This three year program offers direct patient care responsibility under close full time faculty supervision in an academic setting. The goals of the program are to optimize house officers' clinical skills, knowledge base, problem-solving abilities, clinical judgment and patient interactions. Many of the rotations, both inpatient and outpatient, are in our subspecialty ward services which allow trainees to learn each subject area from an expert in that field.
The vast majority of the house staff rotations are at Tufts Medical Center where trainees rotate through the medical subspecialties as well as the ambulatory care practices. Additionally, house staff have several dedicated primary care rotations at Tufts Primary Care Boston (our internal medicine practice). In these continuity clinics, interns and residents follow their own patients, many of whom are recruited from their inpatient services.
Each trainee also spends time rotating in a community hospital, Newton-Wellesley Hospital. In this setting, house officers work with trainees from MGH and are exposed to community-based medicine and a diverse case load.
The overall structure of each training year along with the time allotted for the typical types of rotations per year is described below. In addition to the rotations listed below, we offer subspecialty inpatient and outpatient electives and research or teaching electives depending on each resident’s interest and career goals during all three years.
In conjunction with their residents and attendings, interns have primary responsibility for patient care. The interns have thirteen 3-week inpatient blocks over the course of their year. We have a “3+1” structure for interns so that each three week inpatient block is followed by a one week block of ambulatory and/or elective time. The inpatient experiences include ward rotations at Tufts Medical Center on the Cardiology services (including Cardiac Care Unit), General Medicine Service (at Tufts Medical Center and at Newton Wellesley Hospital), Nephrology, Medical ICU, Pulmonary, Infectious Diseases, Geriatrics, Hematology/Oncology, Gastroenterology, and Bone Marrow Transplantation/Leukemia Services. Continuity clinics are not scheduled while interns are on ward rotations. Additionally, interns have night float rotations where they are only responsible for cross-covering patients who are already admitted to the hospital. In general, interns are on long call until 8 pm every fourth night during these rotations. There is extensive night float coverage on all rotations.
Interns have flexibility in requesting rotations they are interested in for their “+1” week. They also have scheduled continuity general medicine clinics during this time. All interns rotate through a 1-week Patient Safety/Quality Improvement rotation. Examples of other opportunities include being on the Inpatient Hyperglycemia Service, Addiction Medicine Service, or inpatient medicine subspecialty consults.
The internship starts approximately ten days prior to July 1 to facilitate the transition of the house staff. At the end of the year, the interns will have 7 days off prior to starting their residency.
Second Post Graduate Year
The second year is broken down into three-week blocks. Roughly two-thirds of these are inpatient rotations while the rest are ambulatory rotations. Residents generally do not have back-to-back inpatient ward rotations. At Tufts Medical Center the inpatient rotations include: Cardiology, Pulmonary, Infectious Diseases, Gastroenterology, Renal, Hematology/Oncology, and the Medical Intensive Care Unit. There is one rotation in the second year in the Newton-Wellesley Hospital intensive care unit as well. There is extensive night float coverage on all inpatient rotations; these residents admit patients to the hospital and supervise night float interns.
Second year residents have a substantial amount of ambulatory and non-inpatient time in their schedule. During this time they have two Primary Care rotations along with several subspecialty rotations including Rheumatology and Endocrinology. There is flexibility in the schedule for research and inpatient subspecialty consult rotations as well based on their interest and career goals.
Third Post Graduate Year
The third year also consists of three-week blocks and is designed to complement the first two years of intensive training in inpatient medicine with an emphasis on ambulatory medicine. More than two-thirds of the year is spent in ambulatory rotations. Inpatient experiences at Tufts include the General Medicine, Advanced Heart Failure, Geriatrics, Cardiac Care Unit, and the Medical Intensive Care Unit. There is one general medicine rotation and a neurology rotation at Newton Wellesley Hospital as well. There is extensive night float coverage on all inpatient rotations; these residents admit patients to the hospital and supervise night float interns.
There are two ambulatory Primary Care blocks, several outpatient rotations in medical subspecialty clinics (mostly tailored to resident interest/career goals), four weeks in the Tufts Emergency Department, and several weeks of medical consults. There are several blocks of elective time with opportunities for research projects. Some residents have used elective time in their third year to explore global health options by working in developing countries.