The HO-1 year is designed as a broad exposure to direct patient care in internal medicine.  We have 13 four week rotations, 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 block in the medical intensive care unit and 1 block in the coronary care unit.  The remaining 4 blocks are ambulatory rotations including, 1 block in the Emergency Department, 1 block in combined ambulatory geriatrics and palliative care, 1 block in an acute care clinic and 1 block in a variety of subspecialty clinics.   There is an option to have two weeks of research during the ambulatory elective rotation.  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 officer into a skilled internist.  There are 11 required inpatient blocks distributed over the second and third years.  These blocks include general medicine and subspecialty wards, a geriatrics ward, 2 blocks of night float coverage, and the medical intensive care unit and coronary care unit.  The remaining 15 blocks consist of 6 subspecialty consults and clinic experiences, 1 general internal medicine consults, 1 combined ED and private practice internal medicine clinic, 1 ambulatory general medicine and 6 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 tailoring of the upper level schedule to the interests of each resident.  Most residents schedule at least one research block. 

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 each consisting of 2-3 interns, 2 upper levels, 1 fellow, and 1 attending.  The coronary care unit is staffed by one large team consisting of 4 interns, 3-4 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 and neurology ward, call is every fourth.  Interns manage between 5 and 10 patients and admit no more than 5 patients and 2 transfers in a 24 hour period.