Hi everyone! Welcome to the inaugural post on the Yale Medicine Chief’s Blog! We’re certain that many of you have questions about the schedules – how is it generated, how do we keep things fair, etc… and we hope to answer all that and more!
Requests:
Certain vacation months were quite popular, and almost no one wanted vacation at the beginning of the year. The Klatskin service was very popular among our residents, whereas interns preferred Duffy and Peters. 60% of interns and 80% of residents had personal requests related to m(p)aternity leave, conferences, weddings – clearly life happens outside of residency!
Schedule Generation:
To ensure equality, we proceeded with a stepwise process to generate the schedule. First, clinics were assigned as per resident color blocks (for PGY-2s and 3s), and per intern clinic requests (for traditional interns). As many of you know, our traditional internal medicine program is on a 6+2 block system; however for many years this has not applied to our preliminary and anesthesia interns. For the upcoming year, we also made it a priority to ensure these interns have a lighter rotation every 6 weeks, to ensure quality of life is maintained, and to help social groups form among those on each clinic ‘color’ block.
Following the clinic scheduling, we took into account the special requests that many residents have, including weddings and necessary absences, giving high priority to these important events. To ensure fairness to those who did not request special events – we kept a ‘fairness’ tally, so that those who were given time for important life events might choose their vacations or electives after those who had no special requests.
Vacations were then distributed for the first 6 months and second 6 months of the year. Each vacation request fulfilled reduces the number of residents available for backup or jeopardy. We thus had to limit vacation requests for a specific block to ensure we maintained a robust backup and jeopardy pool. Those who did not get their first choice in the first 6 months were given a higher priority for the second six months using our fairness tally.
Electives were distributed based on everyone’s preferences, as well as ensuring that most graduating seniors had an opportunity to work on most rotations during their time here. It is a perennial concern that residents graduate without rotating on the Goodyer cardiology floor service – unfortunately there are just not enough spots on this two resident service to ensure every resident gets this experience. However, all residents will have CCU time during their first and second years (and some during their third years), to ensure a robust cardiology experience. Additionally, we were able to ensure rising seniors who put this rotation as their first choice and had never done Goodyer were able to have the experience. Similarly, the popularity of Klatskin, our liver service, outweighs our supply. We have a longstanding relationship with the Bridgeport program which helps staff the service; and although this slightly decreases access to Klatskin, we would not be able to staff our services and supply residents with the current amount of elective time available. Again, we were able to ensure rising seniors who ranked this rotation first and had never rotated on the service had access. We were able to ensure 86% of residents got their first choice, and everyone got one of their top two choices. 70% of residents will get to do both their first and second choices!
Finally, we filled in the remaining rotations, with an attempt to balance nights between residents, ensure ICU time was similar and that PGY1s and 2s got experience in both the MICU and CCU, and minimize transition issues where coverage needs to be pulled for a resident starting a daytime rotation after nights.
We understand the schedule isn’t perfect – our 82 upper year residents cover 53 rotations for 26 2 week blocks; not accounting for clinic blocks or equality, there would be over 10^49 possible ways to arrange these blocks – and that’s just the residents. However, we hope we’ve been able to satisfy many of your requests, provide you with a balanced schedule, and ensure you get a well-rounded experience in internal medicine.