The ACGME requires all internal medicine residency programs to have a longitudinal continuity experience. There are clinic continuity sessions required over the course of the three years. To meet this requirement, the expectation has traditionally been that while on inpatient and outpatient rotations, residents attend one—or in some instances two or three— half-day continuity sessions each week. This requirement frequently leads to fragmentation and distraction as residents are unable to focus on ambulatory training. Additionally, scheduling the continuity session on the same day of the week for consistency can be challenging with resultant poor continuity of care for patients in the outpatient setting.
Our program has successfully transitioned from a traditional 12-month model to a “6+2” block model. In our model, following 6 weeks of a combination of a core rotation with elective or vacation, there is a 2-week ambulatory block followed again by another 6-week combination of core rotations and electives. During these 6 weeks, while the rotations may vary, the resident will not attend clinic. The resident will be able to focus on management of patients and attend all hospital-based didactic activities. There will be no hand-offs as none of the team members have to leave for clinic.
The core curriculum required for all residents includes the following rotations: