Residents split time ~60/40 between University Health Truman Medical Center, western Missouri's only safety net hospital, and one of the region's largest tertiary referral centers, St. Luke's Hospital, with hands-on exposure to the full spectrum of internal medicine. They rotate through both inpatient and ambulatory experiences in each of the IM subspecialties, including 3-4 months in a variety of ICU settings. Trainees have a robust experience in QIPS, completing a QI project each year.