With much excitement the MMC Internal Medicine Residency Program transitioned to a block scheduling (“4+2”) in July 2014. This redesign of the resident schedules was the culmination of more than a year of collaboration between our residents, program leadership, teaching faculty, and hospital administration. Our goals were to improve the clinical learning environments (both inpatient and outpatient) for our residents and faculty, enhance our team-based approach to care of all patients, and introduce new curricular elements to train the modern internist.

The curriculum is now organized around alternating blocks of 4 weeks (predominately inpatient service blocks, night float, consult rotations, and electives) and 2 weeks (predominately continuity clinic, outpatient medical specialties, quality improvement, administrative time, and vacation).

4 Week Block

Rotation Title R1 (total weeks) R2 (total weeks) R3 (total weeks)
General Medicine Inpatient (Days) 10 4 10-12
General Medicine Inpatient (Nights) 2 4 (2 weeks at a time x 2) 0
Critical Care Medicine 4 4 4
Inpatient Cardiology (Med C) 4 4 0
Inpatient Hem/Onc 2 4 0
Inpatient Nephrology Transplant 2 0 0
C-A-T Night Float (Cards/Hem-Onc/Nephro) 2 0 4 (2 weeks at a time x 2)
Other (2-4 weeks) Emergency Medicine
Inpatient Geriatrics Consult
Inpatient Neurology Consult
Rural Medicine
Inpatient Renal Consult
Inpatient Infectious Diseases
Inpatient Pulmonary Consult
Inpatient GI Consult
VA Medical Specialties
Electives 2 6 8

2 Week Block

  Monday Tuesday Wednesday Thursday Friday
7:30-8:30 AM Morning Report Morning Report Grand Rounds* Morning Report Board Review
Morning Continuity Clinic Specialty Clinic** M&M Conference,
Personal Practice Management Time,
Quality Improvement
Specialty Clinic**/Elective Specialty Clinic**/Elective
Mid-Day Pre-Clinic Conference   Pre-Clinic Conference Intern Report Pre-Clinic Conference  
Afternoon Continuity Clinic Specialty Clinic** Continuity Clinic Continuity Clinic Academic Half-Day

*Grand Rounds time is 8:00 AM - 9:00 AM

** Specialty Clinic Themes:

  • R1 Year: Endocrinology, Nephrology, Neurology, Geriatrics, Sports Medicine, Women’s Health, Bramhall (MMC Urgent Care, MMC Dermatology Clinic, MMC International Clinic)

  • R2 Year: Endocrinology, Pulmonology, Hematology, Infectious Diseases, Palliative Care, Bramhall (MMC Urgent Care, MMC Dermatology Clinic, MMC International Clinic)

  • R3 Year: Cardiology, Oncology, Gastroenterology, Surgical Specialties, Bramhall (MMC Urgent Care, MMC Dermatology Clinic, MMC International Clinic)

Continuity Clinic: Resident continuity clinic locations include MMC (Bramhall Campus), Maine Medical Partners Westbrook Internal Medicine, and the Portland VA Clinic. Each resident has their own panel of patients as part of a larger three resident coverage team (one resident from each 4+2 “track”).

Vacations: 4 weeks per year which come out of the “+2 weeks”

Longitudinal Curriculum Weeks:

  • R1 Year: Foundations of Patient Safety and Quality Improvement
  • R2 Year: Evidence-Based Medicine
  • R3 Year: Patient Safety: Root Cause Analysis/M&M