3+1 Schedule Overview

Most residency programs have 4-week rotations, culminating into 13 block rotations for the year with clinic time taken out of the wards and consult time primarily. Given our focus on resident education and the need to train in a new and ever-changing healthcare environment, we made an innovative change in how we deliver education and training.

  • Our core rotations – wards, ICU and some consults – are almost always 3 weeks in duration, followed by a week-long clinic rotation.
  • The week-long clinic rotation contains primary continuity clinics, as well as other subspecialty clinics such as Cardiology, Pulmonary, ID, GI, Renal, Hem/Onc, etc. 
  • The second and third year residents also have the option of choosing a secondary continuity clinic, usually focused on post-residency career plans.
  • The week-long clinic block also has two half-day educational sessions that focus on a number of topics, including pre-clinic curriculum, practice management/medical home curriculum, and EBM.
  • Residents almost always have the weekend off prior to starting a clinic week. This allows for recovery time on a consistent basis, every 3 weeks.

This is an innovative schedule design that allows many exciting educational opportunities to occur:

  • Clinic is not inserted into rotations such as wards and consults; thus, it allows the time needed to learn on those rotations without being pulled elsewhere.
  • Clinic is a valued rotation and, since most physicians' lives are spent in the clinic (subspecialist and generalists), it is important to focus time in this area instead of inserting it into different rotations where the resident is unable to completely focus on the clinic experience.
  • The clinic week allows dedicated time to learning outpatient medicine in a consistent and focused manner.
  • The residents are divided into firms so the patients have consistent care by a group of physicians.  The firm system also allows the residents to know exactly which residents will be in clinic on the following + 1 week, which facilitates a more organized and patient focused transition of care.
  • Firms also allow residents to develop a true group practice model approach to outpatient care.
  • Three weeks of a rotation appear to be an ideal amount of time to spend on any given service.
  • Residents are not "pulled away" to clinic when on the wards and consult service; thus, improving continuity of care, transitions of care, and overall consistent learning from patients, the team, and faculty physicians.
  • There is now a guarantee of having a weekend off at the end of 3 week rotations and before beginning the clinic week which allows recovery time before beginning the clinic week.
  • We have developed as much symmetry as possible for wards in each system in order to reduce transitions for residents and interns.
  • Both systems function in a drip model approach; our prior system was a bolus model which we felt was not as conducive to learning with the highs and lows of patient numbers.The drip model approach also allows more consistent care of patients over time which is important in the era of duty hour restrictions.
  • Both systems have face to face sign-out between the teams and night float with an attending present for morning sign-out, which decreases transitions of care, improves overall quality of transmitting information, and provides feedback on admissions from the night float team.
  • Elimination of educational and emotional pull of clinic during wards
  • Restructuring of educational conferences to improve process and flow of care for the patients and the teams (see educational conference changes section).
  • Increased opportunity for coordinated case management rounds with all members of the healthcare team (physical therapy, pharmacy, nutrition, social work, nursing)
  • Please click here to view information on the University Wards
  • Please click here to view information on the VA Wards
  • Please click here to view information on the University MICU
  • Please click here to view information on the VA ICU

Goals

  • Augment knowledge and skills of ambulatory medicine through clinical practice, and didactic and interactive learning experiences
  • Experience outpatient team based care while learning practice management
  • Enhance clinical competency with the goal to become an independent outpatient practitioner in Internal Medicine

Three main components of the +1 week:

  • Continuity clinic at (designated) primary continuity clinic site
  • Other ambulatory clinical experiences
  • Tuesday/Friday educational seminars (including Evidence-Based Medicine)

Intern +1 week

Depending on the location of your primary clinic (VA or OHSU/Old Town), the schedule will vary on a 3-month rotating basis.

  • There are a total of three "+1" rotations offered in the R1 year: each rotation is for 3 months (or 3 "+1" weeks). All weeks will include 3-5 half-days of primary care continuity clinics, some of these being VA Interim clinic or OHSU Propel clinic.
    • The VA general Ambulatory +1week rotation includes experiences in VA Derm, ENT, Geriatrics Assessment, and Optometry clinics + continuity and VA Interim or OHSU Propel clinics.
    • The OHSU general Ambulatory +1 week rotation includes OHSU Geriatrics Consult clinic, HIV, MedPsych, and Women's Health + continuity and VA Interim or OHSU Propel clinics.
    • The Chronic Illness Management (CIM) +1 week is a 6-month (or 6 "+1" weeks) long rotation which includes CIM at OHSU and VA, with dedicated didactic/project time + continuity and VA Interim or OHSU Propel clinics.
  • There are two seminars (Tues and Fri) that address numerous topics, including screening, immunization, panel management, HTN, DM, occupational medicine, etc.  All of these topics are framed in an Evidence-Based Medicine approach.

