The four plus one system represents an innovative scheduling system that maximizes resident clinical learning while respecting work life balance and wellness. The system is claimed by residents and attendings at large University programs such as Tulane and Harvard. The system has also received praise from our own program residents. .
What is the “4”?
Four represents the traditional four week rotation. For four consecutive weeks, you will participate in traditional rotations, including electives. These weeks are free of interruptions, including continuity clinic and didactic lectures. The rounding team remains together to enable uninterrupted inpatient care. This helps to foster a “team” environment and sense of camaraderie.
During these blocks, we conduct a resident run, attending supervised, Noon Report. The Noon Report is attended by all in-house residents and most on out-patient rotations. This one hour conference features an intern presenting a patient from the floor or a particularly interesting case, followed by a Chief Resident led discussion.
What is the “+1”?
The one is perhaps the residents’ favorite part of the system. During this week, all residents are free from hospital & floor duties. Yes, no wards. Each morning at 07:30, lectures begin from all specialties, with each hour as a different topic. Lecturers vary from attending internists, in-house specialists, specialists from DMC main, or other regional experts. These mornings also house MKSAP review sessions and occasionally workshops.
Afternoons are spent in continuity clinics. Uniquely, Huron Valley residents have a low attending-to-resident ratio in private clinic settings. This allows for considerably more one-on-one teaching, without compromising continuity. It also allows residents interested in private practice to learn about the business of medicine and running a practice. Our residents see considerably more patients in their clinics, and have low “no show” rates.
The “+1” weeks offer intensive didactics, immersion in clinic, and a refreshing break from often grueling floors. Although brand new to Huron Valley, the “4+1” has been a great success.
What else about the “4+1”?
Because the “+1″s constitute a total of ten weeks, HVSH IM residents have only ten, four week, rotations per year. This is at the expense of additional electives, but so far, the benefits have far outweighed this cost. Additionally, because the number of blocks is decreased, the number of residents per team increases, again fostering an excellent rounding atmosphere in a small internal medicine program.
Unlike its allopathic counterparts, the HVSH “4+1 System” has only one cohort of residents. This means that all internal medicine residents are on the “+1” week together, and the floors are staffed solely by attending physicians, physicians assistants, and traditional rotating interns based at HVSH.
What will my schedule look like?
July 1st will always begin a four week rotation block. The following week will be the “+1”. Effectively, it is a five week scheduling scheme x 10. The final two weeks are offered as an elective. Although medicine residents typically begin residency on a medicine service, there is no particular order to the ten blocks.
During the “+1”, you will arrive for lecture at 7:30 am, where four lectures follow (with interspersed breaks). Residents will break to get lunch, and eat together over the Noon Report. After the case finishes, residents drive to their continuity clinics (typically five miles or less from the hospital). The day is finished when all clinic patients are seen. For scheduling purposes, Fridays are reversed.