Curriculum - Internal Medicine Residency

Each academic year consists of 13 blocks of 4 weeks each. Over the 3 years of training, each resident has:

• Inpatient rotations:  General medicine and subspecialty services (e.g., ID and oncology), MICU, CCU and night/day floats.  The schedule is carefully arranged so each resident has exposure to general medicine, subspecialties, clinical floors and intensive care units, while not allowing any one area to dominate. Max critical care time = 6 months.  
• Ambulatory rotations:  Continuity medical clinic and medical subspecialties (minimum of 10 months).  For more information, see Ambulatory Program.
• Clinical or research electives
• Urgent care and emergency medicine.

Interns have 4 ambulatory blocks with focused time in their continuity medical clinics and other subspecialty clinics along with additional continuity clinics during their PSQI and Urgent Care Clinic rotations.  For more information about Academic GIM, Clinical GIM and other outpatient rotations, see Ambulatory Program.

Schedules are structured in X+Y (4+2) format to ensure focused time on both inpatient and ambulatory rotations.  

• X (4 weeks) = Inpatient rotations, electives, ER and vacation time
• Y (2 weeks) = Ambulatory with continuity medical clinic in the afternoon and general medicine and subspecialty clinics in the morning

Rotations	PGY-1	PGY-2	PGY-3
Inpatient services
GIM, ID, MICU, CCU, Oncology	6	5	5
Night Float, Day Float	1.5	1.5	1
Ambulatory rotations
Ambulatory blocks	2	3.5	3.5
GRE-Geri-Rheum-Endocrine	0	0.5	0
VAST-VA Ambulatory Subspecialty Training	0	0	0.5
Electives (includes 2 wks vacation)
Electives	1.5	1.5	2.5
Patient Safety QI	0.5	0	0
Emergency/Urgent Care
Emergency Medicine	0.5	0	0
Urgent Care Clinic (VA)	0.5	0.5	0
Vacation	0.5	0.5	0.5
TOTAL	13	13	13

Conference and Inpatient Work Schedule

7-8 am | Work Rounds

First year residents pre-round on their patients in preparation for resident-run work rounds at 7 am. The team resident is responsible for supervising the clinical activities and for teaching the members of the team.

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8:15-11 am | Attending Rounds

Held 7 days per week at all inpatient sites. Led by the faculty, these rounds integrate clinical management and teaching with an emphasis on learning at the bedside.

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12-1 pm | Didactic Education

Most of our conferences are held from 12-1 PM with other key conferences scheduled at other times. These conferences are considered protected time. See Didactic Education for more details.

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5 pm | Sign-Out Rounds

Sign-out is held daily and led by the team resident. First year residents present the results of clinical work for the day and plans for subsequent management of their patients. Residents directly transition patient care to the covering residents in person-to-person sign-outs. Weekend sign-out rounds on the floor teams takes place between 12-1 pm.

When on Call on GIM Services

• Day team
  • 8 AM-noon:  the Day Float assist with admissions in the morning, allowing the team to manage the patients on their team.
  • 4-6 pm: Drip admission process with interns taking no more than 2 admissions within these 2 hours and no more than 1 admission in the final hour.
  • 12-9 pm: Day Float resident takes admissions after the long call team reaches their cap and assists the teams during the afternoon and the on-call team until 9 PM.
  • 5-9 pm (M-F): A resident moonlighter does all patient cross-cover, relieving the on-call team from this responsibility.
  • 9 pm: Long call ends and on-call team signs out to Night Float Team.
• Night team
  • 9 pm-7 am: Residents and interns on Night Float admit patients and cross cover patients on the floor services.
  • 4-7 am: Drip admission process kicks in again with interns taking no more than 2 admissions between 4-6 am and no more than 1 admission 5-6 am. No admissions are accepted between 6-7 am ensuring the night team can complete their work on time.
  • 7-10 am: Senior residents leave at 7 AM once they sign out to the day senior. Interns present their new admissions to the accepting team and leave by 10 AM.