hours spent caring for patients, these white coats are the residents’ to keep. Residents also each get their own hospital locker to use for all three years.

Q: Is there an educational stipend?

A: Yes. We understand how important conference travel can be to our residents’ education, and work to support residents in their endeavors to present their work at meetings, both locally and nationally. Each resident gets a $1,500 educational stipend to use during their second or third year. This funding can be distributed over two separate disbursements, and includes travel, conference registration fees, and hotel and meal expenses, and board review courses.

Outpatient Continuity Practice

Q: Where will I have clinic?

A: The resident continuity clinic, known as the Temple Internal Medicine Associates (TIMA), is located on the first floor of the Medical Office Building (MOB), across the street from the main hospital.

Q: What is the faculty to resident ratio in clinic?

A: No more than 1:4.

Q: Is there a separate Primary Care Program?

A: Yes. We have a dedicated Primary Care Track. Each year, two interested interns (and at times, PGY-2s depending on space availability) join the program.  You can find more information here.

For more questions, please contact Dr. Paul Williams at Paul.Williams@tuhs.temple.edu

Emergency Department

Q: What is the experience like in the ED?
A: During your ED rotation, you function as a member of the ED team, triaging all types of patients who present for care including fast track, general medicine, neurology, OB/GYN, surgery, and trauma patients. Typically, the ED rotation is split into two weeks as an intern and two weeks as an upper year resident. The ED is a terrific opportunity for residents to not only learn how to begin patient workups from scratch, but also to better understand and get an appreciation for all that our ED colleagues do.

Research

Q: Is there a research requirement?

A: There is no specific research requirement in residency. However, all residents must engage in a scholarly project. Scholarship is broadly defined and includes reviews of clinical topics, original work resulting in abstracts or manuscripts and laboratory experience, and quality improvement projects. Most of our residents actively engage in research. Each year there is a department-wide symposium showcasing the research done by residents and fellows, including posters and oral presentations. Additionally, each resident partakes in at least one quality improvement project during their residency.

Q: Are there research electives?

A: Yes. Residents may choose to do up to 3 one-month research blocks during their residency.

Q: How can I get involved in research?

A: The opportunities to get involved in a research project begin early on during our residents’ training. During our Intern Summer Conference Series (a daily didactic of protected time for the interns), given by junior and senior faculty, the residents get to meet many of the subspecialty attendings. Each fall, during intern year, our department organizes an Intern Research Day, when all of the section chiefs (from each medicine subspecialty) meet with the interns and discuss the ongoing research projects within their section. This morning and afternoon session is protected time for our interns, when their residents hold their work phones. This conference allows the interns to hear about all of the ongoing research projects within each section and provides them easy access to the section chief, who can put them in contact with other faculty members.