WellSpan Medical Education


IMG 9907We utilize the 4+1 scheduling system in our residency program.  If you’re not familiar with the way this schedule works, here are the basics:  

The “4” in 4+1 means that residents will spend 4 weeks on some combination of an inpatient core rotation (wards, ICU, or nights) or an elective rotation (i.e., cardiology consults, endocrinology clinic). The “+1” indicates that after those 4 weeks, the residents will then spend 1 week dedicated to outpatient medicine (continuity clinic and related outpatient experiences). They will then return for 4 more weeks of wards, ICU, elective or night float and after that on to another 1 week of continuity clinic. Vacation time is taken during the “4” section.  Here’s one intern’s schedule:

The most notable benefit of this increasingly common schedule is that it allows compartmentalization of rotations.  During your “4” weeks, you will be able to focus completely on that rotation and not be distracted by being pulled out to continuity clinic one or two half days per week (as would happen in a traditional schedule).  Similarly, it allows you to focus on your continuity clinic experience when you are on the “+1” week—this is your only clinical obligation during that week, so you can really dive in and learn outpatient medicine during those weeks!

Ward Medicine (“Med Res”)

Our ward teams consist of one attending physician, one junior or senior resident, and one intern.  Third and fourth year medical students, rotating from our affiliated medical schools, are important members of the team, as are clinical pharmacists and clinical pharmacy trainees.   Our teams care for a wide variety of patients such that over the three years of training, residents have a rich and varied experience caring for inpatient medicine patients.  Ward teams cap at 11 patients, though interns won’t follow more than 10 patients (and early on in the year, no more than 8 patients).

ICU Medicine (“Med Res ICU”)

Our ICU experience includes both medical intensive care unit (MICU) and coronary care unit (CCU) patients. The ICU rotations are supervised by our pulmonary and critical care faculty--during the rotation, internal medicine residents work collaboratively with house staff from other training programs within the hospital as well.  ICU rotations are intense and challenging but help to develop residents’ confidence and ability to clinically reason and function quickly while under pressure. 

Continuity Clinic (“Apple Hill Internal Medicine” or “AHIM”)

Every fifth week will be spent at continuity clinic at Apple Hill Internal Medicine, which is also our general internal medicine faculty practice. During your residency, you will be one of our junior partners in the practice--you will have the opportunity to build your own panel of patients and learn how to provide high quality, high value chronic and preventive care for them, in addition to honing your skills to care for acute outpatient medical conditions as well.

Elective Rotations

Residents have access to a wide range of clinical elective rotations---from traditional internal medicine subspecialties like cardiology, gastroenterology and nephrology to somewhat less common experiences, like pathology, blood bank and clinical informatics. 

Distribution of rotations:

PGY1 Number of weeks (approximate)
Wards (“Med Res”) 16-18
ICU (“Med Res ICU”) 10
Continuity Clinic (AHIM) 10
Night Float ("Med Res Nights" 4
Emergency Medicine 2
Cardiology Selective 2
Elective 2
Education Week  1
Vacation 2


Number of weeks (approximate)

 Wards (“Med Res”)  10
 ICU (“Med Res ICU”)  8
 Continuity Clinic (AHIM)  10
 Night Float ("Med Res Nights")  2
 Emergency Medicine  2
 Cardiology Selective  4
 Neurology  2
 Geriatrics  2
 Elective  6-8
 Education Week  1
 Vacation (PTO)  2


Number of weeks (approximate)

 Wards (“Med Res”)  10
 ICU (“Med Res ICU”)  8
 Continuity Clinic (AHIM)  10
 Night Float ("Med Res Nights")  2
 Geriatrics  2
 Hospitalist or Primary Care Rotation  4
 Geriatrics  2
 Elective  10
 Education Week  1
 Vacation (PTO)  3

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