We are writing to express our outrage and deep disappointment regarding the sudden and unilateral curricular changes to the Neuro ICU and MICU rotation, changes being implemented in less than one month without adequate notice. Today, we join together in collective action alongside our IM, FM, and EM colleagues because it is clear our voices are not being heard through traditional channels.

These changes were crafted behind closed doors, with little transparency and even less regard for the concerns raised by the Curriculum Committee, our peer-selected representatives who are simply advocating for the best interests of the residents. This is not collaboration. It is dismissal.

With the academic year just over 2 weeks away, there is still no clear or finalized schedule for either ICU rotation. Why are we forcing residents into a mandatory Neuro ICU rotation when there are already issues getting elective time in their specialty of choice, not to mention critical staffing needs in Firm C Blue that would benefit from these same residents? Why not focus efforts on strengthening the general neurology curriculum first, rather than patchworking an ill-conceived plan at our expense?

As for the MICU, in an era when programs nationwide are abandoning 24-hour call structures, this administration is inexplicably reinstating a 24+4 q4 call model. This regressive move worsens the schedule, removes essential supervision for interns on post-call days, and eliminates a valuable learning role for day float seniors—undermining both education and patient safety.

To date, leadership has not even had the courtesy to formally announce these sweeping changes to the IM residents outside of the Curriculum Committee or hold a single Town Hall to hear resident concerns. Since we’ve been denied the opportunity to speak, we are presenting you with the results of our resident survey, which overwhelmingly reflect how deeply unpopular and unsafe these changes are.

We are left with no choice but to take action. This collective action is not symbolic—it is necessary. Our learning, safety, and dignity demand better.

We issue the following demands:

1. Delay implementation of the Neuro ICU rotation and MICU rotation changes by at least 6 months—until the general neurology curriculum is strengthened and residents have rotated through it and until a MICU schedule can be proposed, vetted, and safely implemented.
   
   

2. Make the Neuro ICU rotation opt-in, not mandatory—designed for residents seeking advanced critical care experience. 100% of surveyed IM residents (n=86) do not believe that the Neuro ICU rotation should be mandatory. 
   
   

3. Cap Neuro ICU at 10 shifts, each no longer than 10 hours—there is no justification for 12-hour shifts managing just 3–4 patients.
   
   

4. Immediately withdraw the 24+4 hour call model in the MICU—it is unsafe and outdated and will result in resident burnout
   
   

5. Preserve the MICU day and night float system—it ensures intern supervision, maintains patient safety, and provides essential support during high-volume periods.
   
   

6. If day float is removed, a dedicated senior IM resident must be assigned to supervise interns from noon until sign-out
   
   

7. Reassign the two senior residents intended for Neuro ICU to Firm C Blue—where there is an actual staffing shortage and immediate patient care need.
   
   

We expect a prompt and public response to these demands. We will not quietly accept decisions that compromise our education, our safety, and our patients’ well-being.

Sincerely,

The Internal Medicine Residents