Overall Structure

The interns have a “2+2” structure throughout the year, where they have a two-week inpatient block, followed by a two-week block of ambulatory clinics, elective time, or back-up, known as “plus-two” blocks. For part of the year, they will have back-to-back inpatient blocks followed by a “plus-two” block (“2+2+2”), but these inpatient blocks will be in different subspecialty areas to experience new learning environments. The inpatient experiences include ward rotations at Tufts Medical Center on the Cardiology (General Cardiology/Electrophysiology and Advanced Heart Failure), Nephrology, Pulmonology, Infectious Diseases, Hematology/Oncology, Gastroenterology, Bone Marrow Transplantation/Leukemia, General Medicine services at Tufts (including General Medicine and Geriatrics) and General Medicine at Newton Wellesley hospital.

In general, interns admit on long-call days until 7 pm approximately every fourth day during most ward rotations. There are no 24-hour shifts. Interns also get several weeks of intensive-care time in both the medical and cardiac ICUs. When rotating on night float, interns are responsible for cross-covering already admitted patients, and do not admit new patients overnight.

During “plus-two” weeks, interns are scheduled for their continuity primary care clinics and elective time, where they can request to rotate through any of our consult services or subspecialty clinics. All interns participate in a 1-week Patient Safety/Quality Improvement rotation, and they also have the chance to rotate in our health-informatics or health disparities electives. We have a dedicated back-up system, where each intern will be on back up for 3-4 weeks. During this time, they come in for morning reports and noon conferences but have no other clinical responsibilities unless called in to cover a co-intern on service or in clinic.

Intern year starts about ten days before July 1 to facilitate the house staff transition. Interns have four weeks of vacation, one of which is scheduled for the last week of intern year.

The second year focuses on increased graded autonomy, becoming a leader on the team, and further exploring career and professional interests. The second year is broken down into two-week blocks and typically follows a “2+2” schedule.

Inpatient rotations include inpatient specialty ward services, intensive care time and night rotations. During the second year of residency, residents spend more time in the intensive care units, allowing them to further grow their clinical reasoning and problem-solving skills for some of the sickest patients in the hospital. Residents will typically have 3-4 ICU blocks over the course of the year, including at least one block spent in the cardiac ICU where residents gain exposure to experience managing mechanical support devices like Impella and VA-ECMO. This is a unique Tufts experience.

Ambulatory rotations include primary care continuity clinics, specialty clinics and consults. During subspecialty clinics, residents get additional facetime with subspecialty attendings, allowing them to further connect for fellowship letters and research projects. During continuity clinics, residents have more time to improve their skills as a primary care physician and continue to build their therapeutic relationships with their patient panel. The schedule also offers time for research or other non-medical electives to allow for exploration in non-traditional medical career paths.

The third year also consists of a “2+2” schedule and is designed to complement the first two years of intensive training in inpatient wards and critical care medicine. Third year offers residents more opportunities for electives and ambulatory medicine. Like the prior two years, there is a dedicated night float rotation where residents admit patients to the hospital and supervise night float interns.

Residents have 3-4 weeks of dedicated back-up where they do not have any clinical duties unless they are called in. Third year residents can take up to 2 weeks of dedicated research time to complete any pending research projects before applying to fellowship.

Ambulatory time, like second year, consists of primary care continuity clinic blocks, sub-specialty clinics and consult services. All senior residents must complete a rotation in our emergency department, on the medicine consultation service at Tufts and with the neurology department at Newton Wellesley Hospital. All residents before graduation in their second or third year will also complete an outpatient elective in nephrology, endocrinology, and rheumatology.