The traditional residency program noon conference is no one's idea of a great way to learn. Residents race in late and leave early, preoccupied with their work on the wards while medical subspecialists lecture (however skillfully) on topics that feel disconnected from one day to the next. The learning experience for residents is usually quite passive; residents rarely prepare for conference in any way and are rarely held accountable for material that is presented.

In academic year 09-10, we took the bold step of cancelling our traditional noon conference program and replacing it with Tuesday School, a dedicated weekly half day of inpatient curricular programming. The year is divided into three unequal trimesters:

Trimester I (Blocks 1-3, June-September): Fundamentals in inpatient medicine
Trimester II (Blocks 4-10, October-April): Subspecialty medicine blocks
Trimester III (Blocks 11-13, May - June): Multidisciplinary approach to complex cases

First trimester topics are taught on an annual repeat cycle with second and third year residents serving as co-teachers alongside subspecialist faculty. Second trimester topics are on a two-year repeat cycle; cases in the third trimester are novel every year.

Teaching and learning is a priority at Cambridge Health Alliance. Unless you are on a night rotation, in the ICU, on vacation, or on an away elective, we expect you to come to Tuesday School. Residents on inpatient rotations sign out their patients and their pagers to the hospitalist service at lunchtime so they can be fully present for the whole afternoon of teaching and learning.

The curriculum is designed using principles of adult learning theory. Whenever possible, teaching is case-based using real patients from the Cambridge Health Alliance. Faculty are encouraged to consider the four hours of teaching time as an opportunity to engage residents in active problem solving exercises, debate, conversation and genuine inquiry. We embrace the challenges and opportunities associated with a "one-room schoolhouse" where residents at the PGY1, PGY2, and PGY3 level learn together and teach one another. Supplementary reading for each session is available on line as we know that learning at the residency level is a self-directed process. You get regular feedback on your medical knowledge and readiness for the ABIM Board Examination through monthly Tuesday School exams with questions drawn from the American College of Physicians Medical Knowledge Self Assessment (MKSAP) Program.

The structure is developmental. Over the course of the year, the curriculum moves from the relatively simple to the more complicated to the most complex. We start in the first trimester with approaches to clinical syndromes and review of core principles. In the second trimester, we discuss evaluation and management of specific diagnoses. In the third trimester, we consider undifferentiated complex cases with a multidisciplinary panel of expert discussants.

The syllabus is integrative. The ACGME mandates learning across six core competencies: medical knowledge and patient care are central to the curriculum, of course; but we also weave across all three trimesters learning experiences related to the development of interpersonal skills and communication, professionalism, practice based learning and improvement, and systems-based practice. In our infectious disease block, for example, we review our hospital's performance data on nosocomial infections. In our hematology/ oncology block, we role play family meetings on end of life care. In our nephrology block, we discuss racial disparities in the care of patients with end stage renal disease. Our inpatient evidence-based medicine curriculum is complementary; articles for resident-led journal clubs are chosen intentionally to address questions relevant to a given block's Tuesday School cases and topics.

Though the curriculum reflects the content of the ABIM Board Examination, we don't pretend to "cover" every topic in internal medicine. We hope, instead, to address a broad range of important subjects and engage each in some depth. Our aim is to ensure that through participation in this curriculum you build your skills as a curious and effective life long learner in internal medicine.

The work of developing our Tuesday School innovation is collaborative. We collect and incorporate feedback in real time. A team of resident and faculty advisors is actively engaged in designing and strengthening the curriculum as we go.

Tuesday School First Trimester Schedule
June 30 - Sept 15

Supplemental Wednesday noon teaching sessions in the first trimester curriculum
June 24: Comparative health systems: Intro to health policy
July 1: The lung as pump: obstructive and restrictive disease
July 22: The lung and gas exchange
July 29: Inpatient glycemic control: Diabetes cases
Sept 23: Thinking like a scholar: Preparing case reports for presentation and publication
Sept 30: CXR interpretation

Tuesday School Second Trimester Schedule