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Many people have asked me about my prelim year, so I thought I would post a detailed description. When I was ranking my list for prelim and transitional years not too long ago, I was frustrated by the lack of information out there about the information out there. And with rank lists due next week, I hope this helps some of you with your decision.
Lankenau Medical Center is a very busy and profitable community hospital. Demographically is lies between the poor, generally African-American West Philadelphia and the wealthy, generally Caucasian suburb of Wynnewood on the Main Line. Its main specialties of note are cardiology and cardiothoracic surgery. There are 26 interns and 26 second and third year medicine residents.
Lankenau has a website about the medicine residency (http://www.mainlinehealth.org/imresidency), but some of the information there is somewhat misleading. If there is any discrepancy, use my information below as your guide -- it's very accurate.
Of 53 weeks of the intern year (including one week of orientation before you actually start), there are approximately 32 weeks on service. Service consists of a mix of floors, night float, ICU, and admitting intern duties. Although individual schedules vary quite a bit, your schedule will generally consist of approximately: 14-16 weeks of floors, 4-6 weeks of night float, 8-10 weeks ICU, and 2-4 weeks as admitting intern. That leaves you with about 18 weeks elective (or medicine consult) with about 2-3 weeks of vacation when you include the holiday break. However, when you are on elective, you cover several weekends over the year (about 4-6), which usually works out to be about 2-4 night floats (Saturday night - Sunday morning) and 1-3 weekends of admitting intern (Saturday and Sunday).
I wasn't there for this, but Lankenau opened up a huge new building in 2013. I don't know how it has affected things; I would ask someone who is there now for more information.
There is a mandatory noon conference from 12:15-1 pm everyday on weekdays. There is also a mandatory grand rounds session on Fridays from 8-9 am. Attendance is recorded, and you will get dinged if you aren't there.
Below are highlights for each of the different service areas:
Floors:
- This is where you spend most of your service time.
- There are eight separate internal medicine teams with a slightly different focus. All are hospitalist teams except Team 3 (Dr. Cohen) and Team 6 (cardiology). Teams consist of one attending, one resident, and one intern.
- Teams are capped at 12 patients but can go to 14 overnight. This means that if you start at 13 or 14 patients during the morning because you will send 1-2 patients on team to the non-teaching service.
- Patients can and are admitted to all teams at all times. This functionally means that teams are usually always capped at 12-14 patients.
- You are on long day every 4th day as an intern. The same goes for your resident, but you have long days on different days. Weekends are the standard gold-gray-black.
- You cover and write notes on 8 patients as an intern.
- Hours vary depending on many factors. Even though you can sign out at 4 pm on long days during the week and 1 pm on weekends, this is the exception rather than the rule. In general, interns start at 6:30 am (residents at 7 am) and finish about 5-6 pm on short days. On long days, you finish around 7:30-8:30 pm. Note that many interns find it necessary to start earlier than 6:30 am, because you have to pre-round on at least 8 patients, many of which may be new to you, and be ready to start rounds by about 9:45 am.
- On long days, you are required to be in the ED to do admissions by 4 pm on weekdays and 1 pm on weekends. You then cover your own team and cross-cover two other teams (when they sign out to you). You then typically do 2 admissions (hopefully to your team, but not always) on weekdays and 2-3 on weekends. There is no observation unit in ED (which is very small). This means that the medicine residents end up doing a lot of observation admissions that could otherwise simply be transferred to the obs unit.
- Note that you can be called to the ED to do an admission even on your short days between 1 and 4 pm. This generally happens when it gets busy in the ED with many admissions.
- Most attendings expect you to have a note in progress on all your patients by rounds, but you generally don't have to be finished by rounds.
- Although most patients are admitted to the hospitalist service (except Teams 3 and 6), any team may take private patients. There are usually about 2 or 3 on every team. Residents usually cover the private patients because there tends to be less input from private attendings
- Team 6 is a cardiology team and consists a cardiology fellow in addition to the usual resident and intern. There are several cardiology attendings, each of which may like to round on their patients, making rounds on Team 6 can be very difficult for the intern. Some of the cardiology fellows can be difficult to deal with as well. For these reasons, Team 6 is often the least-popular team for interns. However, it is the only team headed by specialists that you rotate with.
