Curriculum and rotations
WellSpan Internal Medicine uses the 4+1 scheduling system in our residency program. Here are the basics:
- The “4” in 4+1 means that residents spend four weeks on some combination of an inpatient core rotation (wards, ICU or nights) or an elective rotation (such as cardiology consults or endocrinology clinic).
- The “+1” indicates that after those four weeks, residents then spend one week dedicated to outpatient medicine (continuity clinic and related outpatient experiences).
- Residents then return for four more weeks of wards, ICU, elective or night float. After that, they go on to another one week of continuity clinic.
- Residents take vacation time during the “4” section.
The most notable benefit of this increasingly common schedule is that it allows compartmentalization of rotations. During the “4” weeks, you’ll be able to focus completely on that rotation and not be distracted by being pulled out to continuity clinic one or two half days per week, as would happen in a traditional schedule.
Similarly, the 4+1 schedule allows you to focus on your continuity clinic experience when you’re on the “+1” week. This is your only clinical obligation during that week, so you can really dive in and focus on outpatient medicine.
Ward medicine (“Med Res”)
Our three ward teams consist of one attending physician, one PGY-2 or PGY-3 resident and one PGY-1 resident. Third- and fourth-year medical students, rotating from our affiliated medical schools, are important members of the team, as are clinical pharmacists and their trainees.
Our teams care for a wide variety of inpatient medicine patients, providing residents with a rich and varied experience over the three years of training. Ward teams cap at 12 patients, though interns begin the year by following no more than eight patients, and later, no more than 10 patients.
Admitting medicine (“Med Res Admitting”)
One team, consisting of a PGY-2 or PGY-3 resident paired with a PGY-1 resident, is dedicated to admissions. This team focuses on admitting patients during the week to help hone physical examination, differential diagnosis and diagnostic reasoning skills. This team will also assist with cross coverage every fourth night to provide this important experience.
Critical care medicine (“Med Res ICU”)
Our ICU experience includes both medical intensive care unit (MICU) and coronary intensive care unit (CICU) patients. Our pulmonary and critical care faculty supervise the ICU rotations.
Internal medicine residents work collaboratively with house staff from other training programs within the hospital during Med Res ICU. Med Res ICU rotations are intense and challenging, and residents have ample opportunity to become skilled in performing procedures and managing critically ill patients.
This experience helps develop their confidence and their ability to clinically reason and function under pressure.
Continuity clinic (“Apple Hill Internal Medicine” or “AHIM”)
Residents will spend every fifth week at continuity clinic at Apple Hill Internal Medicine, which is also our general internal medicine faculty practice.
During your residency, as one of our junior partners in the practice, you will have the opportunity to build your own panel of patients.
You’ll learn how to provide high-quality, high-value chronic and preventive care for them, in addition to honing your skills caring for acute outpatient medical conditions.
Primary Care Track
Residents with interest in pursuing primary care or other outpatient-based subspecialties can join our primary care track. This track offers enhanced elective choices, increased procedural training and additional mentoring from WellSpan primary care physicians.
