Categorical: 20 weeks
Primary Care: 16 weeks
Outpatient General Internal Medicine
Categorical: 4 weeks
Primary Care: 8 weeks
(4 for Primary Care track)
(4 for Primary Care track)
Categorical and Primary Care:
Full day per week on electives;
Full day every other week on wards, none on nights or ICU
Same as R1
Same as R1
* There are 13 four-week blocks in the academic year.
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Wards provide the backbone of our inpatient clinical education, and allow for the development of diagnostic and patient care skills. While on wards, residents are immersed in the culture of continual improvement that defines Virginia Mason as an institution.
- Our innovative “one-piece flow” rounding system increases efficiency and patient safety, and exemplifies the Lean principles and practice for which Virginia Mason is nationally recognized.
- Each inpatient team is composed of one senior resident (R2 or R3), two interns, and a third or fourth year medical student, with a full time teaching hospitalist attending.
- Four ward teams share admitting with the hospitalist service during the day. Night float team provides cross-cover and admits for the resident teams overnight. All residents have one day off per week while on wards.
- Teaching occurs at the bedside as our faculty employ an interactive teaching style which encourages residents to answer their own clinical questions using electronic resources in real-time while caring for patients.
- Wards teams attend a didactic session and case report Monday through Thursday, as well as Grand Rounds on Friday. In addition, once per month the senior resident leads a teaching didactic on a core inpatient medicine diagnosis to improve knowledge and teaching skills.
Medical Intensive Care Unit (MICU)
In addition to teaching the skills necessary for the care of the complex, critically ill patient, our MICU rotation emphasizes leadership, interdisciplinary collaboration and end-of-life care. Our award winning ICU is staffed by board-certified subspecialists who are passionate about resident education.
- The critical care team consists of two senior residents, four interns, a daytime intensivist, and a MICU night hospitalist. The four interns are split between the day and night shifts, and they switch halfway through the rotation.
- Interns work approximately 11 night shifts and 11 day shifts, with six days off over the rotation. Senior residents do not work any night shifts and have five days off over the rotation.
- Rounds are attended by a multidisciplinary team that includes not only the residents and attending, but also nurses, pharmacists, respiratory therapists, and patients with their families.
Our night float rotation emphasizes the development of autonomous decision making, efficiency and communication. It is instrumental in training interns to admit patients in an organized, comprehensive and efficient manner, while balancing the demands of cross-cover.
- The night float team consists of two interns, one senior resident and a nocturnist attending.
- The night float shift is from 7 p.m. - 7:30 a.m.
- Interns work five nights in a row and then have two nights off per week, and senior residents work nine nights in a row and then have five nights off.
The swing rotation focuses on admitting new patients to the hospital and is done by second year residents as an opportunity to build clinical acumen and independence. The resident admits patients independently and then staffs with an attending. While there is always an attending in-house to offer support, residents enjoy the autonomy that this rotation offers.
- The swing shift is from 3 p.m. to midnight with the last admission starting no later than 10 p.m. If the resident is in clinic the following day, they must leave the hospital by 10 p.m.
- A resident admits up to four patients per shift and then hands them off to resident or hospitalist teams.
- Primary care residents have a full day of continuity clinic once a week, while categorical residents have a full day of continuity clinic every other week.
- The swing rotation is optional for primary care and required for categorical residents.
Elective Hospitalist Float Rotation
The resident on the hospitalist elective works one-on-one with a Virginia Mason hospitalist faculty to care for six to eight patients without a larger intern team. The resident rounds independently, checking in with the attending throughout the day. This rotation emphasizes autonomy and advanced clinical decision making skills, and is a good option for those interested in a hospitalist career.
- Chosen as an elective by second or third year residents.
- The shift is from 7 a.m. to 7 p.m., or 9 a.m. to 9 p.m., Monday through Sunday, every other week.
- In the off weeks, the resident has about two days of continuity clinic and is otherwise free.
- Residents continue to attend conferences and didactic sessions when they are in the hospital.
Our emergency medicine rotation allows residents to hone their skills in the initial workup and management of patients with a wide range of diseases. Like all departments at Virginia Mason, our Emergency Department (ED) is designed to maximize patient safety and quality care, while minimizing cost and unnecessary testing.
- Residents work one-on-one with board-certified emergency medicine physicians.
- During the block, interns work 15 shifts, consisting of day, evening and night shifts.
Electives in bold are required for completion of Categorical and Primary Care Programs.
- Allergy and Immunology
- Anesthesiology (Moderate sedation certification, optional)
- Away rotation (another institution, rural, or international)
- Dermatology — Required for Primary Care
- Emergency Medicine at Harborview (R3 option)
- ENT — Recommended for Primary Care
- General Internal Medicine I
- General Internal Medicine II – Required for R1 Primary Care
- General Internal Medicine – Advanced – Required for Primary Care, R2 and R3
- Geriatrics — Required as R2
- Gynecology — Required for Primary Care
- Hyperbaric Medicine — Recommended for Primary Care
- Infectious Diseases
- General Surgery — Recommended for Primary Care
- Urology — Required for Primary Care
- Ophthalmology — Recommended for Primary Care
- Orthopedics/Sports Medicine/PMR/Podiatry (Musculoskeletal) — Required for Primary Care
- Palliative Care
- Physical Medicine and Rehabilitation — Recommended for Primary Care
- Primary Care Innovations - Primary Care only
- Procedures (R2 and R3 only)
- Radiology (R3 option, upon approval by department)
- Systems-Based Practice R2 or R3