Internal Medicine Residency

4+1


In 2014-2015 academic year, we changed to a 4+1 ambulatory block schedule.  In this model, residents no longer work in both the inpatient and outpatient settings in the same day.  Instead, they have separate blocks of inpatient and ambulatory rotations.  Each resident is placed into one of five cohorts at the beginning of residency.  Each week, a different cohort rotates through the continuity clinics, and this cycle repeats every 5 weeks.  At any given time, there is one cohort on a continuity clinic week (referred to as the “+1″ week), and the other four are on hospital medicine or subspecialty rotations.  Thus, instead of going to clinic one half day per week, the residents go for five consecutive afternoon sessions during their ambulatory “+1″  week.  The mornings of the “+1″ week have dedicated time for specialty clinic experiences, our formal QI/Patient Safety curriculum, administrative/research time, and ambulatory didactic sessions.  We have found that this results in more satisfaction with both the inpatient and outpatient experiences. Inpatient rotations experience less disruption now that residents aren’t leaving in the afternoons to go to clinic. The continuity clinic week is more enjoyable since residents are not responsible for ongoing care for inpatients while they are in clinic. In addition, we have tried to make the ambulatory week very light on call, allowing residents to “recharge” after busy inpatient rotations.