The 4∶1 schedule: a novel template for internal medicine residencies.

Background: It is widely acknowledged that there is need for redesign of internal medicine training. Duty hour restrictions, an increasing focus on patient safety, the possibility of inadequate training in ambulatory care, and a growing shortage of primary care physicians are some factors that fuel this redesign movement.

Intervention: We implemented a 4∶1 scheduling template that alternates traditional 4-week rotations with week-long ambulatory blocks.