The goal of our Internal Medicine Residency Program is to train leaders in healthcare by providing comprehensive and outstanding clinical training to our residents. Upon completion of training, physicians possess the knowledge, skills and attitudes necessary for successful practice of general medicine or further subspecialty training. These attributes for success include humanism, professionalism, clinical skills, management skills, and commitment to lifelong learning.
Our program’s clinical experiences take place at state-of-the-art training facilities.
We offer an innovative 4:1 rotation schedule that consists of 10 (4-week) inpatient rotations throughout the academic year with a 1-week outpatient rotation between each inpatient rotation.
Our didactic experiences complement the clinical experiences to ensure that house staff acquire the essential clinical skills, confidence, and independence required for delivering the highest quality medical care to patients with diverse types of acute or chronic diseases.
We offer special tracks, with three PGY-1 options:
- Categorical, including Primary Care, and Inclusion Health tracks (30 positions, PGY-1-PGY-3)
- Preliminary (10 positions, PGY-1)
Programs of Study
The 3-year categorical Internal Medicine Residency Program exposes residents to a broad and balanced curriculum of inpatient and outpatient medical care.
Each year, residents assume increasing levels of responsibility. Faculty supervision emphasizes evidence-based clinical decision-making, appropriate resource utilization learning and the important role of the resident as teacher. Upper-level residents have considerable flexibility to design a schedule of rotations that meets their specific career needs.
Primary Care Track
With more medical students and residents choosing specialty medicine careers, a shortage of physicians practicing general primary care has been predicted. To address this expected shortage and to train residents interested in practicing general internal medicine after completing their internal medicine residency program, we created a Primary Care Track in 2012 within the categorical Internal Medicine Residency Program.
Residents in the Primary Care Track will:
- Spend less time in electives/inpatient rotations to accommodate a month-long ambulatory care rotation in each year of the residency in one of our suburban primary care clinics
- Be required to do one research project during the residency on a primary care topic of the resident’s choice; residents will be given extra time to work on their projects during their ambulatory months
- Have additional in-depth training in subspecialties that are frequently referred to the primary care physician, such as wound care, urology, and podiatry
- Have primary care mentors to help guide them in their choices for their general internal medicine career
- Have the opportunity to enhance their didactic learning experiences by participating in an episodic Primary Care Journal Club and Ambulatory Morbidity and Mortality Conference
The Primary Care Track curriculum meets requirements of the ACGME for successful completion and graduation from the Internal Medicine Residency Program.
This Primary Care track does not have its own NRMP match number. Rather, two residents will be selected from each matched class prior to the start of the internship based on their desire and commitment to primary care. We may expand this program in future years.
Our primary care track is directed by Nicole Sacca, DO. One of the chief residents will be designated as the primary care chief each year. The primary care chief has the responsibility to arrange schedules and didactic sessions during the ambulatory care month and to provide peer support for the Primary Care Track residents.
Inclusion Health Track
The Inclusion Health track is under the direction of internationally-recognized clinician-educators from the Program for Homeless and Urban Poverty Medicine within the AHN Center for Inclusion Health. Residents enrolled in this innovative track will have the opportunity for in-depth, longitudinal training experiences in the areas of social medicine, health care to underserved populations, health disparities, and population health. Through a combination of specialized didactic, experiential, and research learning approaches, residents will sharpen the clinical and non-clinical skills essential to caring for vulnerable patient populations.
Residents in the Inclusion Health track will:
- Experience Lectures and skills-based training on core Inclusion Health topics, including Social Determinants of Health, Harm Reduction, Motivational Interviewing, Substance Use Screening and Treatment, Behavioral Health Integration in Primary Care, Poverty Medicine, Street Medicine, Population Health Research, and many others.
- Have their primary care continuity clinic at AGH Federal North, located in the North Side—one of Pittsburgh’s most impoverished and medically underserved neighborhoods.
- Rotate through homeless primary care and shelter-based clinics, street out-reach to unsheltered homeless individuals, integrated HIV primary care clinic, ED diversion clinic, FQHC’s, needle exchange, prisoner reentry, and home visits
- Rotate through the CIH Inpatient Consult Service at AGH and Medical Respite Program for socially-unstable patients in need of post-hospital recuperative care.
- Participation in other non-clinical CIH activities, including “hot-spotting” pro-grams, health systems-level advocacy, and program/curriculum development
- Be mentored population health and quality improvement research under the direction of Elizabeth Cuevas, MD and Patrick Perri, MD.
