RWMC: Internal Medicine Residency: Balanced Approach

First-rate Training Without Service Sacrifices
We have taken great pains to assure a humane, balanced residency experience as well as adequate reading and sleep time. Program designs include:

Afternoon crossover float
Night float resident
No call floor teams (no overnight call)
Dedicated critical care teams (on call every 4th night)
Dedicated floor teams (on call every 5th night)
Friday/Saturday Night Resident Float Coverage
Subinterns and medical students from Boston University and University of New England on housestaff teams
Limited patient load
Limits on the number of admissions per 24 hour period
12 months of elective time during the three-year training period
Physician Assistants in the Critical Care areas

Admission Rotation Plan
Nothing undermines excellence more than multiple simultaneous admissions. It doesn't happen in the real world of medicine and it shouldn't happen during a training experience.

By rotating successive admissions among seven eligible housestaff teams, we spare any one of the teams an overload situation, protecting housestaff morale and improving patient care. Residents have time to thoroughly and appropriately evaluate each patient before the next admission is directed to them. That assures time to take an adequate history, round up old records, speak to the referring physician, discuss an assessment and plan, write complete documentation and orders, and even teach a little on the case.

This "many team" concept also allows the "Long Call" team (who are out of the cycle until late afternoon) to be spared any admissions until they have tended to their prior inpatients, many of who are acutely ill and require detailed attention.

This small refinement demonstrates how we dovetail educational concerns with service requirements so the resident opportunity is maximized.