Throughout each year, residents are scheduled for a weekly half-day outpatient clinic, regardless of their assigned block rotation (with a few exceptions), which helps to develop continuity-of-care skills. Year-round brief clinic talks provide bite-sized education on outpatient topics. Formal conferences include scheduled bedside-teaching sessions, occasional grand rounds, daily core curriculum discussions in general medicine and the sub-specialties, residents reports, and periodic journal club meetings interspersed with morbidity/mortality and clinical pathological conferences. Residents also are actively encouraged to conduct clinical research activities, including submission of case reports and design and implementation of clinical protocols. Quality-improvement (QI) skills begin with online courses and then immersion into new or existing quality-improvement projects related to Internal Medicine, often in interprofessional settings with aims aligned to institutional goals, allowing residents to discover how large institutions can manage systemwide improvements. Dedicated QI time allows residents to complete projects or to more deeply examine areas of interest.

Residents’ first year of residency training is focused on the acquisition of basic clinical skills under faculty supervision, with emphasis on medical data-gathering, case presentation, data interpretation and medical decision-making. The second year offers increased exposure to subspecialty medicine, greater responsibility for patient care, and participation in the training of junior residents and medical students. The third year of the residency training combines general medicine with subspecialty experiences, emphasizes evidence-based medicine, and provides seniors with attending-like experiences. Residents also begin the transition into post-residency medical practice or further subspecialty training. A strong emphasis is placed on evidence-based medicine. Since 55% of Hurley’s medical clinic patients belong to a managed-care plan, residents gain extensive experience caring for managed-care patients