We offer 10 preliminary internal medicine residency positions per year. Preliminary residents are selected from among those applicants who intend to enter another field of medicine upon completion of this year, including:
- Physical Medicine and Rehabilitation
- Radiation Therapy/Oncology
Our program gives residents the opportunity to become great physicians by providing access to a diverse patient population presenting with a wide array of clinical conditions. Here are descriptions of the rotations for preliminary and categorical residents:
Our core rotations are designed to cover the fundamentals of internal medicine residency while giving residents the opportunity to shape and augment their education with elective rotations. Core rotations are as follows:
During the general medicine rotation, residents gain knowledge of health promotion, disease prevention, diagnosis, and treatment. The population includes both genders from adolescence through old age, in health through all stages of acute and chronic illness.
On the general medical floors, each team consists of an attending, a PGY-2 or PGY-3 resident, one or two interns, and third- and fourth-year medical students. Interns and senior residents provide day coverage while the Night Medicine team provides overnight coverage.
Attending physician rounds are conducted at least 5 days a week. The attending physicians review the presentation and management of patients with the house-staff. In addition, the team discusses epidemiology, clinical manifestations, pathophysiology, diagnosis and evaluation, treatment, and prognosis of the medical conditions that affect their patients, incorporating relevant and recent literature in these discussions.
Medical Intensive Care
Intensive Care Medicine
Students will gain critical care experience in the AGH Medical Intensive Care Unit (MICU) with a team of six interns, three senior residents, a pulmonary-critical care fellow, and two attending physicians who round 7 days a week.
Interns and senior residents provide day coverage while the Night Medicine team provides overnight coverage. The pulmonary and critical care fellows provide 24-hour in-house coverage. The house staff take primary responsibility of managing critically ill patients, including performing most diagnostic procedures. All major management decisions are reviewed by the ICU medical team on daily morning rounds and evening rounds. During the ICU rotation, we teach trainees the following:
- Techniques of resuscitation
- Respirator management
- Bedside hemodynamics
- Management of acutely ill medical patients
Senior residents also have the opportunity to rotate through the WPH medical ICU.
AGH's Cardiac Care Unit (CCU) cares for patients with acute heart failure, myocardial infarction, unstable angina and cardiogenic shock. Cardiac catheterization and intra-aortic balloon pumps are routinely employed.
The CCU is staffed by three senior residents, an intern, a cardiology fellow, and a cardiology attending. The residents rotate between day and night shifts for overnight coverage. The cardiology fellows provide 24-hour in-house coverage.
During the rotation residents learn:
- Techniques for electrical and chemical cardioversion of arrhythmias
- Swan-Ganz catheter insertion
- Cardiac resuscitation
- EKG interpretation
- Principles of cardiac emergency therapy
- Management of acute cardiac illness
Our program offers training in the outpatient setting, to prepare residents pursuing careers in primary care and outpatient based specialties. In our Medical Ambulatory Clinic (MAC), residents have the opportunity to deliver ongoing care to a group of patients in a setting similar to private office practice.
Utilizing the innovative 4:1 curriculum, we place our residents in many outpatient clinics throughout their residency. Each resident is assigned to a primary care site where they are exposed to the spectrum of primary care during their ambulatory weeks.
Each ambulatory week consists of 5 half days at the primary clinic and one half day of didactics. The rest of the week is spent rotating through many subspecialty clinics throughout the community.
We provide an educational portion of the ambulatory rotation through longitudinal lectures and online modules, along with the weekly ambulatory academic half day.
Night Medicine provides 24-hour resident coverage at AGH and WPH. The Night Medicine Rotation was designed to increase continuity of care for inpatients during nighttime while ensuring that residents do not exceed work hour mandates.
The night teams admit patients and provide cross coverage for the daytime teaching teams from 7 p.m. to 7 a.m. on Monday through Thursday nights and then attend morning report from 7 a.m. to 8 a.m. They then sign out to the primary day teams.
The night teams are supervised by an overnight attending at both sites.
Third-year residents perform house general medicine consults for a 4-week block. This elective exposes senior residents to pre- and postoperative inpatient management and ensures that residents develop expertise in the clinical and interpersonal skills essential to internal medicine.
