Internal Medicine Residency Curriculum

X+Y+Z Block Schedule:

The intent of Shannon Internal Medicine Residency Program is to train competent, well-rounded internists that are capable of practicing full scope, evidenced based, compassionate internal medicine in rural underserved areas including west Texas on graduation.

Our X+Y+Z schedule gives you structure, variety, and a little breathing room throughout the year.

Each 8-week block looks like this:

X = 4 weeks of inpatient medicine, such as wards or ICU
Y = 2 weeks of continuity clinic
Z = 2 weeks of specialty or elective time

Then you repeat.

Why do we like it? Because when you're on inpatient, you're on inpatient. You won't be leaving rounds or the ICU to rush across town for continuity clinic. The same goes for specialty rotations and electives. You have no continuity clinic interruptions.

It's also an important part of our wellness strategy. The schedule is designed so you're never too far from a two-day “golden weekend.” Residency is hard work but having something to look forward to matters.

Over three years, you'll get the inpatient and outpatient experience required for excellent IM training, plus at least six months of rotations tailored to your individual career goals. And there's no driving all over town. Wards, ICU, specialties, and electives are mostly based at Shannon Medical Center Downtown, while continuity clinic is directly across the street at Shannon's Beauregard Clinic.

Work hard. Learn where you are. Then move into something different before you burn out on the same routine.

Sample Schedule:

Electives:

• Women’s Health
• Cardiology
• Infectious Disease
• Gastroenterology
• Nephrology
• Allergy
• ER
• Hematology/Oncology
• Pulmonary
• Dermatology
• Psychiatry
• Geriatrics
• Procedure/POCUS
• Adolescent Medicine
• Outpatient Orthopedics
• Sports Medicine

We will try to honor any other requests if that service is available in the Shannon system.

Inpatient Ward Rotations:

Our 3-year inpatient experience is built around a “learner-manager-teacher” model, with increasing responsibility and independence each year. PGY1 residents are primarily supervised by PGY3 seniors, while PGY2 residents have dedicated time working one-on-one with attendings. There is no 24-hour call since overnight coverage is provided by a senior night-float resident and an attending nocturnist.

All ward rotations take place at Shannon Medical Center Downtown. Residents take new admissions from the overnight team, Emergency Department, and continuity clinic and work closely with nursing, consultants, case management, therapy services, and other members of the healthcare team.

One thing that makes our program different is Shannon’s open ICU. Residents can continue caring for their patients when they transfer to the ICU while working alongside the critical care team. Residents also communicate directly with specialists, building the confidence and skills to manage complex patients and use consultants effectively.

Our goal is real autonomy with the right support. As residents progress, they take increasing ownership of their patients, with attendings becoming more like trusted advisors and educators. Dedicated ICU rotations with intensivists are also included in all three years.

Residents arrive at 7 a.m. in preparation for attending rounds that start at 9 a.m. Rounds typically finish by noon to 1 p.m., leaving afternoons for new admissions, patient care, teaching, and conferences. Resident duties at all levels are covered by the attending for residents to go to Academic Half Day. There is no “short call” or “long call.” Work hard, take care of your patients, and get the job done. When the work allows, your attending may send you home early.

We want seniors ready to run the team, make decisions, communicate confidently, and take ownership of your patients.

Continuity Clinic Rotations:

Our resident continuity clinic is located in the newly renovated Beauregard Clinic, directly across the street from Shannon Medical Center and just across the waiting room from the IM Residency offices. With 20 exam rooms and two procedure rooms, it is a space built specifically for resident education and patient care.

Residents from all three PGY levels work in teams, allowing you to build real continuity with your patients throughout residency while learning alongside your classmates and senior residents. Faculty provide direct supervision and mentorship while giving you increasing independence as your skills and confidence grow.

When you're on clinic, you cover the team's inbox, follow-ups, and patient concerns, allowing your teammates on wards, ICU, electives, and specialty rotations to focus on the rotation they're on. When you're away, they do the same for you. Your patients are always covered, and you aren't trying to manage an inbox while taking care of hospitalized patients.

Clinic also includes daily outpatient teaching over lunch, and there are no scheduled patients during Academic Half Day so your educational time stays protected.

Didactics:

ACGME requires at least four hours of didactics each week. We don't believe education should be about checking a box. Our residents have multiple learning opportunities throughout the week, with teaching designed to be practical, interactive, and relevant to the patients they are actually caring for.

Academic Half Day (AHD)

Every week, residents have a protected Academic Half Day from 1–5 p.m. Clinical duties are covered so residents can step away and focus on learning together. Residents on night float, vacation, or other leave are excused.

AHD goes beyond traditional IM lectures. You'll see board review, M&M and patient safety, quality improvement, ethics, coding and billing, business of medicine, interdisciplinary topics, POCUS, procedural simulation, townhalls, and plenty of clinical medicine.

It's also intentional time for the whole residency to be together. Learn together, grab some food, talk, laugh, and actually get to know the people you're training with. Residency is hard work, and we want AHD to help build both great physicians and a strong team.

Afternoon Report:

Think Morning Report without the morning. Once a week, residents on the inpatient services lead case-based discussions with faculty and specialists based on real patients from wards, ICU, and specialty rotations.

We hold it at the end of the day so we're not interrupting rounds or pulling you away from patient care when the hospital is busiest.

