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Baystate's Learner-Manager-Teacher Model-EIP Project

ACGME Educational Innovations Project (EIP)

Our Internal Medicine Residency Program was one of only 17 Internal Medicine residency programs chosen in March 2006 to participate in the first round of  the Accreditation Council for Graduate Medical Education's Educational Innovations Project (EIP). 

The EIP empowered programs to develop innovative training models for the purpose of advancing quality patient care, facilitating competency-based education and outcomes assessment, and better serving the professional needs and career goals of residents.

ACGME awarded EIP grants to Internal Medicine Residency Programs that are demonstrably well-suited and ready for innovation. Qualifications to participate included an excellent accreditation review history, strong institutional support, Electronic Medical Record, and sound program structure.

Learner-Manager-Teacher Model: Baystate’s EIP

A graduating resident being considered for a faculty position 

made a request that changed our program. She asked to 

manage patients on her own before taking on resident teaching.

Her comment prompted us to reexamine our approach.

Understanding that patient care and education are interdependent, we designed a system that maximizes the quality of both - our Learner-Manager-Teacher Model.

We conceived the first year as the Learner stage, the second year as the Manager stage, and the third year as the Teacher Stage.

The L-M-T Model has several advantages.

  • PGY2s are freed from the responsibility of teaching PGY1s. They manage patients on their own, working one-on-one with attending physicians.
  • PGY1s are all taught by PGY3s who have more clinical experience.
  • PGY3s focus on teaching and leadership skills as they supervise PGY1s.
  • Teaching sessions are better focused to the developmentally appropriate stage.

As an Internal Medicine resident here at Baystate, you will participate in this exciting project.

Learn it and do it before teaching it.

To simultaneously maximize both education and quality patient care there must be a proper balance between supervision and autonomy in resident education.


As you gain competence in our Learner-Manager-Teacher Model, you will progress from a high degree of supervision to an increasing amount of autonomy. In addition, you will develop a partnership with your colleagues and faculty, an increased awareness of safety and quality, and the skills necessary to become a life-long learner.

Learner Stage (PGY1)

As a Learner, you will:

  • build a solid foundation of clinical skills
  • become competent to manage common medical problems, stabilize critical patients, and know when to call for help.

As an early physician-in-training,  you will benefit from a high degree of supervision as you learn basic skills. 

Learners have two layers of supervision: their Teaching resident and their Attending physician. This provides the back-up needed to provide safe, high quality care to patients, while also guiding you to identify your learning needs.

Manager Stage (PGY2)

As a Manager, you will:

  • make independent decisions on all aspects of patient care, from initial evaluation to discharge summary
  • increase your competency to manage patients with more complex medical problems

I had to learn about each case on Up-to-Date and from articles. I read more as a Manager and by the end of the month, I was a totally different person. I knew where to look, what to do.  I loved it."

- Resident Manager

As a Manager, you are now much more capable of independent practice and can be granted greater independence in clinical decision-making without compromising patient care.

Managers work 1-on-1 with their supervising Attendings in a collegial and collaborative relationship. You will also share a call schedule, teaching sessions and cross-coverage with a team of four Manager peers.

The Manager stage avoids the anxiety residents typically feel at the end of their first year by eliminating the responsibility of taking on the overseeing and teaching of interns.

Teacher Stage  (PGY3)

As a Teacher, you will:

  • practice and advance your teaching skills
  • supervise Learners

As a Teacher, you will gain more autonomy and develop leadership skills as you supervise and teach Learners in partnership with your supervising Attending.

In addition, the very act of teaching reinforces the knowledge, skills and attitudes involved in patient care. And, supervising Learners gives you needed exposure to a broader scope of clinical problems and teaching tools.