In the Wake Forest Internal Medicine Program, our overarching goals are to promote a progressive growth of proficiency in Internal Medicine knowledge and clinical skills throughout the three years of training. Interns enter a collegial environment that fosters appropriate autonomy early on in training, with a high level of support and guidance. As residents progress through the curriculum, they develop as team leaders and are well-positioned to practice Internal Medicine independently upon graduation.
The HO-1 year is designed to offer a broad exposure to direct patient care in internal medicine. We have 13 four-week rotations during which interns are exposed to a variety of inpatient and outpatient experiences. Interns learn to manage patients on both general medicine and subspecialty inpatient services. Services include general medicine wards, cardiology, nephrology, hematology/oncology, leukemia, and neurology. Each intern experiences 1 block in the medical intensive care unit and at least 1 block in the cardiovascular intensive care unit. The remaining blocks are ambulatory rotations that may include experiences in the Emergency Department, a combined ambulatory rotation in geriatrics and palliative care, an acute care clinic, a VA clinic or an ambulatory elective that offers exposure to a variety of outpatient resources and subspecialty clinics. There is an option to elect two weeks of research during the ambulatory elective rotation. Each Categorical and Primary Care intern has a continuity clinic weekly. Clinical experience is complemented by a unique series of conferences and seminars, including Morning Report and Academic Half Days.
The HO-2 and HO-3 years are designed to facilitate the growth and maturation of the house officer into a skilled internist. Upper level residents transition to a role of leader and manager of the general medicine and subspecialty inpatient services noted above. Additional blocks include a geriatrics ward (the ACE Unit), 2 blocks of night float coverage, and the medical and cardiovascular intensive care units. The remaining blocks consist of subspecialty consults and clinic experiences, 1 block of combined general internal medicine consults and ED consults, private practice internal medicine clinic, general medicine acute care clinic, VA outpatient clinic, as well as Board Study and other various electives. Elective time allows tailoring of the upper level schedule to the interests of each resident. Most residents schedule at least one research block.
During the HO-2 and HO-3 years of the program, the schedule follows a general structure of alternating between 4-week ward services and 4-week non-ward rotations. Continuity clinics are not scheduled during inpatient ward services. Resident continuity clinics are organized into practices, and residents have concentrated clinic weeks during their non-ward blocks that include dedicated sessions for ambulatory quality improvement.
Our interdisciplinary 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. Upper levels supervise the care of 12-20 patients on the ward services. 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 cardiovascular intensive care unit is staffed by 3-4 interns, 2 upper level residents, 1 fellow, and 1 attending.)
Our intern call system consists of a block night float system for ward services, and a short block ( ≤ 6 nights) in the MICU and CVICU.
Our upper level call system consists of a night float that covers Sunday through Thursday and overnight call on Friday and Saturday. Upper levels on ward services cover the Friday and Saturday calls: a total of 2 overnight calls per ward block. In the intensive care unit, call is every fourth day in the MICU and CVICU.