Internal Medicine

Program Mission

We are...

• A program that treats you as an individual

• A program that strives for equity, justice, and care for our community

• A program that aims for excellence in innovation to prepare you for the challenges of medicine, both today and tomorrow

• A program that promises to care for you as you care for others

We are... Penn State Internal Medicine Residency Program.

Program Vision

Train here, excel anywhere: Our vision is to be the best internal medicine residency program, fostering innovative physician leaders who embrace growth and excellence, challenge healthcare inequities, care for others and themselves, and transform medicine for the greater good.

Program Highlights

• Master Educator academies: The Internal Medicine Residency has three Master Educator academies with three Master Educator champions. These champions were selected from competitive pool of clinician educators. They promote the residency program vision and goals, set the educational climate and create a respectful clinical learning environment steeped in curiosity, excellence and compassion. They are responsible for the academy conference series, which stimulates high-order learning.

• Coaching program: All residents are paired with clinical coaches to allow for individualized growth in clinical skills over the course of three years. Coaches are responsible for observing residents in the clinical setting and providing feedback. Furthermore, they will meet with each resident individually every two months and do six-month group meetings.

• POCUS: The program introduced a 36-month point-of-care ultrasound curriculum for the 2019-2020 academic year. All residents receive training in this through didactic and hands-on sessions.

• Research: The residency program created a third assistant program director position, the Assistant Program Director for Resident Research and Scholarly Activity, to promote scholarship among residents. This assistant program director is responsible for the Resident Research Forum, the research elective, the research track and the ABIM Research pathway.

• Protected time for learning: The residency program has two academic half-day sessions weekly that are free of patient care activities: outpatient academic half-day for residents on ambulatory rotations, and inpatient academic half-day for residents on inpatient rotations. These conferences are in addition to the daily noon conference series.

• 4+2+2 scheduling structure: Residents alternate between six weeks of inpatient service and two weeks of ambulatory blocks. This schedule design gives residents the opportunity to focus on their respective rotations while maintaining continuity of care in the residents’ continuity clinics.

• Specialized tracks: The program offers eight internal tracks: Primary Care, Hospitalist, Longitudinal Research, ABIM Research, Health Systems Science, Clinician Educator, POCUS, and Global Health & Health Inequities.

Recent Innovations

• Comprehensive wellness initiative, including streamlined primary care provider visits for residents, class wellness champions and biannual wellness retreats.

• Dr. Jed Gonzalo, recipient of the AMA Redesigning Residency Initiative Planning Grant, is including the Internal Medicine Residency in developing the systems-based practice competency to develop residents into systems citizens. This is in collaboration with Kaiser Permanente, Geisinger and Allegheny Health Network.

• A communications curriculum has been developed by Dr. Paul Haidet and Dr. Rick Koubek (former chief resident) to teach residents evidence-based communications strategies through deliberate practice. This initiative is supported by the 2018 Picker Gold GME Education Challenge Grant.

• Dr. Ami Dewaters, Associate Professor for the Department of Medicine, has received a planning grant in collaboration with multiple health systems from the AMA Redesigning Residency Initiative, for which she has involved the Internal Medicine Residency in improving systems-based practice competencies and incorporated the design-thinking process in order to create systems-level changes in the clinical learning environment. This is in collaboration with Kaiser Permanente, Geisinger and Allegheny Health Network.

At the Center of Medical Care in the Region

As the primary academic medical center in central Pennsylvania, Penn State Health Milton S. Hershey Medical Center has a catchment area of more than 3 million people. Therefore, residents care for patients with a wide range of complex medical cases. Residents gain experience through the diverse pathology seen in the urban, suburban and rural areas of referral. Expanding partnerships with local hospitals and clinical sites will only increase this exposure in the future. Read more about Penn State Health Milton S. Hershey Medical Center here.

Internal Medicine Residency trainees are integral members of the health care teams in both general and subspecialty medicine, providing comprehensive care to the population of central Pennsylvania. The program fosters a culture of professional accountability, commitment to excellence and collaborative collegiality that works hand-in-hand with individual growth and learning.

Systems That Work

Penn State College of Medicine is one of the national pioneers of health systems science. The overarching goal of health systems science education at Penn State is to help current and future clinicians appreciate the interrelationship of biological, psychological, social and systems issues that influence an individual’s health. Therefore, Internal Medicine Residency trainees feel empowered to recognize barriers and implement change within their current health systems.

