Give Online: Help shape patient care for generations to come.
Cleveland Clinic Logo

Program Structure

4+1 Structure

The Cleveland Clinic Internal Medicine program adopted a 4+1 structure to resident schedules in the academic year 2015-2016. The goal of 4+1 structure is to optimize and maximize our residents’ exposure to ambulatory medicine without interfering with training in the inpatient setting. This also creates the unique opportunity to be able to deliver our curriculum in a dedicated manner without interference with clinical duties.

All inpatient, consult and elective rotations are assigned within 4-week blocks called X weeks followed by one week of longitudinal continuity clinic (LCC) defined as Y week.

Structure of X Weeks- Inpatient/consults/electives

Primary Inpatient:
General Medicine, Cardiology, Hematology/Oncology, Gastroenterology/Liver, Medical Intensive Care Unit and Cardiac Intensive Care Unit

Cardiology Clinic/Consult, Vascular Medicine Clinic/Consult, Gastroenterology Clinic/Consult, ED, Renal Clinic/Consult, General Medicine Consult, Endocrinology Clinic/Consult, Neurology Clinic/Consult, Palliative Medicine, Pulmonary Clinic/Consult, Rheumatology Clinic/Consult, Geriatrics Clinic, and Infectious Disease Clinic/Consult

All inpatient and consult rotations have an embedded curriculum with teaching sessions arranged a few times every week by dedicated faculty in that specialty.

Structure of Y week- LCC
Categorical residents have 1 week of longitudinal continuity clinic every 5 weeks.
The preliminary and VA track residents have their elective rotation divided in 1 week blocks at this time.

During the LCC week, categorical residents have

  • 6 – ½ day  IM clinic sessions,
  • 2 – ½ days academic half days (one on Monday AM and Tuesday PM) which is their protected learning time
  • 1 – ½ day for sub-specialty clinic of choice or research
  • 1 – ½ day for administrative responsibilities
First Year

Typical PGY-1 resident schedule

9-10 inpatient modules.

  • General Medicine Teaching Services (Kimball, Tucker) (8 weeks)
  • Medicine night float (2-4 weeks)
  • Medical Intensive Care Unit (4-8 weeks)
  • Palliative Medicine (0-4 weeks)
  • Green Team (GI/Hepatology) (4-8 weeks)
  • Renal Team (0-4 weeks)
  • Cardiology Teaching Service (0-4 weeks)
  • Hematology/Oncology Service (0-4 weeks)
  • Neurology (or in PGY-2 year) (2-4 weeks)
  • Emergency Department (0-4 weeks)
  • Longitudinal continuity clinic (10 weeks)
  • Elective sub-specialty clinic or consult rotation (4-8 weeks)
  • Vacation (3 weeks, plus float week)
Second Year

Typical PGY-2 resident schedule

6-7 inpatient modules

  • General Medicine Services including night float (4-8 weeks)
  • Medicine night float (0-2 weeks)
  • Coronary Intensive Care Unit (4-8 weeks)
  • Green Team (GI/Hepatology) (0-8 weeks)
  • Renal Team (0-4 weeks)
  • Cardiology Teaching Service (0-8 weeks)
  • Hematology/Oncology Service (0-8 weeks)
  • Medical Intensive Care Unit (0-4 weeks)
  • Subspecialty Consult Services  (4-8 weeks)
  • Subspecialty outpatient Clinic and Research Elective (4-8 weeks)
  • Emergency Department (0-4 weeks)
  • Longitudinal Care Clinic (10 weeks)
  • Vacation (3 weeks plus float week)
Third Year

Typical PGY-3 Resident schedule

5-6 inpatient modules

  • General Medicines Teaching Service (4-8 weeks)
  • Medicine night float  (0-2 weeks)
  • Renal Team (0-4 weeks)
  • Green Team (GI/Hepatology) (0-8 weeks)
  • Cardiology Teaching Service (0-4 weeks)
  • Hematology/Oncology Service (0-4 weeks)
  • Medical Intensive Care Unit (4-8 weeks)
  • Subspecialty Consult Services  (4-8 weeks)
  • Subspecialty Outpatient Clinic and Research Elective (4-10 weeks) 
  • Longitudinal Continuity Clinic (10 weeks)
  • Attendance at Cleveland Clinic IM Board Review Course in June (1 week)
  • Vacation (3 weeks plus float week)

David Gugliotti MD
Director, Hospital Medicine Track
Associate Program Director

Hospital Medicine is a growing and dynamic field of Internal Medicine. Expertise in inpatient medicine includes efficiency of care for hospitalized patients, broad-based knowledge in the management of acute medical conditions, and the ability to manage and succeed in a team environment to improve patient care.

In order to meet these goals, the Internal Medicine Residency Program offers an Inpatient or Hospital Medicine Track to give this increased focus to your training. As an adjunct to the Categorical medicine training, you will have a dedicated 2 month Inpatient Medicine block in both your second and third years (similar to the structure of the Primary Care Track). You will be exposed to concepts of quality and patient safety, care transitions, risk management, infection control, and effective consultative practice. You will also be exposed to concepts of leadership training and be introduced to medical business practices.

