UPMC McKeesport Internal Medicine Residency Program Philosophy of Learning

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 physicians 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.
UPMC is committed to providing the best care to all patients regardless of their ability to pay.
Residents participate very actively in patient safety and quality improvement initiatives in collaboration with nurses, care managers, and administrators as multidisciplinary teams.
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 is designed to empower 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 journal club presentation is followed by an open discussion with the attending physicians and the residents to explore the feasibility of changing our practice.

Clinical Pathological Conference (CPC):

This monthly activity is designed to train the residents on using 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 clinical vignettes at regional and national meetings.

Mortality and Morbidity / Patient Safety:

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

Topics cover all aspects of general internal medicine and its subspecialties. Topics cover the entire curriculum and are constantly undated. Presenters are well prepared and have the opportunity to use interactive audience response system. Board review sessions are also provided internally.

Medical Grand Rounds

Is a biweekly event. First class updated presentations are provided by topnotch speakers, mostly from within the UPMC Health System.

Attendance at Annual ACP Meeting

The PGY-2 residents are supported to attend the annual national American College of Physicians (ACP) or the Society of Hospital Medicine (SHM) meeting as during their second year of residency. These very highly rated meetings enhance clinical skills, provide intensive update sessions, and offer an opportunity to showcase their posters at a national forum.

Learning through Research and Inquiry

Research/Scholarly Activity

Our program teaches our residents 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.

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, when 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 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 to conduct 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.

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
Interaction with faculty, nurses, peers, and supporting staff
Careful handoffs via verbal doctor-doctor communication as well as quality dictated discharge summaries
Learning to work within a multidisciplinary team

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 remotely review radiological pictures and reports.

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 interviewing and examining 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.