College of Medicine

Curriculum

Curriculum

The curriculum offers a broad and balanced experience in both ambulatory and inpatient settings that prepare the graduate for a career in general internal medicine, either primary care, hospital medicine or to continue training in a subspecialty. By the end of the three-year program, graduating residents leave as skilled and confident practitioners in the care and treatment of major acute and chronic diseases.

Full-time conduct daily rounds on admitted patients and supervises residents in the ambulatory clinic and the hospital. The faculty provides oversight in patient care, but also will allow autonomy as appropriate. Residents are responsible for the work-up of patients, for writing orders, and for performing diagnostic procedures and therapy. Additionally, there are daily conferences and teaching rounds in the various medical subspecialties. The collaboration between FSU and TMH provides a foundation for transformational learning and allows residents to have innovative and inspirational experiences. Since we are a smaller program, you will receive full attention from the faculty.

4+1 Schedule

The program will follow a 4 + 1 schedule, which will consist of 4 weeks of rotations followed by 1 week of protected clinic time. Morning and afternoon clinic sessions will begin at 8:00 AM and 1:00 PM with a clinic huddle, respectively. A clinic day finishes at ~5:00 PM. During the clinic session, residents will see patients from their panel of patients, as well as see acute patients and patients requiring early follow-up visits from other colleagues’ panels.

During the three-year program residents must attend a total of at least 400 half day clinic sessions (10 months). During their week in clinic, residents have:

• A total of eight for interns, and six for senior’s continuity clinic sessions
• Seniors have two clinic sessions with a sub-specialty clinic of their choice
• Option for residents who wish to pursue a career in primary care, to use one of the sub-specialty clinic sessions to see more patients either in IMR or a private practice.
• One clinic session will be dedicated to working on the completion of required MKSAP assignments, PEAC modules, upcoming didactics, going to appointments, running an errand or simply to catch up with work.

Medicine Night Float Team

Our program has no “on-call” duties. A night float system for both admissions and floor coverage is present from Saturday night to Saturday morning. The night float team admits patients from 7:00 PM until 7:00 AM, then attends a supervised transition of care. Patients are admitted to inpatient floors and the ICUs. During the day the admitting team is comprised of one senior and one intern that admits until 7:00 PM. Each intern will only be admitting every 4th day. On a non-admitting day each intern may receive transfers from night float.

Inpatient Workflow

Residents rotate on the inpatient primary service throughout their time in residency. We have three teams, to start, Garnet and Gold, comprised of two PGY-1 residents that are supervised by a PGY-2/3 resident with oversight from one of our clinical faculty attendings. Our Blue team is a senior only team consisting of two senior residents (each will carry up to 10 patients each). Teams pre-round in the morning, typically at 6:00 AM and attend the sign-out of night transfers at 7:30 AM with the attendings. Morning Report is at 8:15. From 9:00-11:00 AM the teams will round, which takes many forms including table and bedside rounds. Each team will complete orders, plan discharges, and write their progress notes from 11:00 AM until 12:00 PM, where we pause for our daily Noon Conference. Following conference, residents will follow-up on pending items and ensure completion of progress notes and discharge summaries prior to finishing for the day. Once the work is completed, residents are free to leave with their pagers to manage any small items from home.

The service takes admissions twenty-four hours per day, seven days per week. Admitting teams rotate amongst the team members. During the day, one PGY-2/3 and one PGY-1 will admit to their team. PGY-1s admit every fourth day, and PGY-2/3s admit every other day. Day admissions go through 6:15 PM to allow the team to wrap up patient care and be able to leave by the end of nightly sign-out at 7:00 PM. A dedicated Night Float service composed of one PGY-2/3 and one PGY-1 will admit from 7:00 PM to 6:15 AM, with the night team signing out overnight transfer patients admitted to the service to the teams under clinical faculty attending supervision. We strictly follow ACGME requirements and maintain that no PGY-1 should touch more than ten inpatient patients per day in the clinical setting, though our census will rarely reach such levels. We aim to have PGY-1 residents carry seven to eight patients at most at a time. Faculty is available 24 hours per day, seven days per week to assist residents in clinical decision making.

Point of Care Ultrasound

Point of care ultrasound (POCUS) is growing in both inpatient and outpatient settings as a diagnostic tool. Our aim is to teach POCUS through a three-tiered curriculum following the continuum of education during residency:

1. Build foundational knowledge of the technology using SonoSim applications
2. Evolve this knowledge into application within clinical work at the bedside using our stock of POCUS probes and tablets
3. Provide a track toward proficiency in POCUS to the residents by completion of postgraduate training through the development of their individual POCUS image portfolio.

The tools to perform this are through core faculty development using the Society of Hospital Medicine’s (SMH) POCUS certification program, providing training for residents with SonoSim modules and cases with built-in knowledge assessments.

Clinical Experience and Educational Hours

The program is in full compliance with ACGME work hour regulations averaging in the low to middle 50th hours. To help maintain patient safety and resident wellbeing, we strictly monitor the clinical experience hour regulations. The program follows a soft cap of 16 patients per team consisting of 2 interns and 1 senior with medical students. Our hard cap is 20 patients per team because we believe that teaching and learning needs time to do so.

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