FM residency - block based vs. horizontal?

[Fortress]

Looking up programs for FM right now and curious to know what are people's thoughts on the pros and cons of block-based vs. horizontal curriculum.

[cookie_m]

This is something that I wished I looked into and did more research on. Am currently in a horizontal program. It sounds nice on paper, but there is a significant disadvantage in that I never feel like I get enough time during the week to learn from the other rotations. In most horizontal programs you spend 2 days back on clinic per week. This leaves you with 3 days per week, which usually works out to 12 shifts in a 4 week rotation. 

You probably do get more learning in terms of practice management, but in terms of acquiring knowledge, not sure if it is ideal. Some of my co-residents like it and some of us hate it. Basically it will come down to how you learn best.  I think the horizontal program is ideal for a rural program. I feel like my learning during off-service rotations is very fragmented because of the structure, but you eventually do get used to it. If you absolutely know that all you ever want to do is outpatient clinic for the rest of your life M-F from 9-5, pick horizontal. 

Pros of Horizontal
-get enough FM clinic volume
-get to learn your patients better over time (although you will initially feel like clinic is extremely stressful)
-will really learn whether or not you love or hate clinic (at this point it is too late)
-better learn to deal with difficult scenarios 

I would definitely speak with current residents for their thoughts as this may also be regional. Have spoken to some other horizontal folks and they did not have the same concerns. It seemed like their structure was a little different and had some better integration.