Internal Medicine Residency Program Curriculum: Scheduling

The 4:1 Template

Instead of the traditional four-week block calendar, the Internal Medicine Residency at LVHN follows a 4:1 scheduling template that alternates traditional four-week rotations with weeklong ambulatory blocks. The four-week rotations include standard rotations in internal medicine and medicine subspecialties. Each four week rotation is preceded and followed by a one-week rotation at our continuity clinic. To ensure continuous resident presence in all areas, the residency is divided into five groups (termed "Cohorts A-E"), with each cohort covering the clinic as a team every fifth week.

Overall, this scheduling template minimizes the conflicts between inpatient and outpatient training, allowing for focused practice during traditional rotations and providing a stronger focus on ambulatory education. By creating an immersion-type model for outpatient training, the template provides 180 continuity clinic sessions over three years of training and provides improved continuity of ambulatory education and patient care. 

Typical Categorical PGY-1 Internal Medicine Resident Schedule

• General Medicine: 2-3 blocks
  • ECLS A, ECLS B, HMS-J
• Cardiology Teaching Service: 1 block
• Critical Care: 2-3 blocks
  • MICU and Cardiac ICU
• Ambulatory Medicine: 10 one-week rotations
• Emergency Medicine: 1 block
• Night float: 2-4 2-week blocks
• Selective/elective rotations: 2-3 blocks

Typical Categorical PGY-2 and PGY-3 Internal Medicine Resident Schedule

• General Medicine: 1-2 blocks
  • ECLS A, ECLS B, HMS-J
  • HMS-I Junior Attending Rotation
• Cardiology Teaching Service: 1 block
• Critical Care: 1-2 blocks
  • MICU and Cardiac ICU
• Ambulatory Medicine: 10 one-week rotations
• Night float: 2-4 2-week blocks
• Elective/subspecialty rotations: 4-6 blocks

* 1 block=approximately 4 weeks