Residents at Mercy Catholic Medical Center rotate at two community teaching facilities in greater Philadelphia.
Mercy Fitzgerald is a 204-bed facility located in Darby, Pa. It serves a diverse population of working and middle class patients in Darby and the surrounding communities. It features a state-of-the art cardiac catheterization and electrophysiology laboratory, advanced MRI and CT scanners. Mercy Fitzgerald hosts Mercy Catholic Medical Center’s CABG and valve replacement centers. An inpatient rehabilitation unit specializing in post-stroke care as well as a busy inpatient psychiatric unit are located here.
Mercy Philadelphia is a 157-bed facility in West Philadelphia. Since 1918, it has served the predominantly under served and working class patients in West Philadelphia. It features state-of-the-art MRI and CT scanners as well as the health system’s hyperbaric oxygen treatment chamber. The hospital has a busy inpatient psychiatric unit and an inpatient alcoholic detoxification unit.
Internal Medicine Floors
Residents rotate on internal medicine floors at both Mercy Fitzgerald and Mercy Philadelphia.
A typical internal medicine team will include two interns, an upper year resident, and medical students working primarily with 1-2 academic hospitalists. These teams work as a unit, allowing education and clinical care to flow freely.
A “drip” system of admissions ensures a constant flow of new patients while strictly enforced caps with non-teaching services ensures that an optimal learning environment is maintained. This clinical load permits adequate time for reading and other learning activities. A night-float system also offers interns and residents adequate time for patient care and rest.
Multiple ancillary services are provided by the hospitals, including performing phlebotomies, starting IV lines and obtaining EKGs among others. These services free the interns and residents from “scut” work and provide more time for learning and clinical care in a pleasant working environment.
Our teams are floor based. This facilitates interdisciplinary collaboration with nurses, physical therapists, social workers, etc. Our residents receive sufficient breadth and depth of training to feel confident for inpatient work in diverse clinical settings ranging from rural hospitals to tertiary academic medical centers after graduation.
Intensive Care Unit
Residents rotate in the intensive care unit at Mercy Fitzgerald. This experience, closely supervised by intensivists, provides residents with exposure to complicated medical cases such as sepsis and respiratory failure. In addition, residents are exposed (via consultation) to post-surgery critical care.
Residents are primarily responsible for ALL procedures in the ICU, ensuring our residents become competent in central line insertion and other common critical care procedures. In the ICU, as on the floors, ancillary staff perform routine clinical duties and interdisciplinary rounding is integrated.
We employ the Society of Critical Care Medicine’s Virtual Critical Care Rounds educational modules which enhance the depth of educational offerings during the rotation.
Other Inpatient Rotations
Care of patients kept in “observation” status—as opposed to admission to the hospital—is becoming increasingly important for both hospitalists and subspecialists. Each intern spends two weeks working one-on-one with an academic hospitalist responsible for observation patients. Residents who wish to gain further experience in observation medicine can elect for an observation rotation as an elective.
With hospitals in both urban and suburban settings, the clinical rotation in Emergency Medicine provides interns and residents with an exposure to patients with a wide range of medical problems. Working with academic emergency medicine physicians our residents act as primary physician for patients presenting to the emergency department. Although they care for a wide range of patients, the focus of the rotation is on evaluation and management of patients who are not usually admitted to the internal medicine teaching service.
Admitting Officer of the Day (AOD)
Residents rotate in the emergency departments as Admitting Officer of the Day. In this rotation they act as the admitting (or triage) physician. They are responsible for initial management of these patients. In doing so, they learn about the initial presentation and management of patients with a wide spectrum of disease.
Eight to ten four-week “blocks” of electives are offered over the three-year program. Although the majority of elective time is spent in core internal medicine electives, options exist for rotations in pathology, radiology, psychiatry, and other non-internal medicine electives. With prior departmental approval, one elective rotation can be taken at an outside institution during the second or third year.
Residents spend two weeks with a board-certified geriatrician. During this experience residents are exposed to patients in the hospital, skilled nursing facilities and home visits. A didactic component complements the clinical experience.
Internal Medicine Consultations
Residents spend two weeks rotating with an academic hospitalist on the internal medicine consult service. The consult service includes pre-operative evaluations and pre- and post-operative care for patients on other services.
Ambulatory care is an essential component of the careers of general internists and specialists. Residents are trained in ambulatory care at hospital-owned primary care clinics as well as community practices in and around our hospitals.
Weekly Ambulatory Care Longitudinal Experience
Interns and residents work in an outpatient setting, including the medical clinics at Mercy Fitzgerald and Mercy Philadelphia as well as private offices of teaching faculty. Residents spend one afternoon each week throughout the three-year residency program. Each practice draws a diverse population of patients from the communities that surround our hospitals.
Each trainee will develop a panel of patients whom he or she will follow throughout their three-year experience. Under the supervision of the ambulatory instructor, the trainee will develop the skills required of a general internist including knowledge of preventive care guidelines, cost-effectiveness of various tests and skills in office management. Residents gain experience with ambulatory electronic health records and interdisciplinary care, working alongside nurses, case managers, and other members of the health care team.
Ambulatory Care Block Rotation
Residents spend one block during their intern year and four blocks during their PGY2 and PGY3 year focused on ambulatory medicine. During these blocks, residents spend extra time seeing their own continuity clinic patients. In addition, they rotate at both internal medicine and non-internal medicine ambulatory sites, gaining important experience in gynecology, neurology, dermatology, ophthalmology, and other non-internal medicine disciplines. There is also an opportunity to select other outpatient ambulatory experiences. During the rotation, there are dedicated didactic sessions on ambulatory topics as well as opportunities to work on research and quality improvement projects.