- Team 3 is Dr. Cohen's team. Dr. Cohen has been at Lankenau for many years is very well-respected for his encyclopedia-like medical knowledge. He is often compared to House. And, like House, he has an extremely old-school and gruff bedside manner. He will yell at residents -- but you learn to not take it badly because he is not at all malignant. He rounds extremely quickly on patients and uses the time he saves to give a lecture on a topic based on case usually presented by a medical student. However, he often wants to do bedside rounds at the end of the day for any new patients on the service, which means you are often there late, even on short days.
- At the end of the day, you sign out to either the long day intern (short day) or to the night float (long day).
- Note that you will dictate a discharge summary on every patient you wrote on if they were in the hospital for more than two days; I would dictate about 25-30 discharge summaries each month I was on the floors.
- On weekends, you are not there with your resident because their long day schedule is different.
- Note than some floor blocks are 5 weeks instead of 4 weeks.
ICU: - There are 4 interns and 3 residents on at any given time in the ICU. One intern and one resident cover nights, meaning that there are 3 interns and 2 residents during the day.
- You are on q4 long day in the ICU as well. Because of the way this works, this means that there are days when there are only 2 interns in the ICU.
- Interns generally write the notes in the ICU. The census is usually about 20, meaning that interns write anywhere from 6-9 notes depending on the day.
- Hours again vary, but you typically start no later than 6 am. You generally signout at around 4:30-5:30 pm on short days, and 7-8 pm on long days.
- You have 3 weeks of days and 1 week of nights. Because of the switch over to nights, you get an extra day off, so you get 5 days off per 4 weeks instead of 4 as on floors.
- Nights consist of you and the resident. For some reason, there are usually extremely busy or else nothing is going on. Hours are from 7 pm to 7 am.
- Interns write the transfer notes for patients coming to or leaving the ICU.
- Rounds in the ICU are usually quite long, starting at about 9:30 am and ending around 12:30 pm.
- Attendings are usually on one week at time. Styles of course vary widely by attending, but most are actually fairly laid back. Dr. Gregory is the exception, who is very intense.
- Again, note than some floor blocks are 5 weeks instead of 4 weeks.
- The ICU is extremely busy in the winter.
- In general, most interns prefer being the ICU rather the floors.
Night Float:
- This is generally the worst of the services in terms of stress.
- There are 2 second-year residents and two interns on night float.
- You cover 4 team lists (or about 50 or so patients), fielding pages and spend the rest of the night doing admissions.
- You generally admit 3-4 patients per night. Note that although residents do not carry the pager, you split all the admissions equally. So if 16 patients are admitted, you will each admit 4 patients.
- There is one to two nocturnist hospitalists on service each night.
- Hours are typically from 7 pm to 7 am on weekdays and 7 pm to 8 am on weekends. You work six nights in row, Sunday night to Friday night. Saturday nights are covered by those on elective.
Admitting intern:
- Consists of one resident and one intern.
- This is service designed to admit patients to the floor during the morning when teams are busy with rounds, and to provide an extra intern in the afternoon and evening to help with rounds.
- Hours are from 9 am to 8 pm. Note that the resident is there from 7 am to 4 pm and signs out the list to the resident on long day.
- You spend your day doing admissions, which are often one after the other. You usually do about 6-7 admissions per day.
- Again, note that there is no observation unit in the ED. Functionally this means that the medicine residents end up doing a lot of observation admissions that could otherwise simply be transferred to the observation unit and quickly discharged.
- Compared to floors, the upside is that you don't have to field pages. Also, you do get both weekend days off, which are covered by interns on elective. However, admissions are probably the hardest thing you have to do as an intern, so this is actually a difficult service.
Electives/Medicine consult:
- If it weren't for electives, this year would truly suck!
- The main issue with electives is night float and admitting intern cross-cover. If you have one of these to do, your weekend is pretty much shot.
