We moved to a new block system in July 2014. Let me explain to you what the 4+1 schedule is, and why it’s good.
4+1 Frequently Asked Questions
* What did we previously have?
Each resident did 4 weeks of a rotation (e.g. floor, ICU, cardio, elective.. etc). Then he/she moved on to do another 4 weeks of a rotation, then another one … etc. There are 52 weeks per year, hence there are 13 blocks per year. Clinic was previously half a day on selected weeks (no clinic on ICU or selected CCU days.)
* What is 4+1?
With 4+1, each resident now does 4 weeks of a rotation (e.g. floor, ICU, cardio, elective.. etc). Then he/she moves on to do 1 week of ambulatory (clinic week). NO more clinics when you’re on the floor, unit or elective.
* How does it work?
A major concept to make this change is the Five Staggered Cohorts.
Residents are divided into 5 groups (called cohorts). It’s like having 5 smaller residencies, instead of one huge group. To provide continuity in patient care, the cohorts are staggered by 1 week. Below is an example of 5 residents who will be doing DRH Floor. The resident on the Red Cohort finishes her floor rotation at the end of week 4. She signs-out to her colleague from the Blue Cohort and she goes on to do a week of ambulatory. The Blue Cohort resident finishes on week 8 and signs out to his colleague from the Grey Cohort. The cycle repeats itself when the Yellow Cohort resident signs out to the Red Cohort again.
* Why is this good?
- Resident’s don’t have to keep struggling to go to clinic and worry about the floor at the same time.
- No need to find coverage for your patients when you go to clinic. No need for Day float at HUH.
- Easier to figure out days off during rotations, as clinic is not an issue.
- More time in clinic improve ambulatory training to comply with ACGME recommendations.
* What about elective time?
You will spend at least 24% of your training on elective rotations. You will also get a chance to choose some of those electives. Requests are accommodated as much as possible.
* One whole week of clinic? I don’t want to do AM and PM clinic for a whole week!
The +1 part of the schedule includes some clinic days, possibly optional subspecialty clinic days, reserved time for research elective and QI projects, jeopardy coverage, and days off.
* OK. What’s the catch?
- We already have a complicated scheduling system. With 4+1, it will be more challenging. Rotation switches have to occur within each cohort, not between residents in different cohorts. Scheduling will be more rigid, and requires a lot of planning in advance.
- You cannot take vacation on +1 clinic weeks.
- This change will affect other departments, divisions and external rotators. 4+1 scheduling requires a major cultural change.