Innovating to Improve Individualized Training in Internal Medicine Residency: Inpatient Threads and Block 2.0

Background The ACGME Internal Medicine (IM) Program Requirements mandate 6 months of individualized training and 10 months of outpatient medicine over 3 years. Balancing these with service needs is challenging. At UCSF, we developed a multi-pronged approach to individualize training across clinical settings. Aim To develop a curriculum that supports individualized education, longitudinal mentorship, and career development while meeting ACGME requirements. Setting An IM residency spanning three hospitals at the University of California, San Francisco. Participants All PGY2–PGY3 categorical IM residents in the 2024–2025 academic year. Program Description Two complementary innovations were implemented: (1) Inpatient Threads, allowing residents to select inpatient tracks aligned with career goals (e.g., generalist, cardiology/critical care); and (2) Block 2.0, a redesigned outpatient/elective curriculum with longitudinal subspecialty clinics (LSCs), skill-based pathways, and scholarly time. Residents completed 2 LSCs annually and enrolled in a GME-wide Academic Pathway. Program Evaluation The redesign was informed by needs assessments and survey data collected from 2014 to 2023. Early outcomes signal improved mentorship and record participation in the resident research symposium. Ongoing evaluation includes ACGME survey data, internal surveys, and focus groups. Discussion This customizable curriculum offers a replicable model to individualize training while preserving the generalist foundation of IM residency.