Schedule

Since July 2014, we have had a “4+1” block schedule.

What does 4+1 mean?

In traditional Internal Medicine residency schedules, house officers leave their rotations one afternoon per week to see outpatients in continuity clinic.  While this structure has provided adequate ambulatory training and allows residents to develop a panel of patients for whom they are the primary physician, it creates a tension between in- and outpatient training and pulls residents in two directions at once – which is not ideal for your education or for patient care!

A “4+1” block schedule means that our house officers have a four-week rotation block (that you won’t leave for continuity clinic), followed by one week of exclusively ambulatory training. This pattern is repeated back-to-back 10 times throughout the entire year.  The ambulatory week includes a combination of continuity clinic sessions, subspecialty ambulatory clinic, two educational half-days including our Quality Improvement & High Value Care curriculum and our ambultory curriculum, and time blocked for administrative duties (like calling patients, following up on lab tests, and writing letters). House officers will still have a longitudinal relationship with their clinic patients and preceptors throughout residency.

So, the “4+1” schedule improves your educational experience, improves patient care, improves continuity with your clinic patients and guarantees that, at a minimum, every 5th week your evenings and weekends are yours!  Note this does not change inpatient rotations, which continue to abide by all duty hours requirements, including the one-day-off-in-seven rule.

Another benefit of the “4+1” schedule is that you won’t be rushing to get to afternoon clinic! This means that your inpatient team won't be leaving and signing out to each other, leaving someone to cross cover all afternoon.  (Prelims - pay attention to this, as it's a big benefit for YOU!)

Preliminary interns do not have a continuity clinic, however, in response to prior feedback, our prelim interns' elective weeks will be spread out in a similar "+1" pattern to allow for a similar feeling schedule. This also allows prelims to participate in the Quality Improvement & High Value Care curriculum if desired.

Primary care interns/residents WILL be on a 4+1 schedule outside of their Ambulatory Year.

Estimated Rotation Schedule (Averages):

Service

PGY-1

PGY-2

PGY-3

Medicine Wards

4-5 months

1-3 months

1-3 months

NIH / NIAID Wards

-

0-1 month

1-2 months

Cardiology Wards/ CCU

1 month

0-1 month

0-1 month

Pulmonology Wards

2 weeks

-

2 weeks

Intensive Care Unit

1-2 months

1-2 months

1-2 months

Oncology Ward, Infectious Disease Consult, Renal Consult, Geriatrics Consult, and Medicine Consult

-

2 weeks each service

-

Night Float

2-4 weeks

2-4 weeks

2-4 weeks

Ambulatory and  Subspecialty Elective

14 weeks

18 weeks

20 weeks

Emergency Medicine

-

2 weeks

2 weeks

Medical Admitting Officer

 

 

2 weeks

Vacation

4 weeks*

4 weeks*

4 weeks*

Preliminary interns have at least 10 weeks of elective time (no ambulatory clinic). Please note the Anesthesia Board requires anesthesia prelims to do 4 weeks of ER, which we will arrange during your elective time so you will be board eligible!

* Vacation time includes one week for either Christmas or New Year’s. Some residents choose instead to work through the holidays and take a different week off, which is fine!