Ambulatory Program - Internal Medicine Residency

Our residents receive extensive training in ambulatory medicine through their continuity clinics, subspecialty practices, acute walk-in clinics and private practices. Through our noon core curriculum and ambulatory conferences, residents expand their primary care knowledge in both didactic lectures and small group discussions.

The Associate Program Director for Ambulatory Education and the Primary Care Chief Resident are responsible for development and implementation of the ambulatory curriculum.

Continuity Medical Clinics

Residents immerse themselves in their continuity medical clinic throughout their residency training at one of the following four sites:

• University Health Center (UHC)
• Primary Care Clinics at the VA
• Faculty Practice Office (FPO)
• Mercy Medical Center

For Interns

Academic General Internal Medicine (AGIM) and Clinical General Internal Medicine (CGIM) Rotations

Interns have four two-week ambulatory blocks with 2 AGIM and 2 CGIM blocks.

• Academic General Internal Medicine: Interns attend their continuity clinics in the afternoons and have a variety of learning sessions in the morning including simulation and ultrasound sessions, literature in medicine, mentorship meetings and wellness half-days.
• Clinical General Internal Medicine: Interns enhance their primary care knowledge and skills by seeing a wide variety of acute and chronic medical conditions alongside our GIM faculty in our Faculty Practice Office.

AGIM Rotation

	Mon	Tues	Wed	Thurs	Fri
Week 1 Mornings	Ultrasound Sim	Practice Based Learning	Literature in Medicine	Wellness Check-In	Mentorship Meeting
Week 1 Afternoons	Continuity Clinic	Academic Half Day	Continuity Clinic	Continuity Clinic	Continuity Clinic
Week 2 Mornings	Opioid Use Disorder Didactics	ACLS Sim and Mock Codes	Yale Curriculum	Ambulatory Hot Topics	Practice Based Learning
Week 2 Afternoons	Continuity Clinic	Continuity Clinic	Continuity Clinic	Continuity Clinic	Continuity Clinic

For Upper Level Residents

X+Y Scheduling

Rotation schedules for PGY-2 and 3 residents are in a 4+2 format.

• X (4 weeks) = inpatient rotations, electives, ER and vacation time
• Y (2 weeks) = ambulatory with continuity medical clinic in the afternoon and general medicine and subspecialty clinics in the morning.

Academic Half-Days

Interns and residents attend an Academic Half-Day one afternoon during each AGIM, CGIM and Y-block. During this protected education time, residents are exposed to a huge variety of topics using various learning formats facilitated by our faculty. Examples include, primary care, business of medicine including documentation, billing and coding, medical education training, high value care, journal club and senior resident led conferences, among others.

Ambulatory Education

Consolidating continuity clinics into 2-week blocks allows residents to focus and build their ambulatory skills and patient panel, provide outpatient exposure to subspecialty care and allow for dedicated time for research and quality improvement.

• Longitudinal Subspecialty Clinics. Resident can choose to "major" in cardiology, GI, ID, endocrinology, pulmonary medicine or other subspecialties over a 3-4 month period. This allows residents to explore these areas in more depth and develop close relationships with faculty in the field.
• Opioid Use Disorder Education. Interns receive early didactic lectures on opioid use disorder, buprenorphine waiver training, and harm reduction with special focus on the social determinants of health in this challenging patient population. Senior residents have the opportunity to rotate in buprenorphine clinics and methadone clinics.
• Inter-professionalism Pathways. We currently have 3 inter-professionalism pathways in Endocrinology, Infectious Disease, and Hematology and Oncology – Providing those residents that are interested with the opportunity to gain more in-depth education and exposure and a potential to gain a Certificate of Excellence in these fields.
• Resuscitation simulation and Ultrasound Session. While not ambulatory-centric, these sessions allow residents to build the skills and confidence in performing procedures and leading codes for when they return to their inpatient rotations.