Residents In Conference

The curriculum for the internal medicine resident is designed to cover all areas of internal medicine and its subspecialties. The curriculum addresses all of the requirements of the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education.

The schedule is divided into 13 four-week blocks for each year. The typical schedule for each year of training is listed below. Rotation duration will vary based on patient care needs and individual resident’s rotation schedule history and interests. Over-night continuity of care is provided by a night float team, with in-house overnight call limited to the Medical Intensive Care Unit (MICU).


PGY-1 Rotations
Inpatient General Medicine 16-20 weeks
Inpatient Cardiology 4-8 weeks
MICU Up to 8 weeks
Night Float 2-4 weeks
Emergency Medicine 4 weeks
Ambulatory Care Up to 8 weeks
Neurology 4 weeks
Subspecialty Consults Up to 8 weeks
Medical Consults and Ultrasound Guided Procedures (Categorical Residents only) 1 week

The PGY-1 curriculum supplies fundamental clinical skills for the future internist. This is accomplished through the provision of supervised care for acutely ill patients in both the inpatient and outpatient settings. The trainee develops confidence in the care of patients with many and varied complex clinical problems. Integrative problem-solving skills and a broad range of clinical tools are thus acquired by the intern, all of which are supplemented by exposure to a structured didactic curriculum.


PGY-2 Rotations
Inpatient General Medicine 8-12 weeks
Inpatient Cardiology Up to 8 weeks
MICU Up to 10 weeks
Junior Cardiology Night Float 4 weeks
Ambulatory Medicine 4-8 weeks
Geriatrics Up to 4 weeks
Subspecialty Consults 8-12 weeks
Research 2 weeks
Quality Improvement and Patient Safety 2 weeks

During the PGY-2, junior residents become team leaders on inpatient general medicine, inpatient specialty medicine, and in the intensive care units, where they learn to direct a health care team in the management and care of patients. This system facilitates the integration of the cognitive and organizational skills necessary for clinical independence, the development of accurate differential diagnoses and the synthesis of effective therapeutic plans. The number of ward rotations decreases to foster development of fluency in the sub-specialties of internal medicine.


PGY-3 Rotations
Inpatient General Medicine 4-8 weeks
Inpatient Cardiology Up to 4 weeks
MICU Up to 8 weeks
Sr. General Night Float 2-4 weeks
Medical Consults and Ultrasound Guided Procedures 4 weeks
Ambulatory Medicine 4-8 weeks
Subspecialty Consults 8-16 weeks

PGY-3 training is designed to fine tune leadership, decision-making and teaching skills, through increased autonomy. Rotations in the sub-specialties of medicine and supervisory roles on all services facilitate development of the skill-set necessary to transit into the practice of internal medicine or pursue additional training in a sub-specialty fellowship program. Ambulatory clinical development is also emphasized through a two-month ambulatory clinic block rotation.

Ambulatory medicine is a crucial component of any internal medicine residency program. We prepare our residents for the care of patients in the outpatient arena in a variety of platforms, including urgent care clinic, subspecialty outpatient medicine rotations and the resident physician's continuity care practice. The latter averages one half day per week over the 36 month residency and allows the resident to provide care to his/her own panel of patients under the guidance of the internal medicine faculty. Residents do not see patients in their outpatient practice during their MICU or night float rotations.

An integral part of the Ambulatory Rotation is protected time devoted to Quality Improvement activities as well as research. Here residents spend time developing and participating in Practice Based Learning Improvement (PBLI) projects. Residents learn to investigate and evaluate their care of patients, appraise and assimilate scientific evidence, and continuously improve patient care based on constant self-evaluation and life-long learning. The results of PBLI projects can then be submitted by residents for presentation at local, regional and national meetings.

Residents will have the opportunity to participate in the care of homeless adults in the City’s Sulzbacher Center, an outreach to the downtown community, under the direction of its Medical Directors. Residents will learn about healthcare disparities that affect socioeconomically disadvantaged populations through a didactic web-based curriculum.

The ultrasound guided procedure rotation is intended to acquaint the medical resident with a wide variety of procedures performed while on the inpatient wards service. Faculty supervise and evaluate residents throughout the rotation. Bedside ultrasound is an integral part of many procedures, including central lines, paracentesis, thoracentesis, mid-line placements and anatomically-difficult lumbar punctures. Residents will go through a methodical training regimen consisting of pre- and post-tests, procedural knowledge and technical skills acquisition, full simulation training using high-fidelity simulators, and patient procedures. Throughout the rotation the resident receives feedback and is able to learn and teach others the intricacies and troubleshooting of individual procedures.

The 2-week quality improvement and patient safety rotation has components of QI/patient safety didactic sessions, Hospital Committee participation, mentorship, self-study in the Institutes for Healthcare Improvement (IHI) Open School modules, and development of a QI project that is to be presented at the end of the rotation. Residents work with our Office of Research Affairs for the purposes of learning how to combine research and quality improvement. Lastly, they participate in simulations to practice evaluating systems errors and develop processes for improvement.

The night float rotation is an effective solution to meeting the duty hour requirements mandated by the ACGME, as well as providing trainees with after-hours decision-making opportunities. The duties of the night float intern provide the trainee with the experience necessary to make acute, inpatient care decisions, of a broad range of severity. The senior night float resident supervises and supports the night float intern. The cardiology night float resident provides after hours management experience with potentially unstable cardiac patients, as well as cross cover decision-making in more stable cardiology patients. Night float teaching rounds with the program leadership keep the educational spirit of the rotation viable, and provide continuous feedback between the night float team and the residency leadership group.

Mega teams on inpatient general medicine is a program that uses a mega team concept for structuring ward teams on inpatient general medicine. Mega teams facilitate the conduction of effective work rounds and allow for easy cross coverage for days off, clinic, etc. By increasing the number of senior residents per team from one to two, every intern has a designated senior resident partner for the month (as opposed to one senior for every two interns). Mega teams are used at the beginning of each academic year and greatly facilitate work rounds and bedside teaching by senior residents, allow interns a gradual adjustment to decision making in acute patient management, and facilitate patient care and a team concept by simplifying necessary absences from the service.

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