Schedules and Rotations
How it looks: 4+2+2
Our resident schedule is intentionally designed around clinical and educational continuity to optimize both your learning experience and patient care delivery. We recognize that fully adjusting to a new rotation and building strong team cohesion—both vital for resident development and effective patient management—requires dedicated time. Therefore, our core medicine ward and critical care rotations are four consecutive weeks in length, providing ample opportunity for immersion. All other rotations are structured as two-week blocks.
Key Rotations
Medicine Floors and ICU rotations are scheduled with intern and resident in the same four-week block with attendings on a weekly cycle to maximize education and team continuity.
Observation Unit: The observation rotation will staffed by one PGY2 and one PGY1 will work on this service, like a floor rotation, under the supervision of a hospitalist attending. This rotation is structured to allow house staff to have more opportunities to “admit” and manage patients of lower acuity.
Ambulatory: Ambulatory, including continuity clinic, will be scheduled such that residents will have continuity clinic two consecutive weeks out of each 8-week block (6+2 model), for a total of 12 weeks per year. Addiction medicine is covered during this rotation.
Co-Management: At NWH all admitted surgical patients are co-managed by a medicine team. Third year residents will manage this service with a supervising attending. The residents will also cover consults for non-surgical services.
Subspecialties/Electives: Will be scheduled based on the interest and perceived needs of the resident. Time spent in an outpatient setting varies from 25% to 75%. Available electives include Cardiology, Gastroenterology, Endocrinology, Hematology/Oncology, Infectious Diseases, Nephrology, Pulmonary, Rheumatology, Palliative Care, Neurology, Radiology, Radiation Oncology, Pain Management, Pathology, Sports Medicine, and Research.
Typical Day on inpatient in the first year:
7:00 AM – Night float signs out to day team with Nocturnist oversight. Night float goes home.
8:00 AM – Teaching attending checks in with intern about patients – just like a senior resident would do
9:00-10:30 AM – Walk/bedside rounds with Attending and two interns that make up the team
11:30 – 12:30 – Interdisciplinary rounds with entire care team
1:30 - 2:15 PM (Monday & Thursday) – Afternoon Report
1:00 - 4:00 PM (Wednesdays) – Academic half day – Attendings cover patient care while interns learn
4:30 - 5:00 PM – Sign out to cross-cover team and then go home if not cross-cover team – Attending oversight
5:00 - 9:00 PM – Cross-cover intern manages resident floor patients – Call attending is in house support
9:00 PM – 7:00 AM – Night float covers admitted teaching patients. Can help with admits if time allows, but primarily an Attending function.
How we cover “call” and nights
Ensuring continuous resident coverage for our patients is crucial for both quality patient care and resident education. Minimizing interruptions in care by unfamiliar residents is equally important, while remaining mindful of resident work hours.
Our solution utilizes a two-inpatient-floor team system, with each team consisting of one senior resident and two interns. To ensure consistent patient coverage and minimize handover disruptions, we employ a system of intern “swing” cross-coverage. Two senior residents remain on-site to assist their assigned interns before they leave for the evening. During the week, a dedicated Medicine Admissions Resident (MAR) provides additional support to the swing intern throughout their shift. On weekends, one of the floor residents serves as the swing resident, providing senior support to the intern. This system, coupled with a minimum of two hospitalists/nocturnists on-site at all times, ensures ample in-house support for our residents. Instead of relying on colleagues for guidance, interns and other residents have ready access to attending physicians for immediate answers.
Night Float is a two-week rotation (6 days/week) involving two interns and one resident (except Fridays, when the MAR fills the resident role). The interns manage already admitted patients, while the resident handles new admissions.
Rotation Weeks by Program Year
PGY-1:
Wards: 12 weeks
Critical Care: 4 weeks
Night Float: 6 weeks
Observation Unit: 4 weeks
Ambulatory: 12 weeks
Subspecialty/Elective: 10 weeks
Vacation: 4 weeks
PGY-2:
Wards: 8weeks
Critical Care: 4 weeks
Night Float: 6 weeks
Observation Unit: 4 weeks
Ambulatory: 12 weeks
Subspecialty/Elective: 12 weeks
Palliative Care: 2 weeks
Vacation: 4 weeks
PGY-3:
Wards: 8 weeks
Critical Care: 4 weeks
Night Float: 4 weeks
Emergency Department: 4 weeks
Ambulatory: 12 weeks
Subspecialty/Elective: 12 weeks
Co-Management: 4 weeks
Vacation: 4 weeks