4+1 Programs?

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Scean

Scean

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I did search the forum but istead of searching each and every residency website - who knows of existing 4+1 structured (ward+clinic week) internal medicine programs?

I like this idea as I watched the inefficiency of my resident/intern having to peace out to clinic for the afternoon and interrupting the flow of ward work for the day.

Tulane pushes it hard - I just dont know of the others

Also - did any programs pitch this as an upcoming change to those who just interviewed?
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off the top of my head

NS-LIJ
OHSU (3+1)
UCDavis

Tulane pushes it hard because its PD created/invented the 4+1 schedule
 
also off the top of my head, based on places where I interviewed

UMDNJ-NJMS (8+2)
St. Luke's-Roosevelt (6+2)
SUNY Upstate (3+1)
 
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UTSW just changed to 4+1 within the last year or so, if I remember correctly.
 
Several programs are considering this type of schedule (with good reason, IMO). Off the top of my head, I know Hopkins is switching to 6+2, UChicago is switching to 4+2 (both for the upcoming year). I'm sure there are others.
 
How about making an easy-to-read list?

3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate

6+2
St Luke's-Roosevelt

8+2
UMDNJ-NJMS

Unknown
Kentucky (3m+1m?)
UC-Davis

Coming soon...
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
 
Last edited:
Temple has it
Cedars Sinai is trying to
 
IIRC Kentucky's schedule was something like 3 (months) + 1 (month)
 
michaelrack said:
So a 4+1 (week) schedule meets the ABIM/ACGME requirements for a continuity clinic???

I can't see how a 3+1 (month) schedule would meet those requirements.
Click to expand...

Kentucky got a grant from the ACGME to try out this new 3 month wards/1 month clinic thing and to collect data on it.

Cincinnati got a similar grant and does something like 16 months of wards, then a 12 month block of all outpatient, then finish up with 10 months ward work. The residents loved the outpatient year during 2nd year since they could also pack in a lot of moonlighting then too.
 
Hopkins will be a 6+2 next year
 
so it's 1 month of continuity clinic for eveyr 4 months of wards or 4 months of non-cc?

my program next year has me scheduled (as a pgy-2) in 3 months of clinic, 2 months of wards, 2 months of icu, and a month of nightfloat, the rest as electives.
 
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Penn is 6+2, Yale is 1m outpatient and 1m inpatient, so 4+4?

Traditional: UNC, UWash, Mt. Sinai
 
LossForWords said:
Kentucky got a grant from the ACGME to try out this new 3 month wards/1 month clinic thing and to collect data on it.

Cincinnati got a similar grant and does something like 16 months of wards, then a 12 month block of all outpatient, then finish up with 10 months ward work. The residents loved the outpatient year during 2nd year since they could also pack in a lot of moonlighting then too.
Click to expand...

Yeah, both of these programs are EIP (Educational Innovations Project) programs...they were given leeway to experiment with different types of schedules. I thought Kentucky's approach was interesting, but Cincinnati's schedule led me to bump it way down the list. 16 straight months of wards would make me want to put a gun to my head, frankly.
 
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Raryn said:
Given there's not more than 15-20 X+Y programs, there's something like 380 "traditional" programs. Lets not list them all :p
Click to expand...

Nope, we need to list all of them for 50 pages (half of them based on hearsay and inaccuracies), then let JDH rank them, then argue about them for another 50 pages. That's our style.

Also, I'm hoping to see at least a few places with unorthodox schedules like 3+4, 51+1, or 7+3i.
 
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UC - Denver expanded the 4+1 schedule to their residents at all levels.
 
While this thread is helpful, you have to read the fine print at each program on 6+2, 4+1, 3+1, 4+4 scheduling.

Some programs while they have inpatient and outpatient curriculum separated, you still have to do a half afternoon twice a month while on general wards to preserve patient continuity. Other places, someone else will have to see your patients, and you won't have true continuity and have to get signout from your colleagues (if he/she writes poor notes).
 
