Rotations and Schedule
The academic year is divided into thirteen four-week blocks. Here is how they fit together.
Sample schedule
| Rotation type | PGY-1 | PGY-2 | PGY-3 |
|---|---|---|---|
| Floors | 6–7 blocks | 3–4 blocks | 1 block |
| Nights | 1–2 blocks | 1–2 blocks | 1 block |
| MICU | 1 block | 1–2 blocks | 1–2 blocks |
| Vacation | 1 block | 1 block | 1 block |
| Electives | 2–3 blocks | 3–4 blocks | 5–6 blocks |
| Hospitalist | — | — | 1 block |
| Admitting Resident (MAR) | — | — | 1–2 blocks |
| Junior Attending | — | — | 1 block |
Medical wards
There are eight medical ward teams caring for general medicine inpatients. Each team consists of one PGY-2, three PGY-1s, and one or two medical students from St. George’s University and New York Medical College; some teams have a PGY-3 as junior attending. Teams carry 14–18 patients on average, with interns capped at 10. PGY-3 residents work on the inpatient units as junior attendings during the day or as hospitalists in the evening, which allows significant autonomy in patient care.
On-call structure. Teams admit every day; interns are on call every third day until 8 pm, and there is no overnight call for interns or residents on the wards. All teams admit until 7 pm, when the night float takes over admitting duties at 8 pm. Interns and residents are guaranteed at least one full day off every weekend. Weekend MICU calls are covered by residents on elective. There are no 24-hour calls — the longest shift at any level is 12 hours.
Night float
Two PGY-2 residents and four or five interns provide cross-coverage for the medical wards, six days a week for a two-week rotation. All admissions are supervised by the on-call hospitalist, who is available for emergencies. The shift runs 8 pm to 7 am.
ICU, CCU, and ventilator units
There are 22 ICU beds on the medical service. Each MICU team consists of two Pulmonary and Critical Care attendings, a Pulm/Critical Care fellow, a senior resident, two PGY-2s, and four PGY-1s for a one-month block. Day and night teams work 12-hour shifts (7 to 7), eliminating overnight calls in the MICU on weekdays, and there is 24-hour attending coverage. Ventilator unit teams consist of a senior resident, two PGY-2s, and two PGY-1s, five days a week for two weeks.
Medical Admitting Resident (MAR)
The MAR is a unique PGY-3 rotation. Once the Emergency Department admits a patient, the ED house staff present to the MAR, who rapidly assesses the patient from the available data, triages by severity, and assigns the patient to an on-call team or consults the MICU for admission. MARs also provide consultation to all other departments in the hospital. They work 12-hour shifts, 14 shifts per month.
Simulation laboratory
Lincoln’s Sim Lab opened in 2012. All residents and medical students train there in clinical scenarios, procedures, teamwork and communication, embedded-patient exercises, and megacodes, using state-of-the-art equipment. Learn more about the Simulation Center.
Outside cardiology rotations
Residents rotate in the CCU at Bellevue Hospital for exposure to pre- and post-cardiac-catheterization care, and with the cardiology consult team at St. Barnabas Hospital for post-catheterization care and EP studies.
Practice-Based Learning (PBL)
Selected PGY-2s teach junior residents, interns, and medical students and participate in Sim Lab activities on a schedule that follows the time of year.
Electives
All residents rotate through every medical subspecialty over three years. On subspecialty rotations residents split their time between outpatient clinics, pre-operative clinics, and inpatient consultation — on average a third to a half outpatient — working closely with subspecialty attendings. Electives offer direct exposure to procedures such as bone marrow biopsy, arthrocentesis and joint injection, hemodialysis, and EGD/colonoscopy. Residents on elective take one or two MICU weekend calls.
Ambulatory care
Quality ambulatory training is a critical part of the program. We have an on-site ambulatory care pavilion and a satellite clinic, Morrisania, about 10–15 minutes away. Faculty practices are fully integrated with resident practices, and house staff work side by side with their preceptors. Each resident spends one half-day a week in continuity practice and one to two months each year on an ambulatory block, with time in gynecology, ENT, ophthalmology, women’s health, adolescent medicine, and the allergy clinic. Third-year residents manage their own patients independently with indirect attending supervision.
Point-of-care ultrasound (POCUS)
A two-week rotation, begun in July 2019, supervised by faculty trained in hospitalist POCUS. The department has four ultrasound machines and three handheld devices. Residents scan lungs, heart, IVC, aorta, gallbladder, kidneys, and bladder among other organs, seeing normal and abnormal findings, and use ultrasound for bedside procedures. More about POCUS.
Ventilator management
A two-week PGY-3 rotation. Residents oversee the care of all ventilated patients on the telemetry unit with the primary teams and under ICU supervision, and run daily teaching sessions on ventilator management and alarms.
Research
A two-week rotation. Residents discuss their project with Dr. Vidya Menon, the department’s Research Director, a month in advance and develop a clear workflow for the rotation. Expectations include involvement in clinical research, QI projects, case reports, and posters. More about research.
Social Medicine, Lifestyle Medicine, and CATCH
Newer rotations bring residents into community health education and street medicine (Social Medicine), the South Bronx’s first Lifestyle Medicine program, and addiction medicine through the CATCH consult service.