The Rochester Educational Tradition
We believe that the best way to learn medicine is one patient at a time. The individual patient is the focus of all rounds and conferences, which often take place at the patient's bedside—a hallmark of a Rochester residency. We create an environment built on support for learners and unencumbered by hierarchy, emphasizing collegiality rather than competitiveness. We promote and expect the participation of all learners in academically rigorous discussions, and we keep our focus on helping our patients.
State of the Art Ambulatory Curriculum
We adopted a "6+2" Block Model in June of 2014. In a “6+2” block structure there is a 2-week long ambulatory block after every 6 weeks of “usual rotations” throughout residency. Within the ambulatory blocks residents have concentrated ambulatory experiences in their own continuity clinics, in subspecialty clinics, and quality improvement. There is also a dedicated education half day per week in the ambulatory blocks. In contrast, continuity clinics are removed from the “usual rotations,” which allows residents to focus on their inpatient and elective experiences.
Our residents have indicated that switching into the block model has markedly improved their experiences in their continuity clinic, in ambulatory subspecialty training, on the floor teams' continuity, on education, and on their quality improvement training. We surveyed our residents before and after adopting our Block Model. Some survey highlights include:
- Overall Satisfaction with Ambulatory Training Improved: 86% of our interns (who experienced their first year in the Block structure) agreed with the statement “I am very satisfied with my training in ambulatory medicine.” In a survey of our R2s and R3s (who lived in both structures), 87% answered “strongly agree” to the following statement: “overall I prefer the Block Model structure over the old structure (1/2 day per week clinic).”
- Ability to Focus on Ambulatory Education Improved: Before the Block Model, only 29% of residents agreed that they were able to focus on their outpatient education while in the clinic; in the Block Model, 90% agreed with the same statement.
- Ambulatory Subspecialty Training Improved: Prior to implementation of our Block Model, 31% of our R2s and R3s agreed with the statement “I am satisfied with my ambulatory training in subspecialty medicine;” after 1 year in the Block Model, 82% agreed with this statement.
- Fewer Handoffs and Higher Quality Care of Inpatients: Before the Block Model, 77% of residents felt that their continuity clinic resulted in additional handoffs in their inpatient experiences, and 46% indicated that their continuity clinic duties interfered with their ability to provide high quality care to patients on their inpatient teams; in the Block Model, however, only 10% and 12% of residents agreed with those statements.
Our survey 2-years into the block model was at least as favorable as at 1 year. Additional detail about our block model can be found at this link: The "Block Model" at the University of Rochester.
Our resident primary care practice has been recognized as a Level 3 Patient Centered Medical Home. In addition, we have a patient Dashboard embedded in our electronic medical record that allows residents to follow outcomes data (e.g., HbA1C, BP control, vaccination and screening completion) for their panel of patients (their whole panel or by disease subsets, such as diabetic or hypertensive patients) and those of the practice as a whole. This powerful tool allows residents to conduct meaningful, real-time quality improvement projects involving their panel of patients.
The Rochester Setting
The University of Rochester and Strong Memorial Hospital were selected as one of the 8 institutions around the country to spearhead innovations in the Clinical Learning Environment by the ACGME. This prestigious honor is based on the University of Rochester’s longstanding commitment to innovating at the graduate medical education level and the commitment of the University’s leadership to excel in creating a wonderful clinical learning environment. This award is helping ensure that the University continues to be at the forefront of medical education over the next several years; residents have multiple different opportunities to become involved in these cutting-edge quality and safety initiatives throughout the institution.
The Rochester community was ranked #1 of 306 communities in an Institute of Medicine report for providing healthcare at the lowest cost per Medicare beneficiary. As healthcare costs continue to rise, Rochester is considered a model that other communities are trying to emulate. Our residents learn to practice medicine in this high quality, cost-effective environment, which will prepare them well for practice as cost-containing healthcare reform efforts proceed.
The University of Rochester Medical Center is a prestigious medical center that emphasizes the highest quality patient care and cutting-edge research. The medical center was one of the first in the nation to become funded as a Clinical and Translational Science Institute by the NIH in 2006, and is now the coordinating center for the entire NIH CTSA Program. The patient diversity is tremendous, with a broad mix of patients from urban, suburban, and rural settings; patients from a range of socioeconomic, racial, and ethnic backgrounds; and with a blend of medical problems ranging from bread and butter illnesses to the most esoteric diagnoses.