Curriculum - Internal Medicine Residency

Residents have inpatient rotations on 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.

The remainder of their time is spent on clinical or research electives, including subspecialty outpatient experiences during the mornings of their Y blocks.

During the 36 months of training, residents in the categorical program participate in the following curriculum. The number of inpatient rotations is fixed for each year of training and consists of floor rotations (general medicine, Med-ID and oncology), ICU's (MICU and CCU/telemetry), night and day floats, and Night Acting Chief Resident (NACR) rotations.

Each academic year consists of 13 blocks of 4 weeks each. The total number of ICU rotations is capped at 6 months and the total number of night float rotations are capped at 4 months.

• PGY-1 residents:  7.5 inpatient blocks (6 floor or ICU rotations plus 1.5 day or night float rotations)
• PGY-2 residents:  6.5 inpatient blocks (5 floor or ICU rotations plus 1.5 day or night float rotations)
• PGY-3 residents:  6 inpatient blocks (5 floor or ICU rotations plus 1 day float, night float or NACR rotations)

Rotations	PGY-1	PGY-2	PGY-3
Inpatient services	6	5	5
Night Float, Day Float	1.5	1.5	0.5
Night Acting Chief	0	0	0.5
Ambulatory	1	3.5	3.5
Academic GIM	1	0	0
Electives (with 2 wks vacation)	1.5	1.5	2.5
QI Elective	0.5	0	0
GRE-Geri, Rheum, Endocrine	0	0.5	0
VAST-VA Ambulatory Subspecialty Training	0	0	0.5
Emergency Medicine	0.5	0.5	0
Urgent Care clinic (VA)	0.5	0	0
Vacation	0.5	0.5	0.5
TOTAL	13	13	13

Inpatient and ambulatory rotations are structured using an X+Y format. All inpatient, elective and ER rotations are part of the X component with spaced 2-week ambulatory blocks during the Y component. For more information about Academic GIM and our FleX+Y system, see Ambulatory Program.

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

• 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 with any clinical work for the teams during the afternoon and for 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.
• 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.