3+1 Resident Block Schedule (AIRE Study)
The Pediatrics Residency Program at UTCOM-Chattanooga transitioned to an X+Y (3+1)
immersion schedule on July 2019. In this format, each resident spends three weeks
on a core or block rotation followed by one week of ambulatory pediatrics. This scheduling
format is part of a pilot project (called AIRE) approved by the ACGME Pediatric Residency
Review Committee and is implemented at 15 pediatrics programs around the country.
The goal of this scheduling format is:
- Improved continuity in pediatric resident clinics
- Less conflict between inpatient and ambulatory responsibilities
- Improvement in resident wellness, leading to less burnout
- Improved patient and resident satisfaction
During core rotations (inpatient/hospital medicine, subspecialty electives, PICU,
etc), residents' time is devoted to that rotation. Clinical duties and educational
efforts of core rotations are not interrupted for residents to attend continuity clinic.
Sample Block Rotation (in weeks)
Ambulatory/ Continuity Clinic
Likewise, during the ambulatory weeks, residents can focus strictly on general outpatient
pediatrics. Residents spend four half days in the general pediatric continuity clinic
and three half days in the acute care clinic. Additional time during the ambulatory
weeks include an educational half day, and one half day of Community Advocacy/Scholarly
Activity (CASA time) to work on research or quality improvement projects and participate
in community service and advocacy projects. Residents remain with the same cohort
of residents for the ambulatory week for the entire year, allowing the development
of a "Group Practice" model and optimizing teaching and learning. Continuity clinic
didactics occur once a week with interactive sessions developed and presented by the
faculty from the Division of Ambulatory Pediatrics.
The children in continuity clinc are followed for the entire duration of the resident's
training. Well childrens are followed for health promotion visits, children with acute
illnesses are managed, and children with chronic illnesses are followed concurrently
with pediatric subspecialists. The patients are seen by their regular resident physician
for as many of their healthcare visits as possible. This experience simulates the
usual practice of private pediatricians. It also helps the resident learn longitudinal,
on-going care of children with acute and special health care needs in a way that no
month-long rotation can provide. Residents follow 150+ families through the continuity
clinic during residency. Our general pediatric clinic is proud to care for a culturally
diverse patient population with an extensive list of pathology, which provides our
residents with a well-rounded and robust educational experience.
Sample Ambulatory Week
| |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
| Morning |
Continuity Clinic |
Acute Care Clinic |
Continuity Clinic |
Acute Care Clinic |
Acute Care Clinic |
| Afternoon |
Continuity Clinic |
Acute Care Clinic |
Continuity Clinic |
Independent Study |
Didactic Lecture
Block
|
Intern Bootcamp
One unique aspect of the 3+1 schedule at UTCOM is the inclusion of an initial four-week
bootcamp month. New interns spend one week in each of the key areas of the hospital:
inpatient wards, night float, newborn nursery and ambulatory clinic, allowing interns
to understand the workings of the entire system beginning with the first month of
their residency. *In the color graphic above, the weeks of bootcamp are counted as
part of the clinical rotations, rather than their own bootcamp rotation.
Didactic Teachings
| |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
| Morning |
Morning Report |
Board Review or
Ambulatory Lecture
|
Grand Rounds |
Morning Report |
|
| Afternoon |
|
|
|
|
Didactic Lecture
Block
|
