- Discovered the need for more Florida medical residency programs for physicians.
- Launched a successful Internal Medicine (IM) residency program in July 2014.
- All ten IM resident positions filled on the first match.
- Program favors resident education over service.
- Teaching in the classroom is important, but training medicine by the bedside is essential, and you will learn by watching, studying, and doing.
- To learn how to make good decisions in an atmosphere of uncertainty, we will teach critical thinking along with deliberate practice to improve your clinical reasoning skills.
Ward Based System on Inpatient Floors
- A supervising attending will be responsible for all of the patient care and teaching for resident teams, but the residents will be provided with the autonomy to develop their clinical skills.
- Residents are responsible for all admissions, documentation, orders and discharge planning, etc., related to patient care.
- Routine interdisciplinary work rounds provide representation and foster cooperation among nursing, pharmacy, social work and physical therapy departments.
4+1 Continuity Care Clinic Experience
- Resident rotations will be spaced at regular intervals, including four weeks of in-patient wards or sub-specialty electives, followed by a one week ambulatory clinic block.
- No continuity clinics while on inpatient or elective services to eliminate the separation and potential conflict between the inpatient and outpatient spheres.
- This schedule, paired with seeing patients in community based outpatient clinics, gives our resident outpatient practices real world experience. Please see our 2014 Block Schedule Sample below. The year is divided into 10, five week blocks. This leaves four weeks of vacations and two weeks of electives and holidays.
The “Block Model” at Oak Hill Hospital: 4 + 1
What is block scheduling?
Block scheduling is an entirely different way to structure a residency program. In the traditional structure residents have a half-day of continuity clinic and sporadic 2-week ambulatory blocks, but inpatient rotations dominate their schedules.
In block scheduling, which we will start JULY 01 2014, every fourth 1 week block will be an Ambulatory Block ( 4+ 1 Schedule).
Within each ambulatory block residents will have 4-5 continuity clinic sessions per week; the remaining time will consist of a mixture of other ambulatory experiences, educational sessions, and quality improvement project time.
The ambulatory blocks are immovable and will not be replaced by vacation. When residents are not in ambulatory blocks they rotate through traditional inpatient rotations and electives, generally without continuity clinic sessions (except for 4 additional sessions spread over the year).
- The Schedule will have 5 teams of 2 interns each ( A-E)
- There will be 4 interns on wards at any given time
- Emergency medicine rotations will start from September 2014 onwards.
- Call frequency will be Q4 days.
- Teams will admit every day to a permissible cap.
- There will be limited night float in the ICU and Emergency Departments till we build up our abilities for resident supervision by upper level residents.
What happens in an ambulatory block?
When a resident is in an ambulatory block s/he will have 4-5 continuity sessions per week, 3 sub-specialty sessions per week, and three additional sessions used for education, quality improvement and administrative time.
Sub-specialty electives will be longitudinal over the course of the year. For example, a resident may choose an ambulatory cardiology elective on Monday mornings, rheumatology elective session Wednesday afternoons, and leukemia clinic Thursday afternoons.
Over the course of the year, the resident will work with the same attending in the same clinic over 12-14 sessions, which allows the resident to develop a longitudinal relationship with the attending and with some patients (e.g., the same patient could be seen in initial evaluation and then again in follow up visits over the course of the year).
What happens with a resident’s patients when s/he is not in an ambulatory block? Each resident will be part of a 2-resident mini-practice consisting of the resident and 1 other residents from her/his class who is in the other CORRESPONDING ambulatory block cycles (e.g., Residents 1 & 5 AND 2 & 8 in the first year schedule.). In this model, over time as we get 2nd and 3rd year residents, one of the partners will be in an ambulatory block at all times. The partners will see each other’s patients for urgent visits that cannot wait until the next ambulatory block of the primary care resident.
|AM||Continuity Clinic||Mandatory Clinic*||Continuity Clinic||Education Session||Cont. Clinic|
|PM||Clinic of Choice*||Continuity Clinic||Clinic of Choice*||Continuity Clinic||Other|
SS = Sub-Specialty
Will residents have traditional elective blocks?
Residents will have both longitudinal ambulatory electives within ambulatory blocks and traditional 2 and 4-week long elective blocks. Traditional elective blocks can be used for inpatient electives, outpatient electives, or mixed inpatient-outpatient electives, depending on the resident’s preferences.
What are the advantages of block scheduling?
Internal medicine is primarily practiced in the outpatient setting following residency, but traditional resident education is still primarily inpatient-based. There are many advantages to block scheduling, some of which are:
- Residents are immersed in ambulatory practice early in residency. This will enable them to build a strong foundation in ambulatory skills early in residency which can be built upon throughout residency.
- Residents spend more total time in ambulatory training, both in their primary care practice and in sub-specialty ambulatory experiences. Since about 3 quarters of internal medicine is practiced in the ambulatory setting, residents will graduate more prepared for practice or sub-specialty fellowship training. Residents will also be better informed about what different career options are really like prior to committing to a specific career direction.
- When in ambulatory blocks, residents are not pulled toward other patient care commitments. This allows them to focus entirely on their continuity practice and ambulatory electives.
- Removal of clinics from floors rotations and traditional inpatient elective blocks helps keep the whole team present each afternoon, allowing for better continuity with patients and more time for teaching and learning.
- The structure of electives in an ambulatory block allows for longitudinal relationships to form between residents and their ambulatory preceptors and patients.
- Ambulatory blocks contain dedicated time for ambulatory education and quality improvement education and projects on residents’ primary care panel of patients.
- The mini-practice structure formed by residents covering each other’s patients in clinic simulates many future practice structures.
The First Four Weeks
- These weeks will be devoted to the wards, electives, ICU and ER rotations.
The +1 (Fifth Week)
- This will be the ambulatory / continuity bock.
- Continuity Clinic (20-22 Weeks) (Access Health Care Physicians)
- Cardiology (3-4 Weeks) (Private Office & Oak Hill Hospital)
- Critical Care (3-4 Weeks) (Oak Hill Hospital)
- Endocrinology (3-4 Weeks) (Private Office & Oak Hill Hospital)
- Hematology/Oncology (3-4 weeks) (Private Office & Oak Hill Hospital)
- Gastroenterology (3-4 Weeks) (Private Office & Oak Hill Hospital)
- General Internal Medicine (20-22 Weeks) (Private Office & Oak Hill Hospital)
- Geriatric Medicine (3-4 Weeks) (Private Office & Oak Hill Hospital)
- Infectious Disease (3-4 Weeks) (Private Office & Oak Hill Hospital)
- Nephrology (3-4 Weeks) (Private Office & Oak Hill Hospital)
- Rheumatology (3-4 Weeks) (Private Office & Oak Hill Hospital)
- Residents are expected to participate in hospital quality improvement committees.
Business of Medicine, Health Care Reforms
- We aim to train our residents in these essential, but frequently ignored, aspects of a physician’s daily life.
- Organizational behavior, change management, conflict resolution and contract negotiations are vital skills. Oak Hill Hospital has conferences where these areas are explored in depth.