Ambulatory Care/Primary Care

 The Internal Medicine Residency Program has a firm commitment to graduate internists with expertise in primary care medicine.  Since communication skills are a cornerstone to the provision of primary care, our emphasis on primary care includes a written curriculum and defined goals in physician-patient communication.  This is included in the overall written Curriculum which describes all key educational activities and rotations and is handed out before Orientation. 

Review of communication skills is initiated shortly after match results become available.  At that time, matched physicians are sent the written Curriculum and reading materials on the suggested techniques for various interview situations.  At the annual Orientation for new house staff, this material is reviewed.  Such review occurs in the course of lectures, demonstrations, and observation of previously video-taped interviews.  Lectures at the annual Orientation include the following:     

History taking - in the Hospital

History taking - in the Clinic

Effective use of an interpreter and the culturally sensitive interview

Introduction to Spanish

Terminal illness and giving "bad news"

Patient counseling, education, and effecting compliance

Cultural competence training is an important part of communication skills;  and the residency training program has a curriculum for training residents in Cultural Competence and Diversity that seeks to achieve favorable communication outcomes for patients, physicians and other providers.  Cultural competence is taught in both lecture and interactive formats.  As part of faculty development activities, faculty, as trainees and trainers, are included in the curriculum on Cultural Competence and Diversity.

Continuity of care (including coverage and tracking) is another key element of primary care medicine.  Thus, to provide continuity of care to our patients, each resident physician is assigned to a Continuity Office Practice.  There, residents have the opportunity to care for a diverse patient population with a broad spectrum of problems.  The patients present for preventive health care, simple problems, and sometimes chronic and/or complex problems.  The residents care for patients on a long term basis, providing comprehensive, coordinated care as part of the Continuity Office Practice team.  The computerized medical record system simplifies the process of of tracking and monitoring care given to patients in other settings. 

Residents spend at least 20% of their time following their panel of patients in a single Continuity Office Practice.  This is accomplished by attending the Practice at least two sessions a week, under the supervision of a board certified internist.  Each team generally consists of one attending and four residents, and ample time is allowed for physical examinations, treatment, and patient education.  The continuity site has an appointment system which accommodates personal appointments as well as walk-in patients and referrals. The continuity site operates at least 40 hours a week, including 8 hours on weekends. 

Residents also spend 1 month of block ambulatory Continuity Office Practice during both the PGY-1 and PGY-3 years of training.  While on the block continuity rotation, residents provide care to their own ambulatory patients, as well as cross-covering patients usually followed by other members of their Continuity Office Team.  During the block ambulatory Continuity Office Practice, residents attend a weekly ambulatory care conference where topics from the curriculum on Ambulatory Care and Cultural Competence are taught. 

Patients are followed from the ambulatory to the inpatient arena, as well as from the Hospital to the Continuity Office Practice.  New patients seen during an admission are encouraged to follow up as an out patient to the resident's Continuity Office Practice.  And when outpatients are admitted, the primary house officer who usually cares for the patient is able to track the patient via the clinical computer system.           *