At University of Miami at Holy Cross Hospital we prepare each of our residents to have a strong clinical background; propelling graduates towards success as General Internists and as leaders in medicine.
Our curriculum focuses on gaining the necessary skills to succeed including clinical skills in non-medicine specialties such as dermatology, gynecology, sports medicine or urology, to understanding the inner workings of an Accountable Care Organization (ACO), to working in interdisciplinary teams and successfully managing chronic diseases. The year is designed around a “4+2” scheduling system.
The 4+2 Clinical Schedule
In many academic institutions, residents are pulled in two directions. When caring for very sick inpatients, residents are commonly asked to address the needs of ambulatory patients in continuity clinic. Not only is it difficult to shift from the inpatient to outpatient pace, there is also a simultaneous loss of continuity in both settings. The innovative 4+2 system eases the transition between settings and provides ample time for transition of care. Residents are assigned an inpatient or elective rotation for 4 weeks. During this time, residents focus on just the hospitalized patients that require a significant amount of thought, efficiency, and care management skills.
Following this block, residents transition to a two week ambulatory block with eight continuity clinic sessions and a host of other outpatient experiences. Residents are relieved of inpatient duties and can focus on developing the skills necessary to participate and thrive in a primary care setting. Not only does this schedule allow for greater focus for setting-specific clinical skill development and care plan management, but also for a more flexible didactic lecture schedule. Without afternoon clinics, the typical “morning report” is easily moved to the afternoon, freeing up the morning for urgent care needs such as new lab results, consultant suggestions, and discharge planning. Below details a sample schedule for an incoming intern and the approximate disbursement of rotations across the duration of the residency.