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Creating the Schedule: Step 1

April 07, 2024
by Mark David Siegel

Hi everyone,

I’m fresh off the plane from Ireland and will spend today finalizing the mega-spreadsheet to be used for next year’s schedule. Here’s how it works.

We create assignments for each of the 160 interns and 191 residents who rotate on internal medicine. These numbers include trainees from the Traditional Program as well as Primary Care, Med-Peds, emergency medicine, anesthesiology, psychiatry, interventional radiology, OB-GYN, Bridgeport Hospital, and, for the first time this year, PM&R. Some trainees spend most of the year on internal medicine, while others make brief cameos, like the Bridgeport residents on Klatskin and OB-GYN interns in the MICU.

The key objective is to cover our inpatient services. Since we have two-week rotations, we need to fill 26 blocks. For example, MICU Blue has one resident and two interns, so we need to create 26 resident blocks and 52 intern blocks per year. We do the same for all ICU, step down, and floor rotations at Yale-New Haven and the VA. That’s 1092 floor rotations and 390 ICU rotations for interns and 1144 floor rotations and 390 ICU rotations for residents. The number of blocks per trainee varies by PGY level and program. In the Traditional residency, the number of inpatient rotations varies by color block. This year, Green and Blue have 7 ambulatory blocks while Red and Yellow have 6; in 2024-25, the numbers will be reversed.

The next step is to ensure a humane, educationally sound, fair distribution of rotations across groups. With the elimination of 28-hour call, Traditional residents may see a slight increase in the number of night blocks when VA triage becomes a second VA night rotation. This number will be offset by an increase in the number of Traditional seniors from 89 to 91. The net effect is that the average senior resident will have 3 night blocks next year. Additional goals include strategically distributing general internal medicine and subspecialty time so every resident can rotate on each specialty at least once during their training. We also ensure that each trainee rotates on required services, so categorical PGY1s experience DEFINE-HM (hospital medicine) and Cooney (geriatrics), while every PGY3 experiences Hospital Medicine and Whitman. Each assignment requires coordination with YPC, Med-Peds, and all the departments that rotate on IM.

It’s impossible to create perfect schedules for everyone, try as we might. Each block has a finite number of available rotations, and we have to meet several non-negotiable rules. For example, some rotations are for PGY3s only (e.g., MICU triage) and the ACGME allows only IM residents to supervise IM interns, so we can’t pair EM residents with IM interns. Finally, to meet individual needs, we prioritize vacation requests, schedule non-backup electives in the fall for PGY3s interviewing for fellowship, and try hard to assign residents to requested specialties to help them make key career decisions. This means we have to solve an incredibly complex puzzle when we create the actual schedule, which we’ll explore next Sunday.

Enjoy your day, everyone. Early tomorrow morning, I’ll be driving north to view the total solar eclipse. Hoping for clear skies…


P.S. What I’m reading:

P.P.S. Two last vacation pics:

Submitted by Mark David Siegel on April 07, 2024