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Department of Internal Medicine

Department of Internal Medicine

An innovative scheduling system – 4+1+1


Residency programs across the country struggle with maintaining continuity of care for patients in the outpatient setting while residents are busy working on inpatient services.  In July 2012, we implemented a schedule that we call 4+1+1, to try to minimize the conflicting outpatient and inpatient responsibilities of our residents.  In 4+1+1, residents do 4 weeks of an inpatient rotation, followed by two weeks of elective, ambulatory block, or vacation (this is the 1+1 part).  Residents no longer have continuity clinic during their 4 weeks inpatient blocks.  During the 1+1 weeks, they have 2 or 3 continuity clinics where they can catch up and give their primary care patients full attention.  Between clinic sessions, our state of the art EMR allows residents to manage their panels remotely (see EMR section below).  Residents already appreciate the ability to concentrate fully on their inpatients without the stress of getting to clinic on time.