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. We have based our schedule on a firm system using a 4+1 block schedule. Each of the five firms comprises interns, second-year residents, and third-year residents, who rotate through each of our training sites together.

The first four weeks of each five-week block are spent on a particular rotation, followed by a week of outpatient clinics and ambulatory didactics. Between the four-week rotation and the clinic week is a guaranteed free 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.

Having a dedicated clinic week also permits residents to focus solely on outpatient medicine. Each clinic week offers both primary care continuity clinics and themed subspecialty clinics. Throughout residency, house staff work in ambulatory firms headed by general medicine faculty, which simulates the type of practice you might have once you’ve completed residency.

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. You can start planning your weekend getaways before you even start your residency!

Another new, fantastic feature of this schedule is a guaranteed week of vacation during the holiday season. Each resident will have either the week of Christmas or the week of New Year’s off.

How the firms rotate throughout the year

WeekFirm AFirm BFirm CFirm DFirm E
1 Parkland 1 "+1 Clinic" Parkland 2 VA SPUH
2 Parkland 1 Parkland 2 "+1 Clinic" VA SPUH
3 Parkland 1 Parkland 2 VA "+1 Clinic" SPUH
4 Parkland 1 Parkland 2 VA SPUH "+1 Clinic"
5 “+1 Clinic" Parkland 2 VA SPUH Parkland 1
6 Parkland 2 "+1 Clinic" VA SPUH Parkland 1
7 Parkland 2 VA "+1 Clinic" SPUH Parkland 1
8 Parkland 2 VA SPUH "+1 Clinic" Parkland 1
9 Parkland 2 VA SPUH Parkland 1 "+1 Clinic"

Rotations available for each block

Parkland 1Parkland 2St. Paul University HospitalVA Medical Center
Wards Wards Pulmonary Wards
MICU Cardiology Advanced Heart Failure MICU
Renal Consult Heme/Onc Inpatient Service Cardiology Cardiology
GI/Liver Consult Pulmonary Hypertension/Cystic Fibrosis Service Heme/Onc Service  
ID Consult      
Hem/Onc Consult