Working closely with a core group of faculty, residents learn the general principles of preoperative risk evaluation and management. They:
- Evaluate the patient’s known medical problems
- Assess the associated surgical risk
- Address previously unrecognized medical problems
- Optimize treatment of all medical problems prior to surgery
Quality Improvement and Patient Safety Course (QuIPS)
We are committed to preparing residents to practice independently in the new era of healthcare, providing a comprehensive approach to education and integration of our residents in activities promoting quality improvement and patient safety (QuIPS). During the PGY-2 year, all residents rotate in our two-week intensive QIPS rotation. Here, residents complete IHI modules that serve as an introduction to the fundamentals of patient safety and quality improvement. We also have incorporated a module on diagnostic errors, where residents are taught to consider the cognitive biases that contribute to error, in addition to the system factors, as they develop a fishbone diagram. During the rotation, residents participate in serious event reviews, participate in actual root cause analyses, and complete a variety of other exercises which are designed to bring residents to the forefront of quality and safety in the network. As part of the course, the resident also designs and begins to work on a project of their choosing. The projects can include work already in progress, design of an educational module for the residency program, a performance improvement project, or a research project in the QIPS domain. In turn, many of these projects are presented to the other housestaff at the monthly QIPS conference, and/or presented at in-house, regional, and national conferences.
While the course is the cornerstone of our approach, immersion into our quality and safety culture begins during intern orientation, and is built upon through a series of activities and experiences until graduation.
Third-year residents do a 4-week Geriatrics rotation to gain insight into a key component of community practice. Residents on this rotation, with attending physicians, make house calls, round at nursing homes, and provide care in the geriatric clinic. Residents also spend time in the clinics focusing on:
- Wound care
- Low vision rehabilitation
- PT/OT/SLP therapy
- Movement disorders
- Palliative care (1 week)
The AGH Emergency Department is staffed by residents from the Emergency Medicine, Surgery, and Internal Medicine training programs. On the Emergency Medicine rotation, first-year Internal Medicine residents have the opportunity to see patients with common ED problems as well as a variety of acute medical and surgical illnesses as the initial physician under the supervision of emergency medicine attending physicians.
The objective of the rotation is to learn how to:
- Approach emergency patients
- Manage multiple patients
- Recognize and triage ill patients
- Manage patients acutely
In addition to the core rotations, our program supports professional development by offering distinct training pathways that allow residents to tailor the residency experience to meet their individual career goals. Whether residents want to subspecialize, serve patients in a primary care setting, practice as a hospitalist, or shine as a clinician researcher, our program prepares residents to reach those milestones. Available electives (generally eight to 10 weeks per year) can be performed in an expansive array of specialties at the core clinical sites or at any of several clinical sites across the network or in the community.
4:1 Rotation Schedule
Our innovative 4:1 rotation schedule provides the resident with the best of both worlds: a robust outpatient experience by enhancing continuity in the clinic experience while minimizing the outpatient duties of residents when they are on inpatient rotations. The benefits of the 4:1 schedule include:
- Continuity of Care – You are never pulled off-service, rushing to sign out to leave the hospital for clinic. This improves your patient safety. The primary team will be in house (i.e., in the hospital) to triage acute events rather than letting a covering physician deal with acute problems while you’re at clinic.
- Better Outpatient Experience – In the traditional system, a resident would have clinic for half a day once a week. Now there will be a dedicated week in which the resident will go to clinic Monday through Friday. There will be a better focus on the outpatient side. In addition, it gives the resident a “break” from the daily hospital life. During this time, the schedule is lighter but still demanding and challenging.
- Staff Exposure and Teaching Modalities – In the traditional system, teams would be formed and expected to work cohesively until the one-month rotation was over. With the 4:1 schedule, there will be rotating team members. This will allow interns to see different teaching styles of different seniors and expose seniors to more of the intern staff. By doing so, this encourages more interaction among interns and senior residents making it a friendlier environment in which to learn.
Resident Schedules by Year
Following is a sample PGY-1 schedule for both categorical and preliminary residents.
|General Medicine||4 months||AGH, WPH|
|Critical Care (MICU)||2 months||AGH, WPH|
|Night Teaching||4-6 weeks||AGH, WPH|
|Emergency Medicine||1 month||AGH|
|Ambulatory Clinic||10 weeks||AGH, WPH|
|Elective||2 months||AGH, WPH|
Following is a sample PGY-2 schedule.
|General Medicine||2-3 months||AGH, WPH|
|Critical Care (MICU or CCU)||2 months||AGH, WPH|
|Night Teaching||2-4 weeks||AGH, WPH|
|Quality Improvement and Patient Safety||2 weeks||AGH|
|Oncology/Bone Marrow Transplant||2 weeks each||AGH, WPH|
|Elective||2-3 months||AGH, WPH|
|Ambulatory Clinic||10 weeks||AGH, WPH|
Following is a sample PGY-3 schedule.