Dr. Jed Gonzalo, Associate Dean for Health Systems Science Education for Penn State College of Medicine and Associate Professor of Medicine, has received a planning grant from the AMA Redesigning Residency Initiative to create program that will develop trainees such that they graduate as truly systems-conscious internists.

Dr. Ami DeWaters, Associate Professor for the Department of Medicine, has received a planning grant in collaboration with multiple health systems from the AMA Redesigning Residency Initiative, for which she has involved the Internal Medicine Residency in improving systems-based practice competencies and incorporated the design-thinking process in order to create systems-level changes in the clinical learning environment.

General Application Information

Applications are accepted through ERAS only.

Due to the high volume of applications, our internal deadline for submission is September 30th and interviews are by invitation only.

Application Requirements

A committee reviews the entire application and does not base a decision solely upon the USMLE scores. Osteopathic (DO) applicants are expected to submit COMLEX scores, in addition to USMLE scores.

The program requires a chair’s letter plus two additional letters of recommendation to be attached to the ERAS application. In the event a chair’s letter is not available to an applicant, an additional faculty letter of recommendation will be accepted.

The institution sponsors only J-1 visas for international candidates.

Year of graduation should be within five years of date of application.

The NRMP requires all interviewees to receive a copy of the Resident Agreement. .

Preliminary Program Requirements

Applicants to other disciplines (i.e., anesthesia, dermatology, neurology, radiology) requiring a preliminary year must submit a separate ERAS application to the Internal Medicine Preliminary Program in addition to the specialty application. We do not require an additional interview with our program.

For details regarding the program and/or a preliminary program interview, email IMresidency@pennstatehealth.psu.edu.

Dr. Priyanka Lakshmanan leads all the residents through a longitudinal, year-long wellness curriculum during inpatient academic half-day. She focuses on developing the ability to help recognize burn-out in yourself and others, and subsequently developing mindfulness and resiliency tools.

To supplement the curriculum, each class has a wellness retreat once a year. During the retreat, the class has no clinical duties, goes off-campus, and focuses on team-building and personal resilience strategies.

In addition, residents volunteer to represent their class on the resident Wellness Committee, which is an organization that focuses on planning and implementing wellness activities for all the residents throughout the year.

The NRMP Fellowship Match has proven very successful for Penn State's internal medicine trainees, with an overall success rate of greater than 95 percent. The majority of those who have applied to fellowship have placed in one of their top three program choices even in the most competitive specialties.

Residents have a diverse education by experiencing multiple different health care systems.

During training at Penn State, residents will have the opportunity to learn in three different hospital systems: Penn State Health Milton S. Hershey Medical Center, a large, tertiary academic medical center; Lebanon VA Medical Center, one of the best VA hospitals in the country; and Penn Medicine Lancaster General Hospital, a large urban community-based hospital.

Explore the next sections to learn more about the clinical schedule, which has a focus on education and wellness.

Block clinic scheduling improves resident satisfaction with the primary care experience. Therefore, the program uses a 4+2+2 system in the residency, so that each resident will have 4 weeks of dedicated inpatient service, 2 weeks of an elective rotation, and 2 weeks of dedicated time in their ambulatory clinics.

The resident primary care clinic is located at Penn State Health Cocoa Outpatient Center, 1150 Cocoa Ave, Hershey PA, 17033.

The established night float system provides exceptional 24-hour care to all patients. As a result, residents in the program are rarely required to work 24-hour shifts. Most inpatient rotations have a 6:00 am - 6:00 pm shift structure.

The program strongly believes in ensuring that residents have time to dedicate their concentration exclusively to their education. There are established weekly outpatient and inpatient academic half-days during which residents do not have any clinical responsibilities.

The program's goal is for every resident to have the time and opportunity to explore their clinical and future career interests. Residents receive significant elective time and can choose electives in any subspecialty, including allergy and immunology, cardiology, endocrinology, gastroenterology, hepatology, hematology, infectious disease, oncology, palliative care, pulmonology, rheumatology and more. For those interested in academic careers, there are also electives available in research and medical education.

The clinical curriculum in the Internal Medicine Residency is a journey to becoming an exceptional clinician, educator and scholar.

The Internal Medicine Residency uses an ambulatory block schedule in place of traditional weekly clinic sessions.