Resident +1 week

  • Depending on the location of your primary clinic (VA or OHSU/Old Town), the schedule will vary on a 6-month rotating basis.
  • There are a total of ten "subspecialty +1" rotations offered in the R2/R3 year.
    • Residents will rotate on four "+1 subspecialty rotations" over 2 years
    • Each rotation is 6 months (or 6 "+1" weeks) long and relates to a specific subspecialty experience.
    • Subspecialty topics include – Allergy, Cardiology, CIM, Geriatrics, Gastroenterology/Hepatology, Hematology/Oncology, Infectious Disease/HIV, Palliative Care, Pulmonology, Nephrology, and Rheumatology clinics.
  • All weeks include 3-5 continuity clinics and may include a second continuity clinic experience if chosen over priority ranking of the subspecialty clinic rotation assignments.
  • There are two seminars (Tues and Fri) that go over numerous topics including screening, immunization, panel management, HTN, DM, occupational medicine, etc.
  •  All of these topics are framed in an Evidence-Based Medicine approach.

Goals

  • To increase your knowledge of the nature and extent of health disparities and health system gaps in our community and country
  • To increase your sociocultural awareness and expand your appreciation for the impact of the social determinants of health
  • To improve knowledge, skills and attitudes toward indigent health and health care through exposure to clinical practice and relationships in a safety net clinic
  • To provide you with the skills and capacity to feel empowered to address health care for indigent/unstably supported individuals and to address health system and social system gaps that these individuals encounter
  • To better understand addiction and addiction treatment options
  • To allow you to have additional continuity clinics on a weekly fashion

You will rotate through a variety of sites throughout the Portland metro area, including Central City Concern (a large nonprofit agency serving single adults and families in the Portland metro area who are impacted by homelessness, poverty and addictions). You will also visit patients in their homes, accompanied by a member of a Home-Based Primary Care team from the VA. For some of these rotations you will be an observer and for others you will be a provider. Each opportunity has been individually selected to give you a broad exposure to the care of the underserved in our community.

Additionally, through experiential activities, readings, reflective writing and group discussion, you will have the opportunity to explore and reflect on topics including professionalism, your sense of purpose in medicine, health care delivery issues, bias, and social justice.

All IM subspecialties are offered to residents

  • Cardiology, Endocrinology, GI, Hematology, Infectious Diseases, Oncology, Pulmonary, Renal, and Rheumatology, in addition to Palliative Care and Pre-Operative Medicine
  • Over the course of training, residents will have the opportunity to work in most subspecialties.
  • We strongly encourage residents to diversify his/her education by rotating in all specialties and avoiding too much focus on one subspecialty of interest.
  • Most consult rotations are 1-3 weeks in duration. The range is due to a number of scheduling and personal needs.
  • If you are scheduled on a consult rotation for 2 or more weeks, you will be asked to work the weekend in-between.
  • There are no continuity clinics during consults, which results in residents being more fully present, thereby enhancing continuity of care and increased teaching and consistency of presence for the team.
  • Healthcare has changed, and so the way we learn and work needs to change.  We noted for some time that much of the work of the wards, consult services, and ICUs occurred in the morning, yet we put many teaching conferences in the morning hours and that directly conflicted with patient care.
  • Noon Report, formerly called Morning Report, was moved to 12:00pm.

Noon conference

  • This conference is held on Tues, Thurs, and Fri.
  • Tues and Thurs offer core curriculum content throughout the year.
  • Friday conference includes QI, CPC, Fireside Chats with the Program Director, and other curricular offerings.

Grand Rounds

Held every Tuesday at 8:00am  

  • You will receive a 5-week elective in your second year, and a 3-week elective in your third year; to plan other clinical activities suited to your needs.
    • International electives can occur only once during the two-year period due to institutional/risk management issues.
    • Our current international site is Botswana in partnership with Beth Israel/Harvard