4+1 System and Firm System

Here at UT Southwestern Medical Center, we are committed to continuous improvement based on the evaluations we receive from our residents. This is truly a resident run program. We have based our schedule on a firm system using a 4+1 block schedule. Each of the five firms comprises interns and residents who rotate through each of our training sites together.

Similar to the 4+1 schedule at other programs, the first four weeks of each five-week block are spent on a particular rotation, followed by a +1 week of outpatient clinics and ambulatory didactics. Between the four-week rotation and the clinic week is a guaranteed free weekend, called the Golden Weekend. There are no continuity clinics during each four-week rotation, allowing residents more time to concentrate on their inpatient services and more flexibility to plan for teaching, didactics, and days off.

Still not sold? Each resident is guaranteed a free weekend every five weeks, which really helps recharge your batteries before starting your next rotation. And because of the nature of the 4+1 system, when you start as an intern, you will be able to predict your weekends off for the entire three years of your training! Another fantastic feature of this schedule is a guaranteed week of vacation during the holiday season, either the week of Thanksgiving, Christmas, or New Year’s.

What makes UT Southwestern’s 4+1 schedule different from the others? Currently, the +1 week offers both primary care continuity clinics and a variety of subspecialty clinics. Starting next year, we will have new “Hybrid” rotations that will contain these subspecialty clinics, freeing up the +1 week for more experiences in research, Quality Improvement, and continuity clinics, just to name a few.

Hybrid Rotations

You might be wondering, what are “Hybrid” rotations? We are combining the strengths of our inpatient and outpatient experiences in each of the major subspecialties at all 3 of our hospitals into a single, uninterrupted experience. This will give every resident and intern a 4-week emersion into each these subspecialties. We have had so much success with our new Nephrology Hybrid rotation this year that starting next year, we will offer one for Gastroenterology, Infectious Disease, Hematology/Oncology, General Medicine (Gynecology, Dermatology, Allergy, etc), Neurology, and a combined Rheumatology/Endocrinology.

These Hybrid rotations will be built into each year of training so that at the end of your three years here, you will have been exposed in great depth to each of the major subspecialties, creating a very strong and valuable general medicine experience for each of our residents. Plus, you will have every weekend off during Hybrid rotations.

Resident Block Schedule
Sample Intern Block Schedule

Rotations available for each block

Parkland Memorial Hospital

  • General Wards
  • MICU
  • Cardiology
  • Hybrid Rotations:
    • Nephrology
    • GI/Liver
    • Infectious Disease
    • Hematology/Oncology
    • Neurology
    • Rheumatology/Endocrinology
    • General Medicine
  • Inpatient Hematology/Oncology

UT Southwestern William P. Clements Jr. University Hospital

  • General Wards
  • MICU
  • Acute Heart Failure
  • Inpatient Gastroenterology/Liver
  • Hybrid Rotations:
    • Infectious Disease
    • Neurology
    • Hematology/Oncology

Dallas Veterans Affairs Medical Center

  • General Wards
  • Combined MICU and CCU service
  • Hybrid Rotations:
    • Nephrology
    • GI/Liver
    • Infectious Disease
    • Hematology/Oncology
    • Neurology
    • Rheumatology/Endocrinology
    • General Medicine