During any two-week ambulatory block, residents provide longitudinal care for their patients in the primary care clinic and spend time in other subspecialty clinics. This allows our residents to experience the full spectrum of outpatient care.

The longitudinal care clinic is a level III patient-centered medical home and is supported by an experienced staff. Residents treat patients with a wide variety of disorders, ranging from routine primary care and prevention to more complex and esoteric problems. Residents also enjoy a very low patient no-show rate in their clinic, which allows them to quickly build and follow a patient panel.

The residency program has an academy-based system of master educator champions and coaches to guide residents in their lifelong Internal Medicine education and career development. Each resident is assigned to one of three academies and is assigned an academic coach.

Program features include:

• Bimonthly educational conferences led by one of three master educator champions.

• Longitudinal relationships between residents and faculty coaches to address learner-identified coaching and mentoring needs.

The Internal Medicine Residency places a strong emphasis on the EBM training of residents. The multi-faceted curriculum, which extends beyond traditional Journal Club, includes:

• EBM scripts during outpatient academic half-day that enable residents to discuss important EBM concepts such as surrogate outcomes and hierarchy of evidence, without being limited to a particular research study. EBM scripts are based on clinical scenarios and teach such concepts in an interactive manner.

• EBM consults during academic half-day, which are short (10- to 15-minute) presentations from senior residents, each tasked with answering a clinical question. Residents practice formulating a question, searching and appraising the literature and discussing findings with their peers. This format allows residents to become familiar with sources of original research studies but also pre-appraised information such as the PIER modules, TRIP database, etc.

• EBM mini-CEX allows senior residents to practice the application of EBM principles in real time, while caring for their clinic patients.

The Internal Medicine Residency believes formal teaching sessions should exemplify current learning theory of learner-driven topics that utilize interleaved sessions of interactive teaching with small-group case-based education and a consistent use of retrieval practice.

Noon Conference

Noon Conference is held from 12:00 pm - 1:00 pm. Mondays, Tuesdays, Wednesdays and Fridays. The Internal Medicine chief residents guide facilitated discussions and presentations about various aspects of residents’ clinical scenarios.

Academic Half-Day

Academic half-day is a weekly teaching session in both the inpatient and ambulatory settings. Both inpatient and outpatient academic half-days feature protected time for active learning. Residents are completely excused from clinical care during these sessions.

Academy Conferences

Academy conferences are led by Master Educators who use clinical cases to investigate broader clinical questions, health systems and decision-making skills.

Grand Rounds

7:30 am - 8:30 am every Tuesday are reserved for Department of Medicine Grand Rounds. Here, invited guest speakers and internal experts present new research developments, updates on best clinical practice and other topics of interest from the broad realm of internal medicine.

Morbidity and Mortality Conference

The Morbidity and Mortality Conference focuses on providing a safe forum for many interprofessional disciplines to identify ways to provide better care. Most cases are identified by residents, presented by the chief residents and integrated directly into quality improvement projects.

The majority of residents are highly successful in completing research in their residency training. Many residents achieve publications and podium/poster presentations at regional, state, national and international conferences.

As an example, in recent years, residents have presented at the following national and local meetings:

• Allergy, Asthma, and Immunology

• American Association for Bronchology and Interventional Pulmonology

• American College of Cardiology

• American College of Gastroenterology

• American College of Rheumatology

• American College of Physicians Regional and National Conference

• American Heart Association

• American Society of Clinical Oncology

• American Society of Nephrology

• American Thoracic Society and CHEST

• Inflammatory Bowel Disease International Conference

• International Academy of Cardiology

• Penn State Annual Resident/Fellow Research Day and Quality Symposium

• Pennsylvania Medical Society

• Society of Critical Care Medicine

• Society of General Internal Medicine

• Society of Hospital Medicine

For those residents who wish to pursue careers with independent research programs, the program also sponsors the .

The institutional Physician Scientist Training Program is also available as a resource for career development.

The primary care track is for residents interested in pursuing careers in primary care or ambulatory-based subspecialties. Residents focus on clinical and non-clinical skills needed to achieve excellence in ambulatory medicine and become part of a community of primary care champions. PCT residents still experience a strong core of inpatient rotations but have increased exposure to ambulatory electives in various settings. Residents also engage in a second longitudinal clinic with an experienced outpatient physician who serves as a key professional mentor.

