Our resident curriculum is designed as a 4+1 ambulatory block schedule. By adopting this model, our residents 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. On any given week, there is one cohort on a continuity clinic week (referred to as the “+1″ or “plus 1” week), while the remaining four cohorts are on inpatient service or subspecialty rotations.  Thus, instead of going to clinic one half day per week, residents have five consecutive afternoon sessions during their ambulatory “+1″ week. We’ve found this 4+1 structure allows for improved predictability for each resident’s schedule and a better concentration of ambulatory medicine and primary care, all while maintaining patient continuity.

Our +1 schedule also allows for mornings during the +1 week dedicated to specialty clinic experiences, our formal QI/Patient Safety curriculum, administrative/research time, and ambulatory didactic sessions, and procedure training in our simulation lab.  Since converting to this 4+1 curriculum in 2014, we’ve been able to optimize resident satisfaction with both the inpatient and outpatient experiences. Inpatient rotations experience less disruption and continuity clinic is more enjoyable since residents are not responsible for ongoing care for inpatients while in clinic. In addition, our ambulatory week tends to be light on call, allowing residents to recharge after busy inpatient rotations.