We have an innovative 2+2 schedule that allows residents to spend an equivalent amount of time training inpatient and outpatient, to be prepared to become true generalists who can practice in either setting by the time of graduation.

The inpatient rotation takes place at Cayuga Medical Center, where residents take care of patients with an extraordinary range of internal medicine problems, under direct supervision of teaching hospitalists.  Daily teaching rounds occur on the inpatient service, which include bedside rounds, presentation of assigned topics, and discussion of evidence-based literature and recommendations.

The core curriculum includes daily noon conferences that include lecture series given by general and subspecialty medicine experts, with topics chosen to provide a comprehensive overview of Internal Medicine; we also have EKG rounds, radiology rounds, and Medical Jeopardy.  Journal Club, case conference, and didactics are led by residents with attending guidance.

The outpatient continuity clinic is the cornerstone of our primary care residency experience.  Our residents build a continuity panel over their three years of training, seeing general medicine patients for 5 half-days each week at a single practice site under the supervision of an experienced outpatient faculty attending.  The clinic is where residents develop consequential relationships with their patients, manage chronic diseases, and improve their own practice skills.  During other sessions of the rotation, residents attend outpatient elective sites in subspecialties that interest them, in a longitudinal fashion.  Often, residents will refer their patient to a subspecialist such as Endocrinology, and see the same patient when they are rotating at the Endocrinologist’s office!

In addition to attending the daily noon conference, a half-day per outpatient rotation block is devoted to education.  This educational session includes a case conference presentation with input from our integrated behavioral health team, Yale Ambulatory Curriculum modules, journal club, and guest speakers or workshops that delve deeply into topics related to outpatient medicine.

The impetus to build this curriculum came from our program’s commitment to fostering partnerships with our community, and cultivating in our residents the skills to become community-engaged medical providers. In their first year, residents learn about the social determinants of health and about the network of organizations that provide resources and advocacy to support the well-being of our community. In the second and third years, residents are asked to identify an unmet health need in the community, and develop a strategy to address it in collaboration with a community partner. This project helps residents to develop skills in leadership, public communication and advocacy to better serve their patients and to reduce health inequities. The Cornell Center for Health Equity, of which all our residents become members, provides support for residents by helping them to identify projects, introducing them to appropriate collaborators, and providing mentorship.

Residents learn the fundamentals of clinical quality improvement through didactics focused on core concepts and current methodologies. In their first year, residents spend a full week dedicated to Quality Improvement activities. During this week, they complete a 3-day Lean Six Sigma course to qualify for yellow and green belts. They subsequently meet with advisors and either join an ongoing quality improvement project or develop a new project based on consideration of hospital quality and safety data, or their own experience. Near the end of the third year, residents present their projects at a Quality and Patient Safety Symposium.