Ambulatory curriculum:

During continuity clinic, residents have short outpatient teaching sessions over lunch four days a week. Sessions are typically 35–50 minutes and focus on practical office-based medicine. The things you'll actually need to know when you're sitting across from a patient in clinic. One of those sessions will be a board topic curated from the Yale Curriculum (yes, it’s from the Primary Care Track faculty at Yale IM Residency Program).

Journal Club:

Once a month during AHD, residents lead Journal Club with faculty guidance. The goal isn't simply to critique an article. It's to learn how to decide whether new evidence is good enough to change how you practice medicine.

SIM Lab: Procedures, POCUS, and Mock Codes

We believe you learn procedures by actually doing them.

PGY1 orientation includes three dedicated days of procedures, POCUS, and mock codes. Residents train on ultrasound-capable simulation models for central and arterial lines, thoracentesis, paracentesis, lumbar puncture, arthrocentesis, peripheral IVs, ABGs, and blood draws. Training also includes suturing, I&D, skin biopsy, and pelvic/Pap exams.

You'll also complete an 8-hour POCUS workshop with faculty, a sonographer, and a structural cardiologist. But POCUS doesn't end after orientation. Residents have access to the Program's Mindray TE X ultrasound machines in both the hospital and clinic, so ultrasound can become part of everyday patient care. It’s not just something you practiced once in SIM lab.

Monthly hands-on POCUS sessions give residents additional scanning time with faculty and senior residents, often built around interesting cases from our own services.

The goal is simple: don’t just know the answer for the boards. Know what to do when the patient is actually in front of you.

Board Review:

Every resident receives MKSAP through a paid ACP membership plus a UWorld subscription because board prep shouldn't require you to buy your own resources. PGY3 residents also receive an allowance for board review as well. Board-style questions are built into AHD with faculty there to help with test-taking strategy, clinical reasoning, and high-yield topics you may not see every day in West Texas. Sometimes board prep gets competitive. Residents also prepare for Doctor's Dilemma, ACP's Jeopardy-style competition where IM residency programs from across Texas go head-to-head at the annual Texas ACP meeting.

Learn the medicine, learn how to take the test, pass your boards, and maybe bring home some bragging rights along the way!

Wellness and Annual Retreats:

Working hard doesn't mean losing yourself. There will be long days, difficult patients, and moments when medicine humbles you. That's residency. But burnout isn't a badge of honor, and misery isn't proof that you learned more. We want you to work hard, take great care of your patients and still have friends, family, interests, and a life outside the hospital. Our goal isn't just to get you through three years. It's to help you build a career in medicine you'll still love years from now.

Wellness here isn't just another required lecture about wellness. A resident-led committee plans a monthly activity for anyone who wants to join thus giving residents a chance to get out of the hospital, have some fun, and spend time together outside of work. And the best part? We’ll pick up the tab.

Each class also has a retreat twice a year with protected time away from the usual routine. Retreats include guest speakers, dedicated time to give direct feedback to the Program Director, and an off-campus team activity.

Take a break, have some fun, strengthen friendships, and help shape the program you're part of.

Mentorship and Career Coaching:

You won't go through residency wondering where you stand or trying to figure out your career path alone. The Program Director meets one-on-one with every resident about every six weeks for a check-in, feedback, goal setting, and career coaching.

You'll also have a faculty mentor and are encouraged to build relationships with physicians doing what you hope to do whether that's hospital medicine, primary care, or fellowship. Most of those connections happen naturally, but if you need help finding the right person, we'll make the introduction.

Here, you will have people who know you, know your goals, and are invested in helping you get there.

Semiannual Reviews:

Twice a year, you'll sit down one-on-one with the Program Director or Associate Program Director to review your progress and feedback from the Clinical Competency Committee. This isn't meant to be a “gotcha” meeting. It's a chance to talk about what you're doing well, where you can grow, and what you need from us to keep moving forward.

You will know where you stand, keep getting better, and never be surprised by your feedback.

Quality Improvement and Scholarly Activities:

Every resident completes at least one QI project in their three years of residency. They also complete two scholarly activities yearly. Both of which the resident will have a faculty mentor to help guide the process. Scholarly activities can include formal research projects but could be as simple as leading an AHD lecture, helping in a resident workshop, leading a workshop for college students, participation on a hospital committee, case study or abstract for ACP, etc.

Have work worth sharing? We want you to take it beyond Shannon. Residents are encouraged to present at local, state, and national conferences, with time away and financial support available for presentations. You won't be figuring it out on your own. You'll have access to Shannon's research team and resources, plus additional academic support through our affiliation with Texas A&M University Naresh K. Vashisht College of Medicine.

Find something that interests you, build a project around it, and we'll help you take it as far as you want to go.

Moonlighting:

Residents are encouraged to obtain their full Texas medical license as soon as they're eligible which is typically after PGY1 or PGY2 depending on citizenship and visa status. The Program provides a stipend to help cover the cost.

Interested in moonlighting? Opportunities may be approved case-by-case by the Program Director once you're licensed and ready. Residency comes first, and all clinical work including moonlighting must stay within the 80-hour weekly duty-hour limit.

Build your skills, earn your license, and when you're ready, you may have the opportunity to earn some extra money too.

Volunteerism:

Residents participate in two volunteer activities each year, but what you choose is up to you. It doesn't have to involve medicine. You can pick something you care about. Our community supports our residents and the patients we serve, and we believe being a great physician means staying connected to the people around you. This is simply our way of making giving back part of the culture of our Program.

Do some good. Get involved. Be part of the community you serve.