Our "6+2" Block Model

What is block scheduling?

Block scheduling is an entirely different way to structure a residency program. In the traditional structure residents have a half-day of continuity clinic during their inpatient rotations and electives. In this structure, residents often feel torn between their inpatient and outpatient duties, and they rarely feel focused on their ambulatory training.

In a "6+2" block schedule every fourth 2-week block is an ambulatory block, followed by 6 weeks of the a mixture of all of our other rotations and vacation, then a 2 weeks ambulatory block, and so forth throughout the 3 years.

What happens within an ambulatory block?

When a resident is in an ambulatory block s/he will have 4 continuity sessions per week, 3 subspecialty/elective sessions per week, and three additional sessions used for education, quality improvement and administrative time.

Subspecialty electives are longitudinal over the course of the year. For example, a resident may choose an ambulatory cardiology elective on Monday mornings, rheumatology elective session Wednesday afternoons, and leukemia clinic Thursday afternoons. Over the course of the year, the resident will work with the same attending in the same clinic over 12-14 sessions, which allows the resident to develop a longitudinal relationship with the attending and with some patients (e.g., the same patient could be seen in initial evaluation and then again in follow up visits over the course of the year).

What happens with a resident’s patients when s/he is not in an ambulatory block?

Each resident is part of a mini-practice consisting of other residents who share the same preceptor. In this model, one of the mini-practice partners will be in an ambulatory block at all times. The partners will see each others’ patients for urgent visits that cannot wait until the next ambulatory block of the primary care resident.

Do residents have traditional elective blocks?

Residents have both longitudinal ambulatory electives within ambulatory blocks and traditional 2 and 4-week long elective blocks. Traditional elective blocks can be used for inpatient electives, outpatient electives, or mixed inpatient-outpatient electives, depending on the resident’s preferences.

What are the advantages of block scheduling?

Internal medicine is primarily practiced in the outpatient setting following residency, but traditional resident education is still primarily inpatient-based. There are many advantages to block scheduling, some of which are:

• Residents are immersed in ambulatory practice early in residency. This enables them to build a strong foundation in ambulatory skills early in residency, which can be built upon throughout residency.
• Residents spend more total time in ambulatory training, both in their primary care practice and in subspecialty ambulatory experiences. Since about 3 quarters of internal medicine post-residency is practiced in the ambulatory setting, residents will graduate more prepared for practice or subspecialty fellowship training. Residents will also be better informed about what different career options are really like prior to committing to a specific career direction.
• When in ambulatory blocks, residents are not pulled toward other patient care commitments. This allows them to focus entirely on their continuity practice and ambulatory electives.
• Removal of clinics from floors rotations and traditional inpatient elective blocks helps keep the whole team present each afternoon, allowing for better continuity with patients, less hand offs, and more time for teaching and learning.
• The structure of electives in an ambulatory block allows for longitudinal relationships to form between residents and their ambulatory preceptors and patients.
• Ambulatory blocks contain dedicated time for ambulatory education and quality improvement education and projects on residents’ primary care panel of patients.
• The mini-practice structure formed by residents covering each others’ patients in clinic simulates many future practice structures.