- Electives vary quite a bit in terms of what is required. However, you must show up everyday, and you must be at noon conference and grand rounds. People have gotten in trouble for not showing up to electives like radiology and pathology.
- You can ask around about which electives are easiest, if that's what you want. Easy ones include sleep medicine, radiology, and pathology. Dermatology can vary quite a bit, with some actually wanting you there for longer hours. If you are on other specialty electives like ID, cardiology, etc. you may end up doing fairly long hours.
- Everybody get approximately 18 weeks of electives or medicine consult. Because there are so few medicine consults in the hospital, medicine consult service is pretty much like an elective. You typically see 1-2 patients a day, somedays there are no patients at all and you can leave early.
- One big perk about electives is that you can do an away elective. If you are going someplace else, this can be a time to visit before you move.
Medical students:
- There are many medical students and sub-interns in the hospital, mostly from Jefferson and PCOM.
- In general, (based on my own experience, the expectations of medical students are on the lower side.
- Unfortunately, because they are not allowed to document and cannot enter any orders, the sub-interns are actually not of much help beyond what a third year medical student can do
Holiday block:
- There are 12 days covering Christmas and New years; you work 6 days (on one of the services, including floors, ICU, night float) and are off 6 days
Vacation:
- You get 10 days of vacation, which come as two separate weeks during your electives
Perks:
- During the interview, they mention you have sick days and "personal days." This may be a bit misleading. Note that you must make up sick days whenever on service. I don't think anyone has ever taken a personal day on service, only on elective. Even on elective, the only thing they really allow personal days for is a doctor or dentist visit, and you usually have to provide documentation.
- Unfortunately, there is not many free lunches at noon conference
- In the resident lounge, there are some free snacks and small sandwiches; there is also some free coffee
- Away electives
- Holiday block
To sum up, this is a very busy hospital with an intense leadership where the expectations of interns are fairly high. That being said most people are friendly and professional. You certainly get good training in bread-and-butter internal medicine. I would recommend this program to those interested in community internal medicine, especially hospitalist medicine. Of course, as a preliminary intern, this program, like most prelim medicine programs, is certainly much more medicine than you will need in your career for virtually another other field.
Send me a message if you have any other specific questions I can answer.
Lankenau Medical Center is a very busy and profitable community hospital. Demographically is lies between the poor, generally African-American West Philadelphia and the wealthy, generally Caucasian suburb of Wynnewood on the Main Line. Its main specialties of note are cardiology and cardiothoracic surgery. There are 26 interns and 26 second and third year medicine residents.
Lankenau has a website about the medicine residency (http://www.mainlinehealth.org/imresidency), but some of the information there is somewhat misleading. If there is any discrepancy, use my information below as your guide -- it's very accurate.
Of 53 weeks of the intern year (including one week of orientation before you actually start), there are approximately 32 weeks on service. Service consists of a mix of floors, night float, ICU, and admitting intern duties. Although individual schedules vary quite a bit, your schedule will generally consist of approximately: 14-16 weeks of floors, 4-6 weeks of night float, 8-10 weeks ICU, and 2-4 weeks as admitting intern. That leaves you with about 18 weeks elective (or medicine consult) with about 2-3 weeks of vacation when you include the holiday break. However, when you are on elective, you cover several weekends over the year (about 4-6), which usually works out to be about 2-4 night floats (Saturday night - Sunday morning) and 1-3 weekends of admitting intern (Saturday and Sunday).
I wasn't there for this, but Lankenau opened up a huge new building in 2013. I don't know how it has affected things; I would ask someone who is there now for more information.
There is a mandatory noon conference from 12:15-1 pm everyday on weekdays. There is also a mandatory grand rounds session on Fridays from 8-9 am. Attendance is recorded, and you will get dinged if you aren't there.
Below are highlights for each of the different service areas:
Floors:
- This is where you spend most of your service time.
- There are eight separate internal medicine teams with a slightly different focus. All are hospitalist teams except Team 3 (Dr. Cohen) and Team 6 (cardiology). Teams consist of one attending, one resident, and one intern.
