Curricular Innovations: 4:2 block scheduling

Our curriculum will be on a 4 week by 2 week block cycle. The 4 week rotations will be the inpatient wards, ICU, Night Float, or Electives. There are no continuity clinics during this time, so that the residents can focus on their learning on the rotation. The electives during the 4 week rotations will be more focused in the inpatient setting. For many of the subspecialties, the residents will do both an inpatient elective as well as an outpatient experience during the integrated blocks.

The 2 week blocks are called integrated clinic blocks. These blocks will have 8-9 half-days of continuity clinic over the 2 weeks along with 7-8 half-day of outpatient subspecialty clinics. There is dedicated didactic time called, “Learning Labs” that are reserved for 4 sessions during the 2 weeks. Each intern and resident is part of a longitudinal cohort that will be on the same 4:2 cycle.

The learning labs will cover various topics. It is both an opportunity to cover ambulatory topics, but also be able to do more time-intensive workshops. The 4:2 schedules also give predictability in being able to work on longitudinal scholarly activity and research. We have built in some dedicated time within the curriculum, but the standard scheduling will make it easier to use the time outside of duty-hours.

Vacations are taken out of the 4 week blocks as either 1 or 2 week time off. Residents are allowed to take a 7 day vacation over one of the I-blocks each year. 5 days of the time off can also be taken as FLEX days, meaning that they can be spread out throughout the year during the I-blocks. All time off requests much be submitted with ample advanced notice.

This is the sample schedule for the learning labs.

Learning labs : Occur on the 1st Monday AM and the 2nd Friday PM of each block

Monday AM:

  • 8:30-9am: Orientation and sharing of experiences/insights
  • 9:10-10:15am: Outpatient topics
    • Tobacco Cessation
    • Epic Efficiency/Tips
    • Musculoskeletal Exams
    • Chronic Pain
    • Preventative Care
    • Contraception
  • 10:30-11:45am:
    • R1- 6 EBM sessions
    • R2- 4 QI sessions
    • R2/R3: Assortment of clinical reasoning, scholarly activity, independent study sessions
  • 12-1:00: Noon Conference
  • 1-1:30pm: Ambulatory Resident Report- each resident will be assigned 2-3 per year

Friday PM:

  • 1:30-2:15pm: Desktop Time: Goal to leave EPIC desktop completely clear by end of I-block
  • 2:15-3pm: Clinical Questions (everyone share for 10 mins)
  • 3pm-5pm: Simulation lab, outpatient procedures, POCUS, Advanced Care Planning workshop, feedback workshop

Wednesday AM Protected Time:

  • 8-9 am: Resident Report (summer) or Grand Rounds
  • 9:10-9:30am: Team Huddles in Pods
  • 9:30-10am: Complete evaluation of last 4 weeks including evaluations for rotations, attendings, and peers. These are on New Innovations. There is also a Select Survey that is confidential. These will be collected over months and only given to the faculty or rotations when more than 5 surveys are done for that particular person. This will ensure more confidentiality for your evaluations.
  • 10-11:45am: QI, PBLI sessions, EKG modules, ambulatory education modules, evaluations, etc
  • 11-11:45am: Complex Case Conference (twice per year for each resident)

The I-blocks will give you a good opportunity to focus your reading and learning on particular areas. We encourage you to read on the area of focus during the 2 weeks as much as possible. There are resources on the NEJM 360 site as well as our Atlas site that you can access for further readings.

Current I-blocks :

  • Neurology
  • Gastroenterology
  • Infectious Disease
  • Cardiology
  • Pulmonary
  • Endocrine
  • Ophtho/ENT
  • Dermatology
  • Rheumatology
  • Heme/Onc
  • Nephrology
  • Geriatrics- R3
  • Behavioral Medicine
  • Pain
  • Addictions
  • Sleep Medicine
  • Women’s/Men’s Health

In 2019, the R2s will have an EBM I-block

This is a sample template of the IBlock below:

ppmcimriblock