Curriculum and Didactics
Our program takes a unique approach to resident education with the goal of training highly successful, motivated, and competent physician leaders of tomorrow. Our progressive “two plus two” schedule places residents in the ambulatory setting two weeks of every month to deliver care to their own panel of patients as well as to rotate through subspecialty clinics in a novel longitudinal fashion. Our weekly core lecture series is delivered by general and subspecialty medical experts and is designed to provide a comprehensive education into the necessary topics required to become a consummate and caring physician. The regular conference schedule centers on competencies important to developing a strong foundation in evidence-based medicine, quality improvement, professional and personal development and patient care. Residents will gain unique perspective into how systems influence the practice of medicine and delivery of care during their experiences practicing medicine in our high functioning Accountable Care Organization, rotating to our affiliate critical access hospital, short and long term care facilities and federally qualified health care center. Additional time is reserved for a two week orientation as well as a week for in depth quality improvement education. Time and mentorship for a longitudinal community engagement project is reserved during each ambulatory week and will help residents build strong community relationships while simultaneously developing projects to decrease health inequity in the community where they reside. When combined, the Cayuga Medical Center Program offers a uniquely progressive and innovative platform to train physicians that will ensure a resident’s long term success, relevance and happiness upon completion of training.
We utilize a 2+2 scheduling structure to maximize preparedness for both outpatient and inpatient medicine at the time of graduation. Most internal medicine residencies have residents spend one half day per week in their continuity clinic or participate in a 4+1 or 6+2 structure. However, we believe residents should spend an equivalent amount of time training in each setting to best prepare competent clinicians to practice excellent primary care by the time of graduation. Our innovative academic year is broken in to 13 4-week blocks with each block broken into two 2-week rotations. This allows residents to spend one-half of every month in the ambulatory setting maximizing patient continuity, resident skills, satisfaction and comfort in the outpatient setting. Alternating two-week ambulatory and inpatient experiences increases patient satisfaction and promotes resident’s work-life balance by eliminating competing priorities. The 2+2 schedule below is a sample schedule for a PGY1 at CMC.
Note that elective time is built in to ambulatory weeks, see below.
The residency at Cayuga Medical Center differs from the majority of currently operating residencies in its more directed focus on primary care training. To achieve this goal, we have adopted a “two plus two” rotation model wherein residents alternate between two-week hospital-based rotations and a two week ambulatory rotation that is a combination of continuity clinic, longitudinal subspecialty experiences and community projects. Rather than month long subspecialty experiences as occurs in a traditional residency program, our residents will participate in year-long longitudinal experience. Subspecialty experiences and elective offerings will occur once per week during each two-week ambulatory rotation. This scheduling allows for a genuine experience in subspecialty education that more closely mimics their actual practice outside of residency education and encourages the development of stronger relationships and continuity between residents and supervising physicians in subspecialty and elective areas.
The following is a sample of how a PGY1 ambulatory week will be spent.
*Longitudinal Electives. Residents will rotate through subspecialty electives over ten blocks. In the example above, this resident would spend every ambulatory Tuesday morning in the Cardiology office with the same Cardiologist for ten blocks.
** Community Project
The residency’s didactic program will be comprised of daily morning reports focusing on resident lead and faculty supervised presentations of patients cared for in both the inpatient and ambulatory settings. A daily noon conference will consist of a core lecture series led by internal medicine and subspecialty faculty three times a week and a rotating schedule of Tumor Board, Morbidity & Mortality, Journal Club, Multidisciplinary Clinical Forum, Board Review and Quality Improvement & Patient Safety twice a week.
Community Engagement Project
Our patients’ health and well-being are not only products of the health care they receive and the choices they make but also the places where they live, learn, work, and play. Future physicians need to have the skills required to advocate for optimal health and well-being of their patients. Trainees need to advocate for their patients’ health and wellbeing beyond the hospital and clinic settings. Additionally, they must have the knowledge and skills to access appropriate community resources and advocate for their patients and patients’ communities.
The first year of the curriculum is structured to develop the residents’ understanding of the social determinants of health and foster the development of the necessary attitudes, knowledge and skills that will help a clinician interact more effectively with their patients and the community. In their second and thirds years, residents will focus on using their knowledge of community issues to identify a health need in the community and develop a strategy to address it in collaboration with the community. Residents will develop skills in community leadership, public communication, and advocacy as they partner with their community and the Cornell Center for Health Equity to better serve its population and lessen health inequity.
Residents’ exposure to the principals of clinical quality improvement will begin early in the PGY-1 year with attendance in didactics focused on core concepts and current methodologies in the field. Residents in their first year of training will spend one entire week dedicated to quality improvement activities. All residents will complete a 2-day Lean Six Sigma course qualifying them as yellow belts. They will subsequently meet with advisers and join an ongoing quality improvement project or develop a new project drawing on hospital quality and safety data or their own experiences. As part of their Quality Improvement curriculum at Cayuga Medical Center, residents will be embedded on Quality Improvement committees. Additionally, residents will present at the Internal Medicine Program’s monthly quality improvement conference. CMC will host a Quality and Patient Safety Symposium annually to coincide with the National Association for Healthcare Quality (NAHQ) Healthcare Quality Week where residents will present their projects.
Creating programs to train physicians where they are most needed requires innovative programs that partner experienced academic medical educators with motivated rural hospitals. To address the shortage of rural physicians, Cayuga Medical Center (CMC) has partnered with the New York Presbyterian (NYP) Internal Medicine Residency to develop a unique training program with the goal of training highly motivated physician leaders in rural New York.
The Categorical Internal Medicine program will train residents for the entirety of their residency at CMC. In addition to the Categorical Program, CMC has developed a “1-2” Rural-Urban blend training track more commonly employed by Family Medicine residency programs wherein residents spend their first year training at a participating hospital before completing their second and third years of training in a rural community. The CMC “1-2” Rural-Urban blend track will deploy interested first year residents to train at New York Presbyterian in Manhattan for their entire PGY-1 year where they will focus on inpatient and core specialty medicine while the final two years will place the trainees at CMC where they will join categorical residents for their PGY-2 and PGY-3 years. Residents who apply to participate in the “1-2” track will have an identical experience to categorical residents except for their PGY-1 year when “1-2” residents spend their year training alongside NYP-Weill residents. To the best of our knowledge, this program will be the first application of the “1-2” model to an Internal Medicine residency. Please note, these tracks will have separate NRMP match numbers.