- Teams are capped at 12 patients but can go to 14 overnight. This means that if you start at 13 or 14 patients during the morning because you will send 1-2 patients on team to the non-teaching service.
- Patients can and are admitted to all teams at all times. This functionally means that teams are usually always capped at 12-14 patients.
- You are on long day every 4th day as an intern. The same goes for your resident, but you have long days on different days. Weekends are the standard gold-gray-black.
- You cover and write notes on 8 patients as an intern.
- Hours vary depending on many factors. Even though you can sign out at 4 pm on long days during the week and 1 pm on weekends, this is the exception rather than the rule. In general, interns start at 6:30 am (residents at 7 am) and finish about 5-6 pm on short days. On long days, you finish around 7:30-8:30 pm. Note that many interns find it necessary to start earlier than 6:30 am, because you have to pre-round on at least 8 patients, many of which may be new to you, and be ready to start rounds by about 9:45 am.
- On long days, you are required to be in the ED to do admissions by 4 pm on weekdays and 1 pm on weekends. You then cover your own team and cross-cover two other teams (when they sign out to you). You then typically do 2 admissions (hopefully to your team, but not always) on weekdays and 2-3 on weekends. There is no observation unit in ED (which is very small). This means that the medicine residents end up doing a lot of observation admissions that could otherwise simply be transferred to the obs unit.
- Note that you can be called to the ED to do an admission even on your short days between 1 and 4 pm. This generally happens when it gets busy in the ED with many admissions.
- Most attendings expect you to have a note in progress on all your patients by rounds, but you generally don't have to be finished by rounds.
- Although most patients are admitted to the hospitalist service (except Teams 3 and 6), any team may take private patients. There are usually about 2 or 3 on every team. Residents usually cover the private patients because there tends to be less input from private attendings
- Team 6 is a cardiology team and consists a cardiology fellow in addition to the usual resident and intern. There are several cardiology attendings, each of which may like to round on their patients, making rounds on Team 6 can be very difficult for the intern. Some of the cardiology fellows can be difficult to deal with as well. For these reasons, Team 6 is often the least-popular team for interns. However, it is the only team headed by specialists that you rotate with.
- Team 3 is Dr. Cohen's team. Dr. Cohen has been at Lankenau for many years is very well-respected for his encyclopedia-like medical knowledge. He is often compared to House. And, like House, he has an extremely old-school and gruff bedside manner. He will yell at residents -- but you learn to not take it badly because he is not at all malignant. He rounds extremely quickly on patients and uses the time he saves to give a lecture on a topic based on case usually presented by a medical student. However, he often wants to do bedside rounds at the end of the day for any new patients on the service, which means you are often there late, even on short days.
- At the end of the day, you sign out to either the long day intern (short day) or to the night float (long day).
- Note that you will dictate a discharge summary on every patient you wrote on if they were in the hospital for more than two days; I would dictate about 25-30 discharge summaries each month I was on the floors.
- On weekends, you are not there with your resident because their long day schedule is different.
- Note than some floor blocks are 5 weeks instead of 4 weeks.
ICU: - There are 4 interns and 3 residents on at any given time in the ICU. One intern and one resident cover nights, meaning that there are 3 interns and 2 residents during the day.
- You are on q4 long day in the ICU as well. Because of the way this works, this means that there are days when there are only 2 interns in the ICU.
- Interns generally write the notes in the ICU. The census is usually about 20, meaning that interns write anywhere from 6-9 notes depending on the day.
- Hours again vary, but you typically start no later than 6 am. You generally signout at around 4:30-5:30 pm on short days, and 7-8 pm on long days.
- You have 3 weeks of days and 1 week of nights. Because of the switch over to nights, you get an extra day off, so you get 5 days off per 4 weeks instead of 4 as on floors.
- Nights consist of you and the resident. For some reason, there are usually extremely busy or else nothing is going on. Hours are from 7 pm to 7 am.
- Interns write the transfer notes for patients coming to or leaving the ICU.
- Rounds in the ICU are usually quite long, starting at about 9:30 am and ending around 12:30 pm.
- Attendings are usually on one week at time. Styles of course vary widely by attending, but most are actually fairly laid back. Dr. Gregory is the exception, who is very intense.