This track is designed for residents who are interested in Hospital Medicine careers as well as those who plan fellowship training (particularly fellowships with a strong inpatient focus).

The clinical Hospital Medicine rotation will include one-to-one mentorship with a Hospitalist, following a Hospitalist work schedule. These rotations are done at Fairview Hospital, Hillcrest Hospital, or Medina Hospital, three excellent community hospitals in the Cleveland Clinic Health System. These experiences provide a unique opportunity to learn and practice Medicine in these community settings. Residents will learn clinical medicine, transitions of care, and compare the various hospital systems of care. In addition, patients in the community hospital setting often present with more “bread and butter” medical conditions, compared to many patients seen at the Main Campus tertiary care center who are admitted with more complex situations.

The non-clinical portion of the track is comprised of a variety of educational programs and sessions. Problem Based Learning (PBL)cases are used to guide learning about several areas of systems based practice. These sessions are supplemented with directed seminars about topics important to the practice of inpatient medicine. HMT residents spend time learning the basic concepts of Quality Improvement and Patient Safety; this experience includes the opportunity to interact with leaders in the Cleveland Clinic’s Quality and Patient Safety Institute as wells as the designing a QI/PS project. HMT residents also learn the fundamentals of perioperative medicine through a dedicated curriculum of case-based, didactic, and clinical experiences. A graduated experience is provided to residents in the second year of the track to build on knowledge and skills learned during the first year.

Program Details

Hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. The Hospital Medicine track is designed to help physicians become effective agents of change in the complex hospital environment by training them to be leaders in coordinating and participating in the assessment, development and implementation of system improvements. Residents will also become proficient in the care of complex hospitalized patients.

  • Increased experience in both consultative general medicine and perioperative assessment and care.
  • Palliative medicine experience.
  • Dedicated experience in hospital system-based competencies such as patient safety, quality improvement, and risk management.
  • Dedicated experience in leadership skills including team approaches, multi-disciplinary care, management practices, and professionalism.
  • Exclusive one-on-one time spent with experienced academic hospitalists. 

Stacey Jolly MD
Director of Ambulatory Medicine education and Primary Care Track

In addition to the Cleveland Clinic’s three-year Internal Medicine Categorical Residency Training Program, we also offer a three-year Primary Care Track Program.

A three year Primary Care Internal Medicine Residency Track is offered in complement to the  Cleveland Clinic’s traditional three-year Categorical Internal Medicine Residency Training Program.  The Primary Care Track is designed for residents who wish to prepare for the practice of Internal Medicine in the ambulatory setting.   Interested students are encouraged to apply through ERAS  to both the Cleveland Clinic’s Primary Care and Categorical programs.

Residents in both the Primary Care and Categorical Tracks participate in a dedicated longitudinal continuity clinic by General Internal Medicine staff physicians  Primary Care Track residents have an additional dedicated ambulatory experience; one month in their internship year, and three months both in their second and third years. The primary care blocks allow for extended periods of time in longitudinal continuity clinic, weekly seminars on procedures and topics relevant to ambulatory medicine, and experience in ambulatory subspecialty clinics. There are no inpatient responsibilities during the primary care blocks.   Training in the Primary Care Track leaves a resident better prepared for the ambulatory focus of their practice. While highly encouraging a career in ambulatory medicine, Primary Care Track will not impair the ability to sub-specialize. 

Primary Care residents will still receive concentrated exposure in traditional categorical rotations, inpatient hospital and ICU services, subspecialty clinics and general medicine.   The curriculum exposure to office-based dermatology, otolaryngology, women’s health, orthopedics, geriatrics, quality improvement and preventive care among others prepare residents for a broad spectrum of patients.  The residents can choose a mixture of subspecialty clinics that meets their long term goals. 

Preliminary residents typically work as part of a health care team which includes a supervising second or third-year resident, an attending physician, and medical students. Preliminary residents spend the majority of the year on core Internal Medicine rotations. They have elective rotations that are tailored to the needs of the primary specialty they are applying to (Eg. Plastic surgery rotation for pre-derm residents)

The 4+1 schedule structure extends to our preliminary track as well. Instead of IM longitudinal clinic, their Y week will consist of an elective rotation divided as 1 week block at a time.

Typical schedule for preliminary residents

  • General Medicine Teaching Services (Kimball, Tucker) (12 weeks)
  • Subspecialty Services: 8-12 weeks
  • Cardiology Inpatient
  • GI/Hepatology (Green)
  • Hematology/Oncology Inpatient
  • Nephrology
  • Neurology
  • Electives: 8-12 weeks
  • Emergency Department: 4 weeks
  • Vacation: 3 weeks plus a float week

Center of Excellence Track

Hosted by the VA Transforming Outpatient Care (TOPC) Program

The Louis Stokes Cleveland VA Medical Center
Center of Excellence in Primary Care Education

Mamta K. Singh, MD, MS, FACP
Physician Director, Center of Excellence in Primary Care Education
Louis Stokes Cleveland VA Medical Center

As a Categorical Resident, you have the option to participate in the Center of Excellence Track.

