DEPARTMENT OF MEDICINE

Internal Medicine Residency Program

4 + 1 Block Structure

In June 2011, Temple transitioned an innovative ‘4+1’ block structure. Academic years are organized into ten 5-week blocks consisting of 4 weeks of a core residency rotation (electives, medicine wards, ICU, etc.), followed by a 1 week Ambulatory block. This will repeat throughout the year. You will work with a group of approximately 20 people (one-fifth of the residency program) during each of the 1 week Ambulatory blocks throughout the year.

During the 4-week section of the block, you will have no continuity practice sessions. All urgent clinical matters will be managed by you through the EMR or with the help of your colleagues who are in their Ambulatory week. This system provides a clear separation between everyone’s inpatient and outpatient duties. You are free to concentrate on the rotation you are on and do not have to worry about having to leave for your continuity practice. Alternatively, when you are seeing outpatients in your continuity practice, you will not feel preoccupied by caring for your sick inpatients in the hospital.

The 1 week Ambulatory block is divided in the following proportions: 5 half-days devoted to your general medicine continuity practice (one of urgent care), 1 half-day devoted to an ambulatory subspecialty experience, 1 half-day to work on your Quality Improvement project and 1 half-day learning to triage urgent ambulatory issues in the practice and 1 half-day to focus on patient outreach to improve health maintenance screening. Every morning from 8 a.m. to 9 a.m. you will meet for Ambulatory didactics and small group learning. You will work with one primary general medicine attending preceptor and two secondary general medicine attending preceptors through your three years in continuity clinic so that they can provide you with longitudinal feedback and get to know your patients that you see regularly.

Our 4+1 ambulatory structure has improved the overall real-world education of our residents and provide a clear separation between everyone’s inpatient and outpatient duties. The system allows for less fragmentation in care in the hospital while maintaining continuity of care in the outpatient practice. By providing regular contact with the Ambulatory continuity practice, this system has improved resident satisfaction and comfort with outpatient medicine.  Our innovative system reflects the fact that most of medicine takes place in an ambulatory setting.