Bump now that we are in interview season - any newcomer programs to this format?
 
3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA

6+2
St Luke's-Roosevelt

8+2
UMDNJ-NJMS

Unknown
Kentucky (3m+1m?)
UC-Davis

Coming soon...
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
 
3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA

4(inpt)+2(clinic)+2(elective)
WashU

6+2
St Luke's-Roosevelt

8+2
UMDNJ-NJMS

Unknown
Kentucky (3m+1m?)
UC-Davis

Coming soon...
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
 
UVa will likely have a 3+1 system next year.
 
3+1 or 4+1 seems like a much better option-- especially to lear outpatient. Also, your ward weekday isn't cut in half by a clinic!
 
HelpPleaseMD said:
Can someone explain what is meant by 3+1, 4+1 etc? I feel dumb for not knowing this
Click to expand...

3 or 4 weeks of your traditional rotation (wards, ICU, etc.) followed by 1 week of outpatient clinic which is usually your continuity clinic. With this system you don't have to leave your ward team one afternoon a week to go to clinic. You can concentrate on only inpatient or only outpatient. With this you also get one golden weekend a month usually because there's no clinic on the weekend
 
chargersfan said:
3 or 4 weeks of your traditional rotation (wards, ICU, etc.) followed by 1 week of outpatient clinic which is usually your continuity clinic. With this system you don't have to leave your ward team one afternoon a week to go to clinic. You can concentrate on only inpatient or only outpatient. With this you also get one golden weekend a month usually because there's no clinic on the weekend
Click to expand...
Thanks. Yea that does seem a lot better than the 1/2 day a week that my resident leaves for clinic during IP medicine month
 
4+1: Olive View, Cedars-Sinai, possibly Harbor (they're still working on it)
 
Mount Sinai now has a "decoupled program." It varies a little I think but is roughly 6 + 2
 
3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA

4(inpt)+2(clinic)+2(elective)
WashU

6+2
St Luke's-Roosevelt

8+2
UMDNJ-NJMS

Unknown
Kentucky (3m+1m?)
UC-Davis

Coming soon...
Baylor College of Medicine (4+1)
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
 
Adding Mayo - they have alternating inpatient/"outpatient" rotations (outpatient meaning you rotate in, for example Endocrinology, which means you have to do a little bit of inpatient when you cover diabetes), continuity clinics only occurring during the "outpatient" rotations. This is essentially 4+4, as you never have to leave inpatient rotations to go to clinic.

3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA

4(inpt)+2(clinic)+2(elective)
WashU

4+4 (kind of)
Mayo

6+2
St Luke's-Roosevelt

8+2
UMDNJ-NJMS

Unknown
Kentucky (3m+1m?)
UC-Davis

Coming soon...
Baylor College of Medicine (4+1)
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
 
Vanderbilt has a recently implemented (something) + (something) system (I didn't write down specifics, clearly), and UPMC and UVA have plans to roll out a similar schedule in 2014. Michigan and Emory say they're sticking with the traditional schedule.


3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA

4(inpt)+2(clinic)+2(elective)
WashU

4+4 (kind of)
Mayo

6+2
St Luke's-Roosevelt

8+2
UMDNJ-NJMS

Unknown
Kentucky (3m+1m?)
UC-Davis
Vanderbilt

Coming soon...
Baylor College of Medicine (4+1)
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
UVA
UPMC
 
Adding Sinai from earlier
Georgetown also in on the mix with a planned Ward 4 / Amb 2 / Elective or NF 2 system next year

3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown

4+4 (kind of)
Mayo

6+2
St Luke's-Roosevelt
Mount Sinai

8+2
UMDNJ-NJMS

Unknown
Kentucky (3m+1m?)
UC-Davis
Vanderbilt

Coming soon...
Baylor College of Medicine (4+1)
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
UVA
UPMC
 
