I saw a lot of people have had Penn high in their rank list for IM residency, and I thought people might be interested in a story about the care my little brother received there while admitted on an IM teaching service recently. I'm a third year IM resident at a mid-tier university program in the Midwest, and for the record, I have no personal chip on my shoulder about Penn (I didn't apply there for residency; I did for rheum fellowship but ultimately ranked other places higher and matched higher on my list).
My little brother is about 25 and is healthy with no medical problems. He developed a post-flu lung abscess and got admitted to Penn Presbyterian, which is staffed by regular Penn residents and faculty. He was pretty sick and needed NIPPV in addition to lots of IV antibiotics and fluids, but has since turned the corner and is doing well now. He's on a general IM teaching service with a medical student, an intern, a chief resident, and an attending. They noticed that his hemoglobin was low at around 10, with a normal MCV. They ordered iron studies and found a serum iron <10 and ferritin >400. The intern wanted to give IV iron. Per my brother and his wife, this was discussed on morning rounds and the whole team was in agreement that this needed IV iron. He actually got a dose of IV iron before they told me what the numbers were and I said "stop!"
This is so, so clearly anemia of critical illness, right? His total body iron is normal; it's just sequestered in ferritin as a response to the acute critical illness. Adding IV iron will just make the ferritin go higher. Interpreting iron studies is something that I would expect a 3rd or 4th year medical student to do, and is certainly something a January intern should do with ease. So I sent my brother a little chart about interpreting iron studies, which he showed to the intern the next morning. The intern hemmed and hawed but wouldn't admit that he had misinterpreted the iron studies and was still pushing for more IV iron. The attending came in. They asked how she interpreted the iron studies and whether she thought that his total body iron stores were truly low, or whether they were just sequestered in acute illness. She said, "Well, we could know if we knew what the ferritin was." To her credit, she was properly embarrassed when my non-medical brother and his wife both knew what the ferritin was when she, the attending, didn't even know one had been ordered yet. To her massive discredit, she too hemmed and hawed and tried to make something up about how it still might help him, and still ended up recommending more IV iron. I wasn't there but their impression was that she was embarrassed and knew a mistake had been made but couldn't or wouldn't admit it.
So, there were lots of things that happened that I find shocking for what's supposed to be a prestigious, high-quality internal medicine program.
1. That an intern could make it to January without understanding iron studies.
2. That an intern with such serious medical knowledge deficiencies (you know if they don't know what ferritin means, they don't know loooots of other basic things) wasn't flagged officially or unofficially by the program for close supervision by his seniors.
3. That on the first day he got IV iron, it had actually been discussed on rounds and the attending and senior signed off on it without even bothering to know what the ferritin was.
4. That NO ONE could admit they had made mistakes, both the intern in his lack of basic medical knowledge, and the attending in her lack of supervision.
Anyway, if I were applying to residency again, I really would have wanted to know stuff like this. I can't see how something like this could have happened without serious, program-wide deficiencies in medical education and in safe trainee supervision. It seemed like individuals' egos were much more important than patient care, and that is a really toxic situation.
If anyone with more personal experience with the Penn IM program disagrees, I'd be happy to hear a rebuttal. But for anyone who's considering residency at Penn, I think you should think long and hard about the education and supervision you'll be missing there.
My little brother is about 25 and is healthy with no medical problems. He developed a post-flu lung abscess and got admitted to Penn Presbyterian, which is staffed by regular Penn residents and faculty. He was pretty sick and needed NIPPV in addition to lots of IV antibiotics and fluids, but has since turned the corner and is doing well now. He's on a general IM teaching service with a medical student, an intern, a chief resident, and an attending. They noticed that his hemoglobin was low at around 10, with a normal MCV. They ordered iron studies and found a serum iron <10 and ferritin >400. The intern wanted to give IV iron. Per my brother and his wife, this was discussed on morning rounds and the whole team was in agreement that this needed IV iron. He actually got a dose of IV iron before they told me what the numbers were and I said "stop!"
This is so, so clearly anemia of critical illness, right? His total body iron is normal; it's just sequestered in ferritin as a response to the acute critical illness. Adding IV iron will just make the ferritin go higher. Interpreting iron studies is something that I would expect a 3rd or 4th year medical student to do, and is certainly something a January intern should do with ease. So I sent my brother a little chart about interpreting iron studies, which he showed to the intern the next morning. The intern hemmed and hawed but wouldn't admit that he had misinterpreted the iron studies and was still pushing for more IV iron. The attending came in. They asked how she interpreted the iron studies and whether she thought that his total body iron stores were truly low, or whether they were just sequestered in acute illness. She said, "Well, we could know if we knew what the ferritin was." To her credit, she was properly embarrassed when my non-medical brother and his wife both knew what the ferritin was when she, the attending, didn't even know one had been ordered yet. To her massive discredit, she too hemmed and hawed and tried to make something up about how it still might help him, and still ended up recommending more IV iron. I wasn't there but their impression was that she was embarrassed and knew a mistake had been made but couldn't or wouldn't admit it.
So, there were lots of things that happened that I find shocking for what's supposed to be a prestigious, high-quality internal medicine program.
1. That an intern could make it to January without understanding iron studies.
2. That an intern with such serious medical knowledge deficiencies (you know if they don't know what ferritin means, they don't know loooots of other basic things) wasn't flagged officially or unofficially by the program for close supervision by his seniors.
3. That on the first day he got IV iron, it had actually been discussed on rounds and the attending and senior signed off on it without even bothering to know what the ferritin was.
4. That NO ONE could admit they had made mistakes, both the intern in his lack of basic medical knowledge, and the attending in her lack of supervision.
Anyway, if I were applying to residency again, I really would have wanted to know stuff like this. I can't see how something like this could have happened without serious, program-wide deficiencies in medical education and in safe trainee supervision. It seemed like individuals' egos were much more important than patient care, and that is a really toxic situation.
If anyone with more personal experience with the Penn IM program disagrees, I'd be happy to hear a rebuttal. But for anyone who's considering residency at Penn, I think you should think long and hard about the education and supervision you'll be missing there.
