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X + Y Schedule

What is X + Y?

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.

Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8...
Ward Ward Clinic Block
(Group C)
Elective MICU MICU Clinic Block
(Group C)
Elective Clinic Block
(Group B)
Ward Ward Elective Clinic Block
(Group B)
MICU ...

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