Progressive Ward Structure

The Traditional Structure

In our traditional structure, all inpatient rotations had similar responsibilities and patient census expectations. This structure did not facilitate progressive skill development or fully prepare residents for their post-residency careers.

• PGY-1 expectations and goals remained static throughout the year.
• New PGY-2s were responsible for leading and teaching new PGY-1’s on inpatient teams. As a result, PGY-1s, who need the most support, were taught by the most junior residents.
• PGY-3s did not get to take on additional responsibility over the course of residency. At the end of the year, PGY3-s working with experienced PGY-1s had the same level of responsibility as they did 24 months ago.

The Progressive Structure

Unlike traditional ward structures, our progressive structure maximizes learning opportunities and responsibilities for residents.

• Team structure and expectations differ depending on the time of year and whether you are a PGY-2 or PGY-3.
• There are three different types of teams and all residents progress in the same order (A team → B team → C team)
  • A team: a PGY-2 without an intern, working with an attending
  • B team: a PGY-2 or PGY-3 working with one intern
  • C team: a PGY-3 working with two interns
• The A team is an opportunity for residents to solidify their clinical knowledge and inpatient practice before taking on supervisory responsibilities. Residents work 1-on-1 with a full time hospitalist clinician-educators.
• First inpatient rotations for interns are under the leadership of PGY3s, who have the most experience teaching. Later in the year interns work in C teams where they have greater autonomy.

There is also a hospitalist elective for PGY-3s. This elective provides exposure and training in skills such as hospital triage, cross-cover, and coding and billing. You will work one-on-one with a hospitalist with the opportunity to carry a full inpatient census. There are also opportunities for work with hospitalists outside of the Providence system for exposure to different hospitalist models, (open ICU, SNF, and small hospital).