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Continuity Clinic and Ambulatory Care

All residents in the Categorical Program are assigned to faculty mentors (preliminary interns are assigned to either the Program Director or Associate Program Director) who supervise their outpatient continuity and block rotations. Categorical residents are assigned to the General Medicine Clinic at SVH or the offices of general internists at the Fallon Clinic or in the community. The General Medicine Clinic is directed by faculty members who precept all residents who rotate at that site. Residents have their continuity clinic one-half day per week throughout their three years of training. Block ambulatory rotations of 1 month are taken in the PG1, PG2 and PG3 years. Their ambulatory preceptors complete formal evaluations of residents after each monthly block rotation and twice a year for Continuity Clinics. Detailed information on the goals and expectations of the ambulatory experiences and site-specific information on the resident’s duties and responsibilities are provided to new residents at the start of their rotations at each of the ambulatory sites. This information is also available on the hospital’s intranet and has been sent to all mentors.

Please note: The ACGME requires that each categorical resident must attend at least 130 continuity sessions over 3 years.

 

Ambulatory Care

The ambulatory care and preventive medicine rotation is intended to be an experience where residents learn to take care of less acutely ill patients and focus on management of problems attempting to preempt hospitalization, as well as on preventative medicine. A cardinal difference between the approach to hospital medicine and ambulatory medicine is that in the case of the former, the emphasis lies in getting the patient home, while in the latter, it is in rehabilitating the patient in his/her home setting and addressing all the issues surrounding their functioning in that setting.

Through the course of this rotation, residents are exposed to the theoretical aspects of ambulatory medicine in the form of a series of topic discussions, a schedule for which is provided monthly. Most of these discussions focus on outