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Schedules and Firm System

To strengthen the sense of community and family at UTSW, residents are sorted into five "firms" who rotate through inpatient rotations and +1 clinic weeks together. This continuity, along with having weekends off together, helps residents form close relationships over the three years of residency and makes our large program feel much smaller.

Five overlapping circles labeled Firm A, Firm B, etc

4 + 1 Highlights

  • The academic year is made up of ten (10), five- (5) weeks each.
  • The five weeks are broken up into a 4-week rotation followed by a +1 Continuity Clinic week. The 4-week rotations are made up of inpatient wards, ICU, and hybrid rotations.
  • Firms rotate through 4-week blocks together and will always be in clinic at the same time.
  • Shared practice groups made up of residents in each firm help cover each other’s patient panels while they are in clinic allowing those on 4-week rotations to focus their attention on their inpatient responsibilities.
  • The weekend before a +1 clinic week is always a full weekend off (“golden weekend”). This allows for planning all weekends off for the full three years of residency!
  • Preliminary interns follow the same schedule as categorical interns, including elective and vacation time. In lieu of a continuity clinic, preliminary interns spend their +1 weeks in career-specific clinics of their choosing.

Hybrid Rotations

The Department of Internal Medicine has robust divisions in all major Internal Medicine subspecialties. During hybrid rotations, residents get broad exposure to these specialties through both inpatient and outpatient experiences at all three of our hospitals and their affiliated clinics. Residents will spend 2-to-4-weeks immersed in Nephrology, Gastroenterology, Geriatrics, Infectious Disease, Hematology/Oncology, Neurology, Palliative Care, Rheumatology, Endocrinology, Addiction Medicine, Cardiology, and Pulmonary Medicine over the course of three years. An added bonus of these rotations is that most services included in hybrid blocks allow for weekends off.

Sample Block Schedule

 Block 1Block 2Block 3Block 4Block 5
PGY 1 PMH Wards +1 Elective +1 VA Wards +1 PMH MICU +1 PMH Wards +1
PGY 2 Heme/Onc Hybrid +1 Elective +1 Nephro Hybrid +1 CUH ACS +1 PMH MICU +1
PGY 3 PMH MICU +1 ID Hybrid +1 VA CPICU +1 Outpatient Medicine +1 GI Hybrid +1


 Block 6Block 7Block 8Block 9Block 10
PGY 1 Nephro Hybrid +1 CUH MICU +1 PMH CCU +1 Geriatrics/ Vacation +1 CUH Wards +1
PGY 3 Cardio/Pulm Hybrid +1 Elective +1 QI +1 PMH Wards +1 Rheum/Endo Hybrid +1

PMH: Parkland Memorial Hospital
CUH: Clements University Hospital
VA: Dallas Veterans Affair Medical Center
ACS: Advanced Cardiac Care
CPICU: Cardiopulmonary ICU

Rotations Available

General Wards
Combined MICU/CCU    
Advanced Cardiac Care Service    
Hybrid Rotations Nephrology
Infectious Disease

PMH: Parkland Memorial Hospital
CUH: UT Southwestern William P. Clements Jr. University Hospital
VA: Dallas Veterans Affairs Medical Center