The HO-1 year is designed as a broad exposure to direct patient care in internal medicine.  We have 12 one month rotations, 8-9 of which are inpatient experiences.  Interns will be exposed to not only general medicine wards, but also subspecialty services, including cardiology, nephrology, hematology/oncology, and neurology.  Each intern will experience 1 month in the medical intensive care unit and 1 month in the coronary care unit.  The remaining 3-4 months are ambulatory rotations including, 1 month in the Emergency Department, 1 month in combined ambulatory geriatrics and palliative care, 1 month in an acute care clinic and 1 month in a variety of subspecialty clinics.  Clinical experience is complemented by a unique series of conferences and seminars. 

The HO-2 and HO-3 years are designed to facilitate the growth and maturation of the house staff into skilled internists.  There are 12 required inpatient months distributed over the second and third years.  These months include rotations on general medicine and subspecialty wards, a geriatrics ward, 2 months of night float coverage, and the medical intensive care unit and coronary care unit.  The remaining 12 months consist of 5 months of subspecialty consults and clinic experience, 1 month of general internal medicine consults, 1 month of combined ED and private practice internal medicine clinic, and 4 months of electives.  Upper level residents are given the unique opportunity to create their own schedules within this framework with help from the Assistant Chiefs of Medicine.  This feature of our program allows for tailoring of the upper level schedule to the interests of each resident.  Most residents schedule at least one research month. 

Our ward teams consist of 2-3 interns, 1 upper level resident, and 1 attending, as well as medical students, acting interns, clinical pharmacists, nursing case managers, and other helpful ancillary staff.  The medical intensive care unit is staffed by 2 teams consisting of 2-3 interns, 2 upper levels, 1 fellow, and 1 attending each.  The coronary care unit is staffed by one large team consisting of 4 interns, 4 upper level residents, 1 fellow, and 1 attending.

On the wards, our intern call system consists of a night float that covers from 6pm to 8am Sunday through Thursday and traditional overnight call on Friday and Saturday. Interns have overnight call 2-3 times/month.  On the intensive care unit months and neurology wards, call is every fourth day.  Interns manage between 5 and 10 patients and admit no more than 5 patients and 2 transfers in a 24 hour period.

Our upper level call system consists of a night float that covers 6pm to 8am Sunday through Thursday and traditional overnight call on Friday and Saturday.  Upper levels on ward services cover the Friday and Saturday calls for the month, which results in a total of 2 overnight calls per ward month.  On the intensive care unit months call is every fourth day.  Upper levels manage 15-20 patients on ward services.