Residency programs across the country struggle with maintaining continuity of care for patients in the outpatient setting while residents are busy working on inpatient services.  In July 2012, we implemented a schedule that we call 4+1+1, to try to minimize the conflicting outpatient and inpatient responsibilities of our residents.  In 4+1+1, residents do 4 weeks of an inpatient rotation, followed by two weeks of elective, ambulatory block, or vacation (this is the 1+1 part).  Residents no longer have continuity clinic during their 4 weeks inpatient blocks.  During the 1+1 weeks, they have 2 or 3 continuity clinics where they can catch up and give their primary care patients full attention.  Between clinic sessions, our state of the art EMR allows residents to manage their panels remotely (see EMR section below).  Residents already appreciate the ability to concentrate fully on their inpatients without the stress of getting to clinic on time.


Residents and interns on their 1+1 or +4 time participate in their Academic Half Day each week.  This is a 4-hour time block of seminars, workshops, and other training that is completely protected to allow all residents to participate.


Starting in July 2019, we changed our schedule even further. Now only interns do the 4+1+1 schedule.  PGY2 and PGY3 residents have a 4+4 schedule.  It works same, but the residents get 4 weeks off between ward and ICU rotations instead of 2.  This change for upper level residents also gives significantly more protected educational time, as they have more 10 more Academic Half Days each year.