|General Medicine||2-3 months||AGH, WPH|
|Critical Care (MICU or CCU)||2 months||AGH, WPH|
|Night Teaching||2-4 weeks||AGH, WPH|
|Geriatrics||1 month||AGH, WPH|
|Medicine Consults||1 month||AGH, WPH|
|Elective||2-4 months||AGH, WPH|
|Ambulatory Clinic||10 weeks||AGH, WPH|
Our major clinical training sites are Allegheny General Hospital, West Penn Hospital, and their associated faculty internal medicine clinics.
Allegheny General Hospital
Allegheny General Hospital (AGH), located on Pittsburgh’s north side, is a national leader in cardiovascular, cancer, neuroscience, orthopedics, and transplants. It offers a wide array of medical and surgical specialties and has a Level I Trauma Center and LifeFlight aeromedical transport service. It is one of the largest tertiary facilities in the region while upholding a commitment to excellence in patient care, medical education and research.
West Penn Hospital
West Penn Hospital (WPH), in Pittsburgh’s Bloomfield neighborhood, is an academic medical center that has been regionally and nationally recognized for excellence in nursing (region's first Magnet® hospital), bone marrow and cell transplantation, burn care (only center verified for both pediatric and adult burn care), cardiovascular care, and reproductive medicine. It has a Level III Neonatal Intensive Care Unit and completely renovated Emergency Department, Cardiovascular Institute, intensive care units, medical , and surgical and stepdown patient care units.
Ambulatory Continuity Clinics
(AGH Internal Medicine and West Penn Medical Associates)
Our program offers strong training in the outpatient setting to prepare residents pursuing careers in primary care and outpatient based specialties. In our Ambulatory Clinics, residents have the opportunity to deliver ongoing primary care to a group of patients in a setting similar to private office practice. In continuity clinic, the residents are the primary care providers in a firm system arrangement, with faculty on site at all times to provide instruction and supervision.
Each resident is assigned to a primary care site, where they see patients in the office during the ambulatory week. These ambulatory weeks consist of five half days at the primary clinic. We provide an educational portion of the ambulatory rotation through longitudinal lectures and online modules, along with the weekly ambulatory academic half day. The rest of the week is spent rotating through many subspecialty clinics throughout the community
Didactic Learning Experiences
Didactic Conference Series
At both Allegheny General Hospital and West Penn Hospital, we feature both a morning report conference, generally a case based discussion with faculty experts working through the practical aspects of diagnosis and management, as well as a daily noon lecture which is on a variety of topics. The lectures focus on delivering medical didactic content, while also featuring recurring conferences such as Medical Grand Rounds, Journal Club, Morbidity/Mortality Conference, Patient Safety Conference, and the Board Review Series. It is a distinguishing feature of our program to have two daily didactic conferences, as the majority of programs nationally provide one hour daily.
Ambulatory Half Day
One half day per week on ambulatory rotations is dedicated toward didactic learning. During this time, the entire rotating cohort convenes together for conferences that range from case-based discussions, physical examination and clinical skill workshops, and didactic teaching on primary care topics. Not only do these conferences provide a complementary method to the more experiential learning of supervised clinical care, they also foster a great spirit of camaraderie within the cohorts, each functioning as a smaller unit within our program. It makes our big program feel smaller by allowing the residents to get to know a small group of colleagues very well.
Simulation and OSCEs
All residents in our program train in the STAR (Simulation, Teaching, and Academic Research) Center multiple times each academic year. Located on the West Penn Hospital campus, this world-class training facility uses the latest in simulation technology to provide controlled learning scenarios for participants. The center’s virtual hospital environment includes several training rooms, numerous programmable manikin simulators and task trainers, and a host of other equipment to simulate a wide variety of patient care scenarios. As part of a longitudinal patient-physician communication curriculum, residents also participate in simulated patient discussion sessions. During the sessions, residents practice communication with simulated patients surrounding sensitive topics such as end of life discussions, with observation and feedback from faculty and the simulated patient delivered in real time. Another practical way for residents to gain practice and feedback on their clinical skills is the Observed Structured Clinical Exam (OSCE) series, in which preceptors observe residents performing history and physical exams on patients, providing them real time feedback on focused areas of emphasis on a rotating basis through the year.