In the Internal Medicine Residency program at Wake Forest School of Medicine, our overarching goals are to promote a progressive growth of proficiency in Internal Medicine knowledge and clinical skills throughout the three years of training. Interns enter a collegial environment that fosters appropriate autonomy early on in training, with a high level of support and guidance. As residents progress through the curriculum, they develop as team leaders and are well-positioned to practice Internal Medicine independently upon graduation.
Our interdisciplinary ward teams generally consist of 2-3 interns, 1 upper level resident, and 1 attending, as well as medical students, acting interns, clinical pharmacists, nursing case managers and other helpful ancillary staff. Upper levels supervise the care of 10-20 patients on the ward services.
The medical intensive care unit is staffed by two teams each consisting of 3-4 interns, 2 upper levels, fellow, and attending. The cardiovascular intensive care unit is staffed by 2-3 interns, 2-3 upper level residents, fellow, and attending.
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 at Wake Forest School of Medicine 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.
Select residents apply and are accepted into the program, which provides protected time for pursuing translational research with the goal of training future physician-scientists.
The HO-1 year offers broad exposure to direct patient care in internal medicine. 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 and 13 one-week ambulatory medicine experiences. The content of the three-week “X-rotations” includes the following dedicated experiences:
- 10 blocks of inpatient wards (including night medicine, CVICU and MICU)
- One emergency medicine block (ED)
- Two 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 HO-2 and HO-3 years are designed to facilitate the growth and maturation of the house officer 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 HO2/HO3 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 blocked 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 in the MICU and CVICU.
Our upper level call system consists of a night float that covers Sunday through Thursday and overnight call on Friday and Saturday. Upper levels on ward services cover the Friday and Saturday calls: a total of two overnight calls 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 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 resident. They are developed each year with input from our Resident Curriculum Committee.