Categorical training in internal medicine is a three-year program that provides comprehensive training for individuals interested in primary care or subspecialty careers.  First year experiences are intended to expose interns to the myriad of internal medicine disciplines and to help them establish competency in triage, resuscitation and management of a wide variety of patients in both the inpatient and outpatient environment.  In the second and third year, residents continue to mature in their clinical problem solving skills and develop skills in leadership, teaching, and systems based practice.  In our system of mentored autonomy, residents assume increasing responsibility for establishing accurate differential diagnoses, honing in on the correct diagnosis, using the literature to identify appropriate management strategies and coordinating increasingly complex care plans for our patients.  Throughout all years, faculty members are readily available for advice, coaching and supervision.   Experiences in the outpatient setting are combined with inpatient service to emphasize the skills needed to diagnose and manage the illnesses routinely encountered in primary and tertiary care settings.

We have begun implementing changes initiated through the Educational Innovations Project.  We believe that outpatient education can be improved by having residents dedicated solely to inpatient service or outpatient elective.  We also believe that residents need to learn how to work within a practice group model early in their training, as this is how most physicians function out in practice.  The residents are part of a 3 physician practice group, have a set group of patients, and alternate continuity clinic responsibilities every 3 months.  As such, residents have a dedicated continuity clinic month every 3 months and during this month have 3-4 half days of continuity clinic per week.  The rest of this month is dedicated to outpatient elective.

During elective and continuity clinic months, residents do not cover any overnight calls or have weekend obligations.  The months when the residents are on service are dedicated to inpatient care and they are not pulled away from ward duties at any time during the month to do continuity clinic.

Categorical Curriculum

PGY1	Number of Months
General Medicine Service	1-2
Subspecialty Medicine Service	3-4
MICU	1
Elective with Continuity Clinic (includes career development elective and VA elective)	4
Inpatient Consult Elective	1
Night Team	1
PGY2	Number of Months
General Medicine Service	1-2
Subspecialty Medicine Service	3-4
MICU	1
Emergency Medicine	1
Elective with Continuity Clinic (includes Junior Ambulatory Month)	3-4
Inpatient Consult Elective	1
Night Team	0-1
PGY3	Number of Months
Subspecialty Medicine Service	3-4
General Medicine	0-1
Electives with Continuity Clinic	4
Electives without Continuity Clinic	3
Senior Medical Consult (night)	0-1
Night Team	0-1