- Again, note than some floor blocks are 5 weeks instead of 4 weeks.
- The ICU is extremely busy in the winter.
- In general, most interns prefer being the ICU rather the floors.
Night Float:
- This is generally the worst of the services in terms of stress.
- There are 2 second-year residents and two interns on night float.
- You cover 4 team lists (or about 50 or so patients), fielding pages and spend the rest of the night doing admissions.
- You generally admit 3-4 patients per night. Note that although residents do not carry the pager, you split all the admissions equally. So if 16 patients are admitted, you will each admit 4 patients.
- There is one to two nocturnist hospitalists on service each night.
- Hours are typically from 7 pm to 7 am on weekdays and 7 pm to 8 am on weekends. You work six nights in row, Sunday night to Friday night. Saturday nights are covered by those on elective.
Admitting intern:
- Consists of one resident and one intern.
- This is service designed to admit patients to the floor during the morning when teams are busy with rounds, and to provide an extra intern in the afternoon and evening to help with rounds.
- Hours are from 9 am to 8 pm. Note that the resident is there from 7 am to 4 pm and signs out the list to the resident on long day.
- You spend your day doing admissions, which are often one after the other. You usually do about 6-7 admissions per day.
- Again, note that there is no observation unit in the ED. Functionally this means that the medicine residents end up doing a lot of observation admissions that could otherwise simply be transferred to the observation unit and quickly discharged.
- Compared to floors, the upside is that you don't have to field pages. Also, you do get both weekend days off, which are covered by interns on elective. However, admissions are probably the hardest thing you have to do as an intern, so this is actually a difficult service.
Electives/Medicine consult:
- If it weren't for electives, this year would truly suck!
- The main issue with electives is night float and admitting intern cross-cover. If you have one of these to do, your weekend is pretty much shot.
- Electives vary quite a bit in terms of what is required. However, you must show up everyday, and you must be at noon conference and grand rounds. People have gotten in trouble for not showing up to electives like radiology and pathology.
- You can ask around about which electives are easiest, if that's what you want. Easy ones include sleep medicine, radiology, and pathology. Dermatology can vary quite a bit, with some actually wanting you there for longer hours. If you are on other specialty electives like ID, cardiology, etc. you may end up doing fairly long hours.
- Everybody get approximately 18 weeks of electives or medicine consult. Because there are so few medicine consults in the hospital, medicine consult service is pretty much like an elective. You typically see 1-2 patients a day, somedays there are no patients at all and you can leave early.
- One big perk about electives is that you can do an away elective. If you are going someplace else, this can be a time to visit before you move.
Medical students:
- There are many medical students and sub-interns in the hospital, mostly from Jefferson and PCOM.
- In general, (based on my own experience, the expectations of medical students are on the lower side.
- Unfortunately, because they are not allowed to document and cannot enter any orders, the sub-interns are actually not of much help beyond what a third year medical student can do
Holiday block:
- There are 12 days covering Christmas and New years; you work 6 days (on one of the services, including floors, ICU, night float) and are off 6 days
Vacation:
- You get 10 days of vacation, which come as two separate weeks during your electives
Perks:
- During the interview, they mention you have sick days and "personal days." This may be a bit misleading. Note that you must make up sick days whenever on service. I don't think anyone has ever taken a personal day on service, only on elective. Even on elective, the only thing they really allow personal days for is a doctor or dentist visit, and you usually have to provide documentation.
- Unfortunately, there is not many free lunches at noon conference
- In the resident lounge, there are some free snacks and small sandwiches; there is also some free coffee
- Away electives
- Holiday block
To sum up, this is a very busy hospital with an intense leadership where the expectations of interns are fairly high. That being said most people are friendly and professional. You certainly get good training in bread-and-butter internal medicine. I would recommend this program to those interested in community internal medicine, especially hospitalist medicine. Of course, as a preliminary intern, this program, like most prelim medicine programs, is certainly much more medicine than you will need in your career for virtually another other field.
Send me a message if you have any other specific questions I can answer.
