Our curriculum is organized in a ‘4+1’ block structure: 4 weeks of Core residency rotations (electives, inpatient general medicine, ICU, etc.), are followed by a 1 week Ambulatory block, and the sequence repeats throughout the year. During the 4-week portion of the schedule (i.e. when on floors/ elective/ ICU rotations) there are no ambulatory sessions. Similarly, during the 1-week ambulatory block there are no inpatient responsibilities. Separation of inpatient and outpatient rotations frees residents to concentrate on the task at hand without distraction from competing responsibilities.
The 1 week Ambulatory block includes 10 half-days. Five half-days are devoted to the residents’ general medicine continuity practice and a full day is devoted to either an ambulatory subspecialty experience (which we call “majors”) for R2’s and R3’s or to additional ambulatory time in a community primary care practice for R1’s. As you progress to a senior resident, you will gain experience doing in-patient follow up visits and managing transitions of care along with acute care visits. In addition, you will gain experience addressing lab results, patient questions, medication refills for your team etc. This emulates the team structure in a community based primary care practice. The ambulatory week also includes small group learning sessions, training in the simulation lab (for R2’s and R3’s) and a journal club focused on reviewing evidence-based primary care medicine. There is also an opportunity to work on quality improvement projects.
Housestaff do rotations in hospital medicine, including intensive care, at Rochester General Hospital. Hospital-based teams are made up of one upper level house officer (R2 or R3), and one R1. Your team is often joined by one or two medical students from the University of Rochester or other medical schools. Long call is approximately once every 5 days when you stay until 8 pm to sign out to the night float. Weekend call is once/twice every month on floors "Night float" teams admit patients and provide cross-coverage, so there is no overnight in-house call for inpatient teams. Housestaff on all inpatient teams leave after they have completed their clinical and educational responsibilities for the day. The average work week is 65-70 hours.
Continuity clinics. At the beginning of your R1 year you will be assigned to a continuity practice located in a community-based private office in Rochester in addition to your primary continuity teaching practice at Rochester General Hospital. Your two continuity practices will provide you with complimentary ambulatory experiences through your three years in the program. In addition, senior residents spend a full month in their assigned community practice.
Intensive care medicine
Your intensive care experience will be at Rochester General Hospital. Residents work in a combined Medical and Coronary Care Unit, under the supervision of faculty in cardiology, pulmonary- critical care medicine. Formal teaching rounds are held five days per week. Residents overwhelmingly vote this as their favorite rotation year after year.
The majority of your exposure to focused subspecialty medicine will occur during elective rotations. Two types of electives are offered:
Special interdisciplinary electives (SIEs). SIEs are electives in areas not considered part of traditional internal medicine but which are vitally important for practice of general internal medicine in any setting. The program offers electives in, , Ophthalmology, Dermatology, Palliative care and Radiology. Other SIEs can be arranged as desired.
Subspecialty electives. All internal medicine subspecialties are available at the three teaching hospitals and in private subspecialists offices. Many rotations, such as Allergy/Immunology/Rheumatology, and Endocrinology are almost exclusively office-based. Other rotations, such as Hematology/Oncology, Cardiology, Gastroenterology, and Pulmonary offer choices of office-based or combined office-based/inpatient experiences. Electives are also available in, community-based HIV care, home-based geriatric care, and evidence-based medicine..
In addition to Rochester-based electives, every house officer is eligible for at least one four-week "off-site" elective during the R2 or R3 year. . You will continue to receive salary, benefits, and malpractice coverage during approved off-site electives.
A note about choice and options within our training program: We know that internal medicine practice varies with respect to the proportion of office- and hospital-based care. Rural primary care internists tend to spend more time as hospital-based consultants and in intensive care settings than internists in the major metropolitan areas. Housestaff can use the high proportion of elective time to individualize their educational experience to fit their career aspirations.