Primary features

• Population health elective block(s)

• Career exploration blocks tailored to the resident’s particular area of interest

• 2-year health systems science curriculum applied to primary care

• Ambulatory quality improvement initiatives

• Community-building activities

In the hospitalist track, the program emphasizes training hospitalists who can succeed in the rapidly growing field of hospital medicine by putting patient-centered care first, building inter-professional care teams and working and thinking in a systems-based mindset.

Primary features

• Increased rotation time spent in hospitalist medicine

• Increased exposure to rotations where residents work independently as hospitalists

• Opportunity to participate in quality improvement and systems-based curricula

• Rotations on post-acute care

• Opportunities to serve on institutional committees

This research track offers residents the opportunity to develop and work on research projects of their choice for a dedicated period of time in order to further their career as a junior clinician investigator.

Primary features

• Applicants are granted 12 weeks of research time between PGY-2 and PGY-3 years

• Research must be completed at PSU under the guidance of a PSU faculty mentor

• Residents continue in the 4+2+2 block scheduling structure and are expected to participate in their longitudinal clinic

• Monthly progress reports are required to be submitted to Research APD

• Results should be submitted for publication to a peer-reviewed journal or presented at a national conference

• Residents that participate and successfully complete this track will receive recognition during graduation and in letters of recommendation

Project Examples

Explore publications from our recent Longitudinal Research Tack Pathway Residents, here!

The Internal Medicine Residency offers the American Board of Internal Medicine Research Pathway.

The HSSA is designed to develop teachers and role models in Health Systems Science within each department who will guide the new learning and practice models that are evolving for increasingly complex population-focused healthcare systems.

Six Domains of Health Systems Science:

• Population and Public Health

• Healthcare Policy, Economics and Management

• Clinical Informatics and Health Information Technology

• Value-Based Care

• Health System Improvement

• Healthcare Delivery Structures and Processes

During the PGY-3 year, HSS Track residents participate in HSS electives that both build on personal interests in health systems and provide direct HSS consults to inpatient medical teams to illustrate health systems concepts in action.

Learn more about the Health Systems Science Academy

Flexible curriculum for residents desiring longitudinal teaching and curriculum skill development that combines experiences offered by the Woodward Center and the Office of Graduate Medical Education. Participants are individually mentored to create a teaching session and reflect upon their teaching experiences.

The Global Health and Health Inequities Track is available to PGY-2 and PGY-3 residents interested in exploring careers in global health or for people interested in serving underserved populations. Residents can achieve important skills in caring for vulnerable populations nationally and abroad.

Primary Features

• Travel nationally or abroad to underserved areas (4 weeks in PGY-3 year)

• A two-year curriculum partnered with the Global Health Scholars Program through the College of Medicine

• Participation in a global health or health inequity project

• Community engagement activities

Our two-year Point-of-Care Ultrasound (POCUS) track offers residents specialized training to perform bedside ultrasound safely and competently. Following the ACCP/SHM Certificate of Completion standards, this track blends independent image acquisition, supervised scanning and teaching experience to build expertise in diagnostic ultrasound. Graduates receive a completion letter that supports pursuing diagnostic POCUS privileging.

Primary features

• Structured curriculum based on ACCP/SHM POCUS certification guidelines

• Flexible learning through asynchronous scanning with regular, scheduled supervised sessions

• Comprehensive portfolio with minimum diagnostic-quality images in cardiac, lung, abdominal, vascular and soft tissue exams

• Teaching role as PGY-3 participants help lead hands-on POCUS sessions for peers

• Certification with letter of completion provided to support future POCUS privileging applications

Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center accept ongoing nominations for the Exceptional Moments in Teaching award.

The award, given monthly by the Office for a Respectful Learning Environment, accepts nominations from College of Medicine students who are invited to submit narratives about faculty members, residents, fellows, nurses or any other educators who challenge them and provide an exceptional learning experience. See more about the award here.

Previous nominees from the Internal Medicine Residency are listed here.

The annual Resident/Fellow Research Day is held each year (with exception of during the COVID-19 pandemic) on and around the Penn State Health Milton S. Hershey Medical Center campus. The intent of the event is to provide an opportunity for residents and fellows to showcase their research accomplishments to their peers in other clinical departments, as well as their colleagues in the basic sciences. Learn more about Resident/Fellow Research Day here.