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
-
Interns have 6 2-week Clinic Blocks, MICU and cardiology ward/ICU rotations, as well as 5 ward rotations. Residents rotate on Internal Medicine ward services across all three sites: TGH, Moffitt, and the James A Haley VA. Some residents have one ward replaced with an ER rotation during their first year, others have ER as a senior resident. House officer rotations (night coverage) will be 1-2 2-week blocks, and do not start until after August to allow interns to appropriately transition to internship. The remaining blocks are electives that residents give preferential rank. Please see an example intern schedule below
Elective are assigned to provide residents exposure across all subspecialties and unique facets or practices of medicine (e.g. telemedicine, hospital administration and quality). Residents prioritize their elective requests annually before the schedule is created. Certain electives (e.g. Geriatrics, neurology) are graduation requirements and will be integrated into each resident’s schedule within the three years of training.
Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Ward Ward Clinic Block
(Group C)Elective MICU MICU Clinic Block
(Group C)Elective Ward
(or ER)Block 10 Block 11 Block 12 Block 13 Block 14 Block 15 Block 16 Block 17 Block 18 Ward
(or ER)Clinic Block
(Group C)House Officer Cardiology Ward Cardiology Ward Clinic Block
(Group C)Elective Ward Ward Block 19 Block 20 Block 21 Block 22 Block 23 Block 24 Block 25 Block 26 Clinic Block
(Group C)Elective Ward Ward Clinic Block
(Group C)Elective Ward Ward -
The robust training received during the intern affords our residents the skills necessary to take the leadership role on ward teams, as the code team leader while on the cardiology service, and supervise procedures. Our second year residents are the lead of the cardiology ward rotation, and assist the third year residents in the MICU. They have rotations, called night float, in which they are admitting patients from the ER to the ward services or cardiology ward. Additionally, the PGY 2 class mans the House Officer rotation during the first blocks of the year to ease the intern transition.
Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Clinic Block (Group C) Elective Cardiology Ward Senior Cardiology Ward Night Senior Clinic Block (Group C) Elective Ward Ward Clinic Block (Group C) Block 10 Block 11 Block 12 Block 13 Block 14 Block 15 Block 16 Block 17 Block 18 MICU Assist Elective Elective Clinic Block (Group C) Elective Cardiology Ward Senior Cardiology Ward Night Senior Clinic Block (Group C) MICU Assist Block 19 Block 20 Block 21 Block 22 Block 23 Block 24 Block 25 Block 26 Ward Ward Clinic Block
(Group C)Night Float
(ER Admitter)Ward Ward Clinic Block
(Group C)Night Float
(ER Admitter) -
The amount of core rotations during the PGY3 year decreases as residents are preparing for the next stage of their career. This allows more flexibility for scheduling interviews for fellowship or hospitalist/primary care practices, all the while studying for the ABIM Board Exam. Third year residents lead the Medical Intensive Care Unit.
Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Ward Ward Clinic Block (Group C) Elective Medicine Consult Service Medicine Consult Service Clinic Block (Group C) Elective MICU Senior Block 10 Block 11 Block 12 Block 13 Block 14 Block 15 Block 16 Block 17 Block 18 MICU Night Senior Clinic Block (Group C) Elective Ward Ward Clinic Block (Group C) Elective MICU Senior Elective Block 19 Block 20 Block 21 Block 22 Block 23 Block 24 Block 25 Block 26 Clinic Block (Group C) Elective Cardiology Ward Assist Night Float (ER Admitter) Clinic Block (Group C) Elective Elective Elective