The goal of our residency program is to train individuals to become excellent physicians and leaders in an increasingly complicated and demanding health care environment where good clinical skills are necessary but no longer sufficient to provide the best patient care. To accomplish this goal, our program has structured a curriculum that (1) integrates the educational features required to develop the lifelong skills and knowledge needed by leaders in health care, regardless of their specialty, and (2) enlists our talented faculty, many of whom are leaders themselves in their own fields, to mentor and guide the housestaff.
As part of the Educational Innovation Project (EIP), we have created a curriculum of clinical experiences, didactic activities, and unique exposures that utilize the exceptional resources available at the University of Pittsburgh Medical Center (UPMC). These resources include an extensive electronic health record system (UPMC is one of the most wired academic health centers in the country), high-quality simulation training (at the WISER Institute, a leader internationally in procedure simulation), excellent research opportunities (the University of Pittsburgh is ranked fifth in funding from the National Institutes of Health), and first-rate teaching by faculty from one of the largest divisions of general internal medicine in the country.
Our curriculum is based on six themes or components identified in Crossing the Quality Chasm, a groundbreaking report published in 1999 by the Institute of Medicine. This report established the need for a major re-engineering of how health care is delivered and soon became the standard by which health care is measured. It has also become the standard by which the residents in our program learn. However, because medicine and the health care system are ever-evolving entities, our program and its curriculum undergo a continuous review process by residents and faculty to ensure that any necessary modifications are made to meet the demands of training physician leaders for the 21st century.
Our innovative curriculum focuses on the following components, all of which contribute to the knowledge, skills, and attitudes we feel are critical for residents to develop:
We believe that the best training experience depends on giving physicians graded responsibility during their years of training. First-year residents are considered to be their patients' primary physician, and they develop their therapeutic plans, write their orders, and make decisions about their care under the careful supervision of a junior or senior resident and a faculty attending physician. As residents progress through the program and attain greater patient responsibilities and independence, they become team educators and leaders.
The residency curriculum features a variety of conferences that draw from the many general and subspecialty experts here at UPMC as well as from other national and international institutions. The breadth of topics and depth of content make these scholarly meetings a backbone of residency training.
Each first-year resident participates in the Professionalism Retreat, which focuses on the development of leadership skills and on the professional and ethical responsibilities of a physician. Before the start of the second year, first-year residents enrolled in one of the 3-year programs take part in the Learning to Be a Resident Retreat. Residents are educated about the principles of cognitive learning theory and experiential learning theory in an effort to help them structure a learning environment for future first-year residents and medical students under their tutelage. Other topics include running a successful team, resolving conflicts, and optimizing communication skills. The third retreat occurs later in the second year to reassess and build on previous concepts.
The principles of evidence-based medicine are integral to the program's curriculum. The broad goal is to improve patient care by moving residents from an experience-based form of clinical practice to one informed by the systematic application of medical knowledge. The concepts of evidence-based medicine are peppered throughout the curriculum and reinforced in various didactic exercises as well as in clinics and on the wards. Although our program is devoted to educating our residents on the importance and implementation of these concepts, we also recognize the importance of training physicians to recognize patients as individuals who may have special circumstances in which a physician's medical judgment should override the systematic application of the principles of evidence-based medicine.
First-year residents are introduced to evidence-based medicine during their work on the wards and in clinics. Second- and third-year residents participate in Resident Journal Club, a monthly series that formally introduces them to the core concepts of evidence-based medicine.
Emphasis is placed on developing a focused and answerable clinical question, reviewing a relevant article from the medical literature, appraising the article, and answering the clinical question in a manner that allows it to be applied to clinical practice. Typically, the resident chooses an article on a topic inspired by an actual patient scenario that he or she has experienced. Residents are taught the relevant statistical methods and appropriate calculations that are necessary for considering the importance of the article. They then summarize the clinical scenario, answerable clinical question, literature search, and critical appraisal in the form of a critically appraised topic (CAT), a 1-page summary of the project.
A secondary goal of Resident Journal Club is the compilation of CATs that can be archived and readily accessed by other residents. For three sample CATs generated by our residents, click here.
The senior presentation is a scholarly project required by each third-year resident. It is a chance for the resident to implement and showcase the evidence-based medicine concepts that he or she has learned in Resident Journal Club and throughout residency.
The main elements and concepts of the project are the same as those used to evaluate an article in Resident Journal Club meetings except that this time the resident applies them to a body of literature on a particular topic. The resident works on this project over the course of 3–6 months with the aid of a faculty mentor of choice. The subject matter for this project may stem from the resident's clinical experiences, research interests, or involvement in a scholarly project that is part of the resident's program track or pathway. The project culminates when the resident gives a formal presentation of findings to the housestaff and faculty as part of the Core Medical Conference Series.
Each year, the two best presenters receive a monetary award and are invited to formally present their topic at Medical Grand Rounds.
As part of a comprehensive approach to learning, residents and interns complete a series of didactic, case-based, Internet modules that are guided by the concepts of evidence-based medicine. Each case has been carefully chosen and designed to highlight key concepts of patient care in the ambulatory medicine setting. Sample topics include professionalism, hypertension, medical complications of pregnancy, tobacco cessation, and systems-based practice.
The Peter M. Winter Institute for Simulation Education and Research (WISER Institute), one of the most advanced and active medical simulation centers in the country, uses sophisticated educational technology to provide hands-on training for internal medicine interns and residents and other health care professionals. To view the WISER Institute video, click here.
First-year residents are enrolled in a training course on central venous cannulation, in which they learn to develop the skills necessary to place internal jugular, subclavian, and femoral central lines, using life-like simulation systems and portable ultrasound under close faculty supervision. Second-year residents participate in a crisis training course, which teaches teams of medical professionals to complete a rapid-order set of tasks that would be necessary to save a life in a "code" situation.
The WISER Institute also serves as the training site for basic life support (BLS) and advanced cardiac life support (ACLS). For residents interested in learning more, the institute also offers classes in airway management, simulated code training, and many other topics.