The major curriculum elements of the Program are hospital-based medicine, practice-based medicine, intensive care medicine, and subspecialty medicine. Approximately 25% of your time is elective.
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), one or two R1s, plus one or two medical students from the University of Rochester. Call is approximately every fourth night. However, there are "night float" teams that 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 80 hours.
Two principal experiences allow housestaff to learn how to take care of patients in the setting of a primary care practice: weekly continuity clinic practice and practice-based blocks.
Continuity clinics. At the beginning of your R1 year you will be assigned to a continuity practice located in either a community-based private office in Rochester or a teaching practice at Rochester General Hospital. Your continuity practice is the base experience for your three years in the program. As an R1 you will spend one half-day each week in your practice; R2s and R3s spend two half-days per week. Only overnight and intensive care months are excepted from continuity clinic practice. Housestaff are assigned to 1 or 2 continuity clinic preceptors for their entire three years. Because of this close, longitudinal relationship, continuity preceptors often become life long mentors for our housestaff. It is not uncommon for housestaff to actually join a mentor’s practice at the completion of training.
Practice-based blocks. These blocks are 4-8 weeks periods of time spent in the role of a junior partner in one of a variety of primary care practices located throughout Rochester. They are described in greater detail below under Innovative.
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 primary care practice. The program offers electives in Sports Medicine, Office Gynecology, Otorhinolaryngology, Ophthalmology, Dermatology, Radiology, and Psychiatric emergency departments. 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. Extended "longitudinal blocks" blocks are also available, in which housestaff spend 8-12 weeks in up to three different subspecialty offices (see below). Electives are available in adolescent medicine, community-based HIV care, home-based geriatric care, biopsychosocial medicine, evidence-based medicine, and medical ethics.
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. Many of our house officers choose to do off-site electives at other institutions or in other countries. 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.