Training at the University of Chicago
The University of Chicago Internal Medicine Residency Program is dedicated to achieving three predominant aims: excellence in patient care, leadership in medical research, and distinction in scholarship and education. An emphasis is placed on learning by doing. This educational philosophy of resident autonomy and responsibility runs through all three years of the program. Residents are constantly challenged to solve problems on their own, but are backed by an accessible, full-time faculty interested in and responsible for teaching residents.
The 4+2 Curriculum Model
Beginning in July 2013, our residency program moved to a “4+2” curriculum model. In this model, residents have their inpatient and outpatient rotations completely separated. Residents alternate between a 4-week block of inpatient care and consults and a 2-week block of dedicated outpatient ambulatory medicine. Benefits and highlights of the 4+2 model include the following:
* Ambulatory training time is protected and includes at least one administrative/reading half-day per week.
* Outpatient needs, such as prescription refills and paperwork, are covered by a colleague while residents are rotating on inpatient blocks.
* Not having ambulatory clinics during inpatient rotations helps preserve the inpatient team structure.
* PGY1 and PGY2 residents have a year-long longitudinal experience in a sub-specialty clinic during their ambulatory blocks.
Sample categorical intern schedule in the 4+2 system:
* The Department of Medicine has 42 first-year residency positions (34 categorical, 7 preliminary, and 4 medicine/pediatrics) and maintains over 200 beds at the University of Chicago Medical Center.
* Medical patients are assigned to a first-year resident (intern) who is supervised by an advanced resident and an attending physician.
* First year residents typically admit 5 new patients per call cycle and care for 7-10 patients at a time.
* First year residents start building their continuity clinic panel in the Primary Care Group during their first year. In the 4+2 curriculum, ambulatory training now spans the entire three years of residency.
Other Highlights of the Curriculum
* Continuity clinic begins during the first year. First year residents acquire a cohort of patients that they follow throughout the three years of training. Continuity clinics are based on campus, at the Primary Care Group, which serves Chicago’s south side and the surrounding areas.
* Sub-specialty training at the University of Chicago Medical Center is unique in that residents have the opportunity to rotate on dedicated inpatient services run by the sections of Cardiology and Hematology/Oncology. Residents also spend time on inpatient general medicine. Through these opportunities, residents receive rigorous training in a broad range of medical problems.
* Each section in the Department of Medicine has its own outpatient clinic and consultation service through which residents can rotate on consultation, ambulatory, or elective rotations.
* The Section of Pulmonary and Critical Care Medicine operates a 24-bed Medical Intensive Care Unit in which patients from all services receive care. The Medical ICU is housed in the Center for Care and Discovery.
* The Cardiac Care Unit has beds fully equipped for invasive hemodynamic and electrophysiologic monitoring. The case mix includes post-PCI patients, patients with balloon pumps, pre- and post-transplant patients, and patients on ECMO, Impella, and other advanced cardiac assist devices.
* Residents participate in a geriatrics curriculum through outpatient rotation(s) at the South Shore Senior Center. This curriculum also includes formal nursing home experiences.
* Over three years, each categorical resident has a total of ten weeks of elective/research time.
* The housestaff program is in accord with the requirements of the American Board of Internal Medicine. The program is fully accredited by the Accreditation Council for Graduate Medical Education
Teaching conferences complement daily attending rounds. A wide variety of teaching conferences are available to residents.
* Daily Morning Report is the most popular conference among residents. Every day, a resident prepares and presents a case to colleagues, the chief resident, and an attending physician. As you will see on your interview day, residents engage in vibrant discussion and debate during these sessions.
* Morbidity and Mortality Conference and Clinical Pathophysiology Conferences are other favorites among the housestaff. These conferences occur once every three months and focus on both pathologic correlations to clinical disease and on quality control and process improvement. Discussants include faculty from multiple medicine disciplines, residents, and pathologists.
* Residents also attend daily lunchtime lectures on various topics in internal medicine. These lectures are given by both general medicine physicians and subspecialists.
* Daily subspecialty teaching conferences also take place on the wards, for residents rotating in the ICUs and on the Cardiology and Hematology/Oncology inpatient services.
* Our new weekly Face Off conference series is a forum for two attendings to debate a controversial topic in their field of interest.
* Board Review is a chief resident-run series of weekly reviews preparing second- and third-year residents for the ABIM exam. A fellow is present to assist with discussion.
* During the ambulatory rotation, residents participate in an additional ambulatory curriculum that includes lectures on basic management of common outpatient diseases as well as instruction in evidence-based medicine and quality improvement. The recently retooled Evidence-Based Medicine and Journal Club, which is embedded in the ambulatory curriculum, consists of small group learning where residents discuss and analyze recent literature, landmark articles, and translational research with an attending discussant.
* Weekly Intern Report provides protected time during which interns gather to discuss a recent case with the help of an attending and chief resident.
* Monthly firm meetings provide an opportunity for each of the firms in the 4+2 model to discuss outpatient care and other special topics.
*iMIND: An Internal Medicine Resident Led Initiative to Address Inequities in Medicine discusses the importance of improving diversity in training programs, support for trainees that are underrepresented in medicine and engagement with the local community. It also describes possible interventions for improving diversity in recruitment, creating an inclusive residency environment and improving education on diversity equity and inclusion.
All residents may indicate preferences for specific rotations, and most schedule requests can be accommodated. Continuity clinic begins during the first month of residency. Altogether, internship training usually consists of the following:
* 3 months of Inpatient General Internal Medicine
* 2 months of Subspecialty Inpatient Medicine including Hematology-Oncology and Cardiology
* 3 months of Ambulatory Care
* 4-6 weeks of Medical ICU
* 2-4 weeks of CCU
* 4-6 weeks of Consults
* 2 weeks of Emergency Medicine
* 4 weeks of Vacation
Second and third year residents rotate in 2- or 4-week intervals through each of the subspecialty and general medicine inpatient services, the medical ICU and CCU, and most consultation services. Inpatient time is interspersed with two week ambulatory blocks, as part of the 4+2 curriculum model. Senior residents are generally given first priority for choosing rotations to ensure exposure to their areas of interest.