The 3+1 Model
The UVA Internal Medicine Residency Program transitioned in 2014 to a 3+1 model. This change came about after much thoughtful planning by several generations of chief residents. Our academic year is divided into 13 four-week blocks: each resident has a three-week block rotation (either an inpatient ward/ICU rotation or a three-week elective) followed by an ambulatory week (the “+1 week”). This separates inpatient and outpatient time for our residents to focus in each domain.
During three-week inpatient rotations, residents rotate through General Medicine, the Medical Intensive Care Unit, Hematology/Oncology, Acute Cardiology, and the Coronary Care Unit. Our second year residents also do an Emergency Medicine rotation. As above, the time spent on an inpatient service is completely devoted to education and patient care on the inpatient service without interruption for clinics in the afternoons. For categorical interns, one of the thirteen 3-week blocks is available as a consult elective, while the remainder are spent on inpatient time. For PGY2s and PGY3s, 4-5 of the 3-week blocks are used for elective rotations each year, while the remainder of the thirteen 3-week blocks are inpatient rotations.
Every fourth week is the ambulatory +1 week, which consists of 4-5 half-days in the internal medicine continuity clinic, University Medical Associates (UMA); 3-4 half-days in an elective subspecialty clinic to augment exposure to outpatient subspecialty medicine; 1 half-day of protected administrative time to keep up with documentation, evaluations, or personal appointments; and 1 half-day of protected ambulatory didactics and seminars. After the education half-day (pre-COVID), time is set aside for the plus-one groups to get lunch together before heading back for afternoon clinic. The +1 week is a nice break from the busy inpatient service and allows residents to be focused on their clinic patients and education. At the end of the +1 week, every resident has a guaranteed “golden” weekend. Our goal with the 3+1 system is to allow our residents to be 100% devoted to the task at hand, whether in the inpatient or ambulatory setting, and to optimize the educational experience.