Adding Sinai from earlier
Georgetown also in on the mix with a planned Ward 4 / Amb 2 / Elective or NF 2 system next year

3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown

4+4 (kind of)
Mayo

6+2
St Luke's-Roosevelt
Mount Sinai

8+2
UMDNJ-NJMS

Unknown
Kentucky (3m+1m?)
UC-Davis
Vanderbilt

Coming soon...
Baylor College of Medicine (4+1)
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
UVA
UPMC
 
Clarifying Vandy - 8+2 as intern, 4+2 for 2nd and 3rd years
UAB is 4+4 your 2nd/3rd years

3+1
BU
OHSU

4+1
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai

8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis


Coming soon...
Baylor College of Medicine (4+1)
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
UVA
UPMC
 
3+1
BU
OHSU

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai

8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis


Coming soon...
Baylor College of Medicine (4+1)
Brown
AECOM/Montefiore
Cedars
Hopkins
UChicago
URochester
UVA
UPMC
 
3+1
BU
OHSU

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM

8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis

Traditional
Emory


Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UVA
UPMC
 
3+1
BU
OHSU

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM

8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UVA
UPMC
 
3+1
BU
OHSU
UVA
4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM

8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UPMC
 
BU
OHSU
UVA
4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM

8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UPMC
GWU
 
Added Yale

3+1
BU
OHSU
UVA

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown
Yale

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM

8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UPMC
GWU
 
3+1
BU
OHSU
UVA

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA
Richmond University Medical Center
Stamford Hospital (kind of 4+1)
Allegheny General Hospital

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown
Yale

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM

8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UPMC
GWU
UTHSCSA (for summer 2014)
 
3+1
BU
OHSU
UVA

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA
Richmond University Medical Center
Stamford Hospital (kind of 4+1)
Allegheny General Hospital

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown
Yale

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM
Case (after 1st year)
8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UPMC
GWU
UTHSCSA (for summer 2014)
 
VCU

2+2
VCU

3+1
BU
OHSU
UVA

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA
Richmond University Medical Center
Stamford Hospital (kind of 4+1)
Allegheny General Hospital

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown
Yale

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM
Case (after 1st year)
8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Unknown
Kentucky (3m+1m?)
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UPMC
GWU
UTHSCSA (for summer 2014)
 
U of KY Clarification

2+2
VCU

3+1
BU
OHSU
UVA

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA
Richmond University Medical Center
Stamford Hospital (kind of 4+1)
Allegheny General Hospital

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown
Yale

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM
Case (after 1st year)
8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Other
Kentucky (2 mo. wards/consults/ICU + 1 month clinic)

Unknown
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UPMC
GWU
UTHSCSA (for summer 2014)
 
SUNY Buffalo, WVU
2+2
VCU

3+1
BU
OHSU
UVA

4+1
Colorado
Loyola
NSLIJ
Stony Brook
Temple
Tulane
UTSW
Upstate
UCLA
Olive View - UCLA
Richmond University Medical Center
Stamford Hospital (kind of 4+1)
Allegheny General Hospital
SUNY Buffalo

4(inpt)+2(clinic)+2(elective)
WashU
Georgetown
Yale

4+4 (kind of)
Mayo
UAB (2nd/3rd year)

6+2
St Luke's-Roosevelt
Mount Sinai
AECOM
Case (after 1st year)
8+2
UMDNJ-NJMS
Vanderbilt (intern year, 4+2 thereafter)

Other
Kentucky (2 mo. wards/consults/ICU + 1 month clinic)
WVU (alternate ward and elective months. No clinic during ward months, 1 day/week during elective months)

Unknown
UC-Davis

Traditional
Emory
Indiana
Downstate

Coming soon...
Baylor College of Medicine (4+1)
Brown
Cedars
Hopkins
UChicago
URochester
UPMC
GWU
UTHSCSA (for summer 2014)
 
Is this list exhaustive? Or are there many that are still not represented?
 
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