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 two-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 (HMP) is a one-year pathway designed for those residents interested in a career as an academic or community hospitalist.
The Medical Educator Pathway is 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 POCUS Champion Pathway provides enhanced point-of-care ultrasound (POCUS) training for upper level residents interested in further developing their bedside ultrasound skills. Resident POCUS Champions take part in a more advanced multimodal POCUS Champion training program. They work closely with POCUS trained faculty and develop into POCUS instructors within the residency program and medical school. Residents are eligible to apply for this pathway at the end of their intern year.
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.
Point-of-Care Ultrasound Training
Point-of-Care Ultrasound (POCUS) is integrated into the education curriculum for all residents throughout all three years of Internal Medicine residency training. The residency program fosters a supportive educational environment that encourages the use of POCUS in the clinical setting. Residents have access to a simulation and ultrasound lab, along with top-of-the-line ultrasound equipment in both the inpatient and outpatient setting. Learn more about our unique POCUS curriculum.
Intern Year (House Officer-1/HO-1)
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 on a "Y" service (ambulatory medicine). The intern year is structured as an X+Y schedule, with 13 three-week rotations. The three-week X-rotations include the following dedicated experiences:
- 10 blocks of inpatient wards (including general medicine and subspecialty wards, night medicine, Cardiovascular Intensive Care Unit [CVICU] and Medical Intensive Care Unit [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 Y-week features a variety of clinic experiences and educational conferences.
Upper-level Years (House Officer-2 and -3/HO-2 and -3)
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 night float coverage and the MICU and CVICU.
Remaining blocks include:
- Subspecialty consults and clinic experiences
- Private practice internal medicine clinic
- General medicine acute care clinic and VA outpatient clinic
- Elective time tailored to the resident’s interests
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. Each of these years consists of 13 four-week blocks in this 4+4 format. Continuity clinics take place during the non-ward rotations only and 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. Coupling this 4+4 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 in the Intensive Care Units (1 block: CVICU, 1 block: MICU)
- 1 block in the ACE Unit (Acute Care of the Elderly)
- 2 blocks on the General Medicine Wards (Includes General Medicine at Wake Forest Baptist Hospital and/or High Point Regional Hospital as well as the Hospitalist service
- 1 block on Hem/Onc (Hem/Onc A or Leukemia)
- 2-3 blocks on other Wards (e.g. General Medicine at Baptist and/or High Point, Hospitalist, Hem/Onc A, Cardiology Wards, Leukemia, Renal, CVICU, or MICU)
- 0.5-1.5 blocks Resident On-Call (one two-week block is paired with two weeks of vacation)
- 1 block HO-3 Academic Internal Medicine – Internal Medicine consultation to ED and non-Internal Medicine services, daytime admissions to teaching teams to protect rounding, procedures/ultrasound and quality improvement for care of complex patients1 block of VA Outpatient Clinic (HO-3)
- 1 block of Acute Care Ambulatory Rotations: Downtown Health Plaza (DHP; HO-3 only); Outpatient Department (OPD; HO-2 and HO-3)
- 1 block of VA Outpatient Clinic (HO-3)
- 6 blocks of Subspecialty Consult Months (Endocrine, GI, ID, Pulmonary, Renal, Rheumatology) — These rotations provide both outpatient and inpatient consultation experiences.)
- 1 block of Board Study (two weeks) which is paired with two weeks of vacation
- 1 block of Outpatient Perioperative Clinic (two weeks) and Elective (two weeks)
- See separate document for specific requirements of Primary Care Track
- Subspecialty electives (e.g. Heme/Onc, Geriatrics, Palliative Care, Allergy)
- Non-Internal Medicine specialties (e.g. Dermatology, Ophthalmology, Otolaryngology, Sports Medicine)
- Research electives, including the 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
- All residents will be assigned to the jeopardy pool (back-up for unexpected absences) during a limited portion of their elective time
On Call Duties
Our intern call system consists of a block night float system for ward services and a short stretch of nights during the MICU and CVICU rotations.
Our upper-level call system consists of a night float that covers Sunday through Thursday. Upper levels on hematology/oncology and nephrology ward services at Atrium Health Wake Forest Baptist Medical Center cover the Friday and Saturday calls (a total of two overnight calls per resident per ward block). Upper levels on ward services at High Point have a rotating night float system embedded within the rotation. The MICU and CVICU have a night float system where residents 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:
Held every Monday, Tuesday, Wednesday and Friday from 12:00-12:45 pm. Once a week, this conference is replaced by Core Content Review (CCR) on clinical and board-relevant topics. It is directed by the Assistant Chiefs of Medicine (ACMs and attended by the Program Director, faculty and interns and residents. Noon Report is designed to cover high-yield board review topics as well as interesting patient cases. It provides an opportunity to discuss questions and problems regarding diagnosis and management of real patients in an open and supportive environment. Case discussions stem from a variety of inpatient and ambulatory settings with an emphasis on developing clinical reasoning skills. Board-style multiple choice questions are featured at most conferences to stimulate discussion and prepare residents for the ABIM exam.
On Thursday mornings from 9 am-12 pm during the “Y” week, interns participate in the LHS Seminar Series. These small group sessions focus on several important topics to help coach interns on effective communication skills and prepare them to understand health systems, quality improvement, leadership, and lifelong learning in medicine. Here are some examples from this series:
- Evidence Based Medicine Seminar. This small group tutorial focuses on locating, interpreting and critically appraising medical literature pertaining to specific clinical questions.
- Systems-Based Practice Seminar. This series focuses on systems-based issues affecting patients and health care professionals as well as quality improvement.
- Advanced Communication Skills and Professionalism Seminar. This series explores various 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. This consists of a driving tour of Winston-Salem and discussion with community members to explore challenges in access to health care.
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.