Philosophy of Learning

• Learning in a Caring Environment
• Learning in a Scholarly Environment
• Learning through Research and Inquiry
• Learning in a Technological Environment
• Learning through Reflection
• Learning to Work Within the Health Care System
• Quality Improvement Projects

Learning in a Caring Environment

• Patient care is the center of all activities. Our mission is to prepare our residents to practice medicine in the real world following the highest professional and ethical standards.
• We understand that preparing physician to deliver good care goes beyond teaching medical knowledge: we take pride in being leaders in providing our residents with the opportunity to learn about administrative aspects of health care delivery and public policies.
• The UPMC health system is recognized as one of the most wired health systems in the country, leading the way in developing and implementing electronic medical records allowing for remote access to information within the entire UPMC system.
• We have a Hospitalist program which works in harmony with the residency program to provide back up support for the residents and hands on teaching for the night medicine team.
• We strive to provide an educational environment for our residents, closely monitoring work hour rules and avoiding non-teaching “service” work

Learning in a Scholarly Environment

Journal Club

• This monthly activity empowers the residents to independently read, analyze and critique the medical literature. The residents prepare their presentations under close and direct supervision with a faculty mentor and the statistician. A series of lectures are also provided to help the residents understand medical statistics. Each presentation is followed by an open discussion to attending physicians and the residents to explore the feasibility of changing our practice based on that particular study.

Clinical Pathological Conference (CPC)

• This monthly activity is designed to train the residents to use the tools of evidence-based medicine and clinical decision making to evaluate a clinical scenario. Again, each presentation is followed by a discussion on the lessons learned from that case. Often, these cases are submitted as vignettes to the regional ACP meeting.

Case of the Month

• The Night Medicine team selects a case to present followed by a detailed literature review of the subject. It is an opportunity for residents to self-assess, complete an evidence-based topic review and use power point and public speaking skills. Faculty supervision and feedback are provided.

Mortality and Morbidity

• This monthly activity allows residents and faculty to review, critique and learn from cases with unexpected or adverse outcomes. Preparation of this session involves combined resident and faculty participation. Open discussions follow each case presentation and literature review. In addition to medical lessons, we have an opportunity to enforce patient safety and risk management.

Ambulatory Article Review

• Each week, the residents review an ambulatory article and participate in the Rash of the Week. These sessions are article review and discussion-based. To test medical knowledge, questions are sent electronically to all residents and the residents submit their answers.

Daily Noon Conference

Medical Grand Rounds

Newsletter

• Our newsletter welcomes and encourages scholarly contributions by residents. Residents author a review that outlines an approach to a clinical problem they have encountered in a patient. The newsletter also includes personal achievements about our residents and faculty and their families.

Attendance at Annual ACP Meeting

• The PGY-2 residents are supported to attend the national American College of Physicians (ACP) meeting as a group during their second year of residency. By this activity, they are able to observe the role of the national meeting in maintaining skills and updating medical knowledge. They also attend and present at the regional ACP scholarly sessions.

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Learning through Research and Inquiry

Research/Scholarly Activity

Our program educates our residents in the skills needed to be effective lifelong adult learners who are able to self-assess and effectively expand medical knowledge to practice evidence-based medicine now and in the future.
Examples include:

Research: Each resident completes a hypothesis driven or quality improvement research project under the supervision of a faculty mentor. The process starts during the fall of the first year, where research workshops are given. The goal of these workshops is to introduce the residents to the process of research: how to generate a research idea, frame a question and a hypothesis, select a research design, set inclusion and exclusion criteria, determine sample size, collect data, work with the honest broker, analyze the data and reach conclusions.

• The residency program employs a part time statistician who provides assistance during the designing and analysis phases of each research project. We are also contracted with the University honest broker who can access records of patients at all UPMC-Hospitals allowing for a very large database.
• All investigators, hence all of our residents, are required by the Dean's office of the University of Pittsburgh School of Medicine to become certified in Research Practice Fundamentals Modules offered online by the UPMC Institutional Review Board (IRB).
• Residents present their research projects at our annual Resident Research Day competition. In preparation, the residents attend sessions on how to best present their research in power point slide format and in public speaking. Each resident presents a ten-minute power point summary of his/her project followed by five minutes of Q&A. A panel of judges evaluates each project and awards are given based on study design, analysis/conclusions and presentation.
• Our residents are encouraged and supported in bench and clinical research projects with researchers at the university hospital. Each year, several residents participate in these types of projects with resultant presentations at national meetings.
  

Scholarly Activity

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Learning in a Technological Environment 

Information Technology

• Optimize learning at point of care with the help online resources

Procedure rotation

• Practice on simulators under the direct supervision of a faculty member

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Learning through Reflection

Residents self-assess their strengths, weaknesses, and personal learning objectives to help them progress towards their career goals

• Regular feedback
• End of rotation evaluation
• Meetings with mentors
• Semi-annual meetings with program director
• Yearly In-Training Exam – all residents  

Interpersonal and Communication Skills

• Interacting with patients and families in a clear and informative manner
• Careful handoffs via verbal doctor-doctor communication as well as quality dictated discharge summaries.

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Learning to Work Within the Health Care System

UPMC McKeesport Internal Medicine Center

The continuity clinic is the heart and soul of teaching ambulatory care to internal medicine residents. Residents attend their clinic one-half day per week. The clinic and offices are fully staffed with support personnel.

The clinic is equipped with electronic health records, as well as software to review radiological pictures and reports.

We also have a digital camera that we use to capture skin rashes and important physical signs that we share together as a group.

We strive to provide the residents with a professional, sound environment free of commercial influence.

The clinic setting provides an opportunity to teach the basic foundations of medicine. It is a good setting for mini-CEX exams, observing residents teaching their patients, and breaking bad news. The clinic is also a good setting for teaching risk management and dealing with difficult patients.

In addition, the clinic provides an opportunity to learn about real life aspects of care: insurance coverage, formulary status and changes, caring for the uninsured, using generic medications, understanding the financial aspects of tests, medications, co-pays, etc. Residents also learn about billing and coding.

The clinic is contracted with an independent patient survey company that polls our patients on a regular basis. Visit encounter data and patient satisfaction data are reviewed with the residents periodically.

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Quality Improvement Projects

Ambulatory Clinic

• Completing time studies in the residency continuity clinic to improve patient flow
• Participating in a practice improvement projects sponsored by the ACP

Emergency Department

• Developed a system to divert patients from the ED to our clinic reducing the number of ED visits for non-emergent problems.

Hospital

• Established standardized order sets to facilitate best practice and enable process improvement and standardization.
• Admitting Resident for Medical Service (ARMS) rotation that provides opportunity to attend hospital committee meetings to UNDERSTAND how the hospital functions from an administrative viewpoint.

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