How chief residents make the block schedule, step by step

A residency block schedule is the plan for the whole academic year that assigns every resident to one rotation in each block, usually four weeks or a month long. It decides which services are staffed, when each resident does ICU, nights and electives, and where clinic and vacation weeks fall.

In most internal medicine programs, chief residents make the block schedule for core rotations, usually with no training in how to schedule.

Example of a block schedule. Four fictional PGY-2 residents over the first four blocks of the year:

Every block staffs every service, nobody goes straight from nights to the ICU, and vacation weeks sit inside electives. A full year has 13 four-week blocks.

With Chiefly, chiefs don’t make the block schedule by hand. Each step they’d otherwise work through by hand, below, is one Chiefly already handles:

• Gathering requirements. You send last year’s schedule and your requirements in whatever format you have, and our team loads your rules and ACGME requirements, along with the hundreds of nuances we’ve built up over many GME clients. We work to your program’s timeline.
• Fixed dates, staffing, hard rotations and electives. Chiefly generates the block schedule from those rules, with the daily, clinic and call schedules built from it as one integrated system.
• Checking every rule. Every draft is checked against every rule automatically, and anything Chiefly can’t meet is flagged before it goes out.
• Reviewing with your PD and APDs. Your chiefs review drafts, test what-ifs in a sandbox and compare saved versions.
• Publishing. Residents can see the schedule in Chiefly, and every schedule exports to Excel, formatted for whatever your hospital publishes in.
• Managing changes. When leave, late starts or off-cycle residents change the year, your chiefs re-run the schedule themselves and get the result in minutes, with your rules intact, instead of emailing anyone and waiting. Swaps are checked against your rules before a chief approves them.
• Next year. Your rules stay in place for the next chief class to keep or edit, and rollover brings in your incoming matched residents. Dashboards for program directors track each resident’s progress year over year, each new chief class gets its own training, and your scheduling advisor stays the same.

Boston Children’s, with 188 residents across two hospitals, saved more than 3,600 chief and admin hours in its first eight months. UVA Pediatrics, with 40 residents, built its academic year in a week and a half and saved 513 chief hours. A small program with a fixed, repeating pattern may manage in a spreadsheet for a while; see Chiefly vs Excel. More on how it works: residency block schedule software.

By hand, chiefs work from the hardest constraints to the easiest, usually in a spreadsheet:

1. Gather the requirements. Start with the ACGME Common Program Requirements, your specialty’s program requirements, your board’s eligibility rules and your program’s own rules. Pediatrics, for example, requires 12 weeks of intensive care across residency, including at least 4 weeks each in the PICU and NICU. Build the roster by PGY year and track, with off-service rotators, off-cycle residents and known leave; boards decide when time away extends training; see our parental leave guide. Collect vacation and elective requests by a deadline.
2. Lock the fixed items first. Enter everything with a date you can’t move: X+Y clinic weeks, required rotations with fixed dates, in-training and board exams, conferences, and fixed vacations. In an X+Y program, each resident’s Y weeks set the rhythm for the rest of the year.
3. Set staffing minimums. For each service in each block, write down how many residents it needs at each PGY level and the most it can take, counting off-service rotators who fill a slot.
4. Place the most constrained rotations first. Schedule ICU, nights and rotations with few slots before anything else, because they have the fewest places they can go. Spread them across the year and the class, and respect back-to-back limits as you go.
5. Fill the remaining rotations and electives. Assign the rest of the required rotations, then electives by preference, with vacation weeks inside lighter rotations where your rules allow. Track how many requests each resident has been granted, and let whoever has the fewest choose next.
6. Check every rule. Go resident by resident and block by block: back-to-back limits, night limits (your specialty’s Review Committee can cap consecutive weeks and months of night float), staffing minimums in every block, and each resident’s progress toward graduation requirements across all years. Check duty hours too: the 80-hour week, days off and call frequency are each averaged over four weeks; see our duty hours guide.
7. Review with the PD, APDs and coordinators. Share the draft and the trade-offs you made, and fix what they catch before residents see it.
8. Publish it. Send the final schedule to residents, and to rotation directors who need to know well in advance who’s coming.
9. Manage changes through the year. Leave, late starts, off-cycle residents and swaps all ripple through the schedule. For each change, re-check staffing, rules and graduation requirements for everyone affected, save it as a new version, and tell the rotation directors.

About half of a chief’s year. That is what chief residents tell us when we talk with them about scheduling by hand. Chiefs can spend weeks designing the schedule manually and can only satisfy so many constraints at once, and every leave, late start or swap afterwards means re-working the year by hand.

A new chief class has it hardest: in one emergency medicine program, residents rated the incoming chiefs’ first schedule significantly lower, and ratings recovered two months later.

With Chiefly, the build is generated from your rules and every change is a re-run your chiefs do in minutes. UVA Pediatrics built its academic year in a week and a half and saved 513 chief hours, and at Children’s National a mid-year change that took a week or more to work through now takes 15 to 30 minutes.

Finish the block schedule well before the academic year starts on July 1, so residents can plan vacations and rotation directors can plan coverage. Many programs build it in the spring. A workable calendar:

• Fall and winter. Update the rules and roster from this year’s schedule, and collect vacation and elective requests.
• March. Match Week tells you who your incoming interns are; for the 2027 Main Residency Match, it ends with Match Day on March 19, 2027. Hold intern lines as placeholders until then.
• Spring. Build, check every rule, and review drafts with the PD, APDs and coordinators.
• Late spring. Publish to residents and rotation directors, well before July 1.

Build the call schedule from the finished block schedule, since a resident’s rotation usually decides which call they take. Then:

1. Define each call type: in-house 24-hour call, night float, home call and backup call, also called jeopardy.
2. Write down the ACGME limits: 80 hours a week, one day in seven off and in-house call no more than every third night, each averaged over four weeks; 14 hours off after 24 hours of in-house call; and no shift longer than 24 hours plus up to 4 for handoffs; see our duty hours guide.
3. Count weekends, holidays, nights and backup shifts for each resident across the year, and balance them on purpose.
4. Collect requests by a deadline, build, then share a draft for a short review before you publish.
5. Decide how swaps and backup paybacks work before the year starts.

ACGME also expects programs to design call schedules that keep handoffs to a minimum.

Set the holiday rules before anyone asks, publish them early, and apply them the same way to everyone. Common approaches:

• Pair the holidays. Whoever works Christmas gets New Year’s off, and the reverse. One common split covers the 12 days around both: half the program works the six days around Christmas, and the other half works the six around New Year’s.
• Rotate across years. A resident who works a major holiday this year gets it off next year.
• Break ties openly. When two residents want the same holiday off, settle it with a lottery or seniority rule announced in advance.
• Keep a tally. Track the holidays each resident works across all years of training.

Holidays don’t loosen duty-hour rules. ACGME’s FAQ says rotations over the holidays must still comply, even when the hospital is short-staffed.

Every one of them comes from building the schedule by hand:

• Starting with preferences. Electives placed before the fixed dates and hard rotations get torn up later.
• Finding people late. Off-service rotators, off-cycle residents and known leave belong in the roster from the start.
• Checking staffing but not graduation. A shortfall found in a resident’s final year is hard to fix, so check every resident every year.
• Keeping the rules in your head. Schedules often run on rules of thumb passed from one chief to the next. Write every rule down for the next class.
• Changing without rechecking. One swap can break a back-to-back limit or leave a service short.
• Publishing late. Residents can’t plan their lives, and rotation directors can’t plan coverage.