Our Internal Medicine program started transitioning to this model of block scheduling in 2015. Unlike the traditional scheduling model which adds a weekly continuity clinic into a residents existing rotations and duties, this curricular redesign separates continuity clinic into a separate rotation that is repeated longitudinally throughout the year. The “Y” block, or ambulatory block, is 2 weeks in duration and includes the resident’s continuity clinic, weekly academic half day, and additional outpatient subspecialty experiences. The “X” block is 6 weeks in duration, which can be broken into 3 different 2-week rotations or a 4-week rotation (such as ward or ICU) with a 2-week rotation.

Each year in residency is divided into 26 2-week blocks, with residents rotating into their clinic block every 8 weeks. Above you see part of the schedule for a resident in Clinic Group C and Clinic Group B. At any given time, 25% of our residents are in the Clinic Block.

Here are some of the benefits of block scheduling (X+Y):

• Decreases conflicting inpatient and outpatient concurrent responsibilities; thereby reducing resident stress and work hours while on inpatient rotations
• Provides automatic decompression in a resident’s schedule by removing the possibility of > 2 continuous months of more intense rotations (wards, ICU, nights)
• Increases outpatient continuity for routine follow up visits as well as increasing total number of continuity clinic days each year
• Increases ownership and satisfaction in the ambulatory setting; more realistically models today’s primary care practice
• The ability to deliver consistent curriculum (Friday academic half day); where we often put our most important curriculum and simulation training that reaches every categorical resident in our program