The Traditional Structure
All patient rotations are alike with similar responsibilities and patient census expectations. This structure did not facilitate progressive skill development or fully prepare residents for their post-residency careers.
- PGY-1 expectations and goals remained static throughout the year.
- New PGY-2s were responsible for leading and teaching new PGY-1’s on inpatient teams. As a result, PGY-1s, who need the most support, were taught by the most junior residents.
- PGY-3s did not get to take on additional responsibility over the course of residency. At the end of the year, PGY3-s working with experienced PGY-1s had the same level of responsibility as they did 24 months ago.
The Progressive Structure
Unlike the traditional structure, the progressive structure maximizes learning opportunities and responsibilities for residents.
- Team structure and expectations differ depending on time of year and whether you are a PGY-2 or PGY-3.
- There are three different types of teams and all residents progress in the same order (A team → B team → C team)
- A team: a PGY-2 without an intern, working with an attending
- B team: a PGY-2 or PGY-3 working with one intern
- C team: a PGY-3 working with two interns
- The A team is an opportunity for residents to solidify their clinical knowledge and inpatient practice before taking on supervisory responsibilities. Resident works 1 on 1 with a full time clinical hospitalist.
- All interns first inpatient rotations are under the leadership of PGY3’s who have the most experience teaching. Later in the year interns work in C teams where they have greater autonomy.
There is also a hospitalist elective for PGY-3s. This elective provides, exposure and training in hospital triage, cross-cover, and downtime for billing. You will work one on one with a hospitalist with opportunity to carry a full inpatient census. There are also opportunities for work with hospitalist outside of the Providence system for exposure to different hospitalist models, (open ICU, SNF, and small hospital).