Internal Medicine Residency

General Curriculum Structure

Our program is designed in a competency-based advancement structure. Individuals are continuously observed, assessed and provided with feedback in all experiences. Goal-setting is based on Internal Medicine milestones. Once an individual achieves competency in a goal, they set new goals and are advanced in their level of responsibility. As such, we use a competency-based language to define stages of development rather than a time-based language. Our learners move through phases of development - from Learner (PGY1 year) to Manager (usually end of PGY1 year into PGY2 year) to Teacher/Leader (usually mid PGY2 year to end of training). The stages are defined below.

Learner - In the learner phase of training, an individual works under close supervision and coaching to achieve basic milestones in Internal Medicine. We use a deliberate practice model in which learners set milestone-based goals; work to develop knowledge, skills, and attitudes with direct observation and feedback from faculty, seniors, and team members; and then, based on feedback, set new goals. Supervisors are trained in "supervised autonomy" as a principle so that learners are not "directed" but coached to grow.

Manager - Once a learner reaches competency in all learner-level milestones, they advance to the manager phase of training. In this phase, one works to establish independence in the management of common Internal Medicine ambulatory and inpatient patient presentations. Our managers do not supervise learners, nor are they supervised by upper-level residents. They work collaboratively on manager-level rotations with attending physicians to establish competence. Residents consider this the most challenging and most rewarding phase of training as they truly grow into clinical independence in this phase.

Teacher/Leader - Once a manager is considered independent in managing most common medical conditions, they advance to the leader/teacher phase of training. In this phase, they continue to gain the necessary experience over time in managing many medical conditions and they work on teaching and leadership skills. Their milestones during this phase are worded as phrases such as "can teach others...", "leads a healthcare team", "coordinates care across...", "role models for others...". It is in this level of training that our residents lead teams on the wards, in the ICUs, specialize in consultative care, and serve in advanced roles in the ambulatory practice setting.

Schedule Structure

Our unique tandem block schedule was designed by residents and studied in an Internal Medicine residency. The schedule was created with the following goals in mind:

• Separate inpatient/ambulatory responsibilities with dedicated curricula
• Continuity in continuity clinic
• Excellent coverage for continuity patient panel when on inpatient
• Keeping inpatient teams together for evaluation, teamwork purposes
• Maintaining four-week experiences for learning purposes

The tandem block schedule pairs four-week direct patient care inpatient experiences (wards, icu, specialty services - designated as "I" in schematic below) with other experiences (ambulatory, consults, research, electives - designated as A) in an alternating eight-week block schedule. The "A" designation indicates that the resident has continuity clinic three half-days per week during that rotation. The residents are partnered together in practice partnerships so that one of the partners is always in clinic that week and manages outpatient responsibilities for the patient panels during that time. Residents do not have clinic during "I" blocks.

The schematic below represents two residents’ schedules for the first 16 weeks of a year. Each column is two weeks. John and Stacey are clinic partners. They are in clinic three half-days per week on A blocks.

*Ambulatory Morning Report includes EKG interpretation, MSK radiology rounds, psychiatry cases, lifestyle medicine, and topic-based sessions. Friday Inpatient Noon Report includes clinical reasoning series for interns.