This track is designed for physicians with an interest in health care systems, quality improvement, patient safety, and interprofessional collaboration.

During your residency, your schedule will include four outpatient blocks. During the outpatient blocks, you will see patients in a primary care setting at the Cleveland Louis-Stokes Veterans Administration. You will be paired with one other Center of Excellence resident, and together you will share a panel of patients. This unique opportunity provides a great deal of autonomy and unrivaled continuity. Skills and training obtained as a participant in this track will be applicable to all physicians, whether planning further specialty training or a career in primary care.

The Center of Excellence curriculum includes the following:

  • Creation and implementation of Quality Improvement and Patient Safety Projects
  • Yellow belt certification in Lean Six Sigma process improvement training
  • Subspecialty rotations in geriatrics, outpatient procedures, urgent care, and women’s health
  • Subspecialty blocks in the area of your choice at the VA or Cleveland Clinic.
  • Bioethics and health care humanities
1st Year: One Block (12 weeks)
2nd Year: First Block (12 weeks)
Second Block (12 weeks)
3rd Year: One Block (12 weeks)

Background: In January 2011, the Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC) received a five million dollar federal grant to offer physician learners a novel and visionary approach to healthcare in the 21st century. In collaboration with the Cleveland Clinic Internal Medicine Residency Program, the Frances Payne Bolton School of Nursing, and supported by the VA Office of Academic Affiliations, the Center of Excellence will prepares caregivers to work in new models of care that demand teamwork and patient centered care. Participants will be offered novel educational opportunities to build on current strengths in the curriculum as well as acquire new skill sets. As a tribute to the success of this program, it was refunded in 2016 for another 3 million dollars over the next 4 years.


The VA Primary Care Clinics: The outpatient clinical experience at the Cleveland VA medical center serves a diverse patient population of varying age and medical complexity with oversight by dedicated faculty who are selected on academic merit and proven commitment to clinical education. In this environment, participants manage patients in collaboration with pharmacists, psychologists, and registered nurses. Emphasis on chronic disease management is provided via traditional office visits, shared medical appointments, tele-health communication, and through utilization of locally-developed diabetes, chronic kidney disease and heart failure disease registries. The Cleveland VAMC has fully implemented the “PACT” (Patient-Aligned Care Team) model (synonymous with patient centered medical home), which provides dedicated interdisciplinary team members to enhance patient care and provider and patient satisfaction.

Curricular Components:

Training in Six Sigma and other Performance Improvement Tools:The Center of Excellence partners with faculty from the Case Weatherhead School of Management to provide the skills and tools necessary to implement quality improvement into the everyday care of patients. Residents receive training in management skills and receive yellow belt certification in Lean Six Sigma process improvement training.

Leadership in Quality Care Improvement:Residents will become competent in leading and incorporating quality measures and performance improvement into the delivery of healthcare. You will have access to chronic disease registries and will be provided various opportunities to learn how to use these tools effectively for panel and population management, and improve safety and quality at the system level.

Interdisciplinary team based care:Residents will engage in a team-based model for healthcare delivery. To facilitate this model, the VA has partnered with CCF and the Frances Payne Bolton School of Nursing to support the integration of the education of medical residents and nurse practitioner students. As members of a PACT team, residents and nurse practitioners will work collaboratively with RNs, LPNs, social workers, pharm-Ds, health psychologists, as well as dedicated administrative support for a specified panel of patients. The goal of this model is to provide comprehensive patient care while enhancing provider and nursing staff satisfaction.

Proactive Care:Residents will learn motivational interviewing via collaboration with our behavioral health specialists. The will also be teaching patients self-management skills (via collaboration with the Frances Payne Bolton School of Nursing’s NIH funded Self-Management Advancement through Research and Translation Center).

Real time real patient feedback:Residents will be provided unique opportunities to obtain real-time feedback from selected patients to understand the patient experience along the entire continuum of healthcare as patients experience it. Also, video of patient encounters will be reviewed and critiqued by select staff, in order to improve upon patient care skills.

Humanities in Healthcare: Residents will engage in aNarrative Healthcare Course, which includes pre-designated reading assignments of relevant popular press and movies. Discussion of these selections will occur at regular meetings led by members of the Department of Bioethics and Case Western Reserve University. Additionally, the VA has partnered with the Cleveland Museum of Art to develop anArt in Healthcarecurriculum as well as with the Allen Memorial Art Library to provide a historical perspective to the practice of Medicine and Nursing. Residents participate in live session at theh Cleveland Museum of Art as a portion of their training in humanities in health care.