Internal Medicine Residency Curriculum Overview
Although not required, we offer additional training pathways for residents who wish to gain more focused training. The Primary Care Track is a separate program.
The Clinical Scholars in Informatics (CSI) pathway is a two-year program designed for residents to further develop their clinical skills in informatics and health information technologies with the support and guidance of a mentorship team.
The Global Health Pathway is a 2-year pathway spanning the 2nd and 3rd years of residency training. In addition to dedicated educational and mentorship opportunities, the pathway offers residents a dedicated public health month in the 2nd year and an opportunity for an internally-funded international health rotation in the 3rd year.
The Hospitalist Training Pathway is an outstanding pathway designed to train preeminent clinicians as well as hospital system architects and leaders.
The Medical Educator Pathway is a one-year program designed to provide an opportunity for residents to learn about medical education and practice their teaching skills. Activities occur in a longitudinal fashion under the mentorship of our Educator’s Academy, which includes master teachers within the Department of Internal Medicine.
The Research Scholar pathway provides protected time for pursuing translational research with the goal of training future physician-scientists. Residents apply and are accepted into the program during their intern year.
The intern year offers broad exposure to direct patient care in internal medicine. Throughout the year, interns manage diverse patient populations and learn directly from subspecialists in a variety of inpatient services and outpatient clinics.
Our 3+1 model showcases three weeks on an “X” service (wards, ICU, nights, urgent care clinics, VA clinic, emergency department) followed by one week of ambulatory medicine, which features a variety of clinic experiences and educational conferences. Throughout the year, interns manage diverse patient populations and learn directly from subspecialists in a variety of inpatient services and outpatient clinics.
The intern year is structured as an X+Y schedule, with 13 three-week rotations that are each followed by one-week ambulatory medicine experiences (Y-rotations). The Y-week features a variety of clinic experiences and educational conferences. The three-week X-rotations includes the following dedicated experiences:
- 10 blocks of inpatient wards (including general medicine and subspecialty wards, night medicine, CVICU and MICU)
- 1 emergency medicine block (ED)
- 2 ambulatory blocks, including the VA (categorical and primary care interns) and Acute Care Clinic
The remaining ambulatory training will occur on the 13 “Y-weeks.”
The second and third years of residency are designed to facilitate your growth and maturation into a skilled internist. Upper-level residents manage the general medicine and subspecialty inpatient services (cardiology, hematology/oncology, leukemia, nephrology and geriatrics). Additional blocks include 1.5 blocks of night float coverage and the medical and cardiovascular intensive care units.
Remaining blocks include:
- Subspecialty consults and clinic experiences
- Private practice internal medicine clinic
- General medicine acute care clinic and VA outpatient clinic
Elective time allows upper-level residents to tailor their schedule to their interests. Most residents schedule at least one research block.
During the HO-2 and HO-3 years, the schedule follows a general structure of alternating between four-week ward services and four-week non-ward rotations. Continuity clinics are not scheduled during inpatient ward services. Resident continuity clinics are organized into practices, and residents have two half-days of continuity clinic per week during their non-ward blocks that include dedicated sessions for ambulatory quality improvement.
For upper-level residents, each academic year consists of 13 four-week blocks on an X+Y schedule (4+4). In general, a ward rotation is followed by a non-ward rotation, and continuity clinics take place during the non-ward rotations only. Coupling this schedule with the 3+1 structure in the intern year allows for improved overall team continuity and full dedication to inpatient training for both upper levels and interns on ward services.
Example Upper-Level Resident Schedule
The content of the upper-level years is as follows:
- 2 blocks Intensive Care (1-CV-ICU, 1-MICU)
- 1 block ACE Unit (Acute Care of the Elderly)
- 2 blocks Gen Med Wards (Includes Gen Med and Hospitalist)
- 1 block Hem/Onc (Hem/Onc A or Leukemia)
- 1 block Other Wards (Gen Med, Hospitalist, Hem/Onc A, Cardiology Wards, Leukemia, Renal, CV-ICU, MICU)
- 1.5 blocks Resident On Call (one two-week block is paired with two weeks of vacation)
- 2 blocks HO-3 Consult-Procedures-Complex Care (HO-3 CPCC) – Internal Medicine consultation to ED and non-IM services, outpatient preoperative consultation, procedures/ultrasound, and quality improvement for care of complex patients
- 1 block Acute Care Ambulatory Rotations: DHP (HO-3 only); OPD (HO-2 and HO-3)
- 1 block VA Outpatient Clinic (HO-3)
- 6 blocks Subspecialty Consult Months (Endocrine, GI, ID, Pulmonary, Renal, Rheumatology —These rotations provide both outpatient and inpatient consultation experiences.)
- 1 block Board Study (two weeks) which is paired with two weeks of vacation
- 1 block Outpatient Internal Medicine (two weeks) and Elective (two weeks)
- See separate document for specific requirements of Primary Care Track
- Subspecialty (e.g. Hem/Onc, Geriatrics, Palliative Care, Allergy) electives
- Non-Internal Medicine specialties (e.g. Derm, Ophtho, ENT, Sports Medicine)
- Research electives, including Tinsley Harrison Research Pathway (2-3 blocks)
- Community-based experiences and other self-styled electives (including international electives)
- Evidence-based Medicine (EBM)
- Medical Systems and Quality Improvement
On Call Duties
Our intern call system consists of a block night float system for ward services and a short stretch of nights duringthe MICU and CVICU rotations.
Our upper-level call system consists of a night float that covers Sunday through Thursday. Upper levels on ward services cover the Friday and Saturday calls (a total of two overnight calls per resident per ward block). In the MICU, call is every fourth or fifth day. The CVICU will have a night float system where upper levels rotate through short stretches of nights throughout the rotation.
Conferences and Didactics
Conferences in the Internal Medicine Residency Program are designed to enhance the clinical and research skills of residents. They are developed each year with input from our Resident Curriculum Committee.
Routine conferences include:
On Thursday mornings 9 am till noon, interns participate in small-group sessions during Y-weeks that focus on a number of important topics to prepare them for effective communication, understanding health systems, quality improvement and leadership and lifelong learning in medicine.
- Intern Evidence Based Medicine Seminar is a small-group tutorial that promotes experience locating, interpreting and critically appraising medical literature pertaining to specific clinical questions. Mathematical concepts relating to diagnostic test performance and therapy or harmful effects are emphasized to maximize preparedness for the USMLE and ABIM examinations.
- Intern Systems-based Practice Seminar is a series that focuses on systems-based issues affecting patients and health care professionals, as well as on quality improvement.
- Intern Advanced Communication Skills and Professionalism Seminar is a series during which interns explore aspects of effective doctor-patient relationships, professionalism and medical ethics. Specific topics of emphasis include motivational interviewing, agenda-setting in the patient interview and empathetic opportunities in medicine.
- The Community Plunge consists of a driving tour of Winston-Salem and discussion with community members to explore challenges in access to health care. Interns will participate in this activity once in the fall.
The residency program supports elective time for research during your internal medicine training. Every year, our residents publish numerous peer-reviewed articles and present many abstracts at regional and national meetings, as well as participate in our own Internal Medicine Research Symposium. Learn more about research opportunities available to Internal Medicine residents and about Internal Medicine research at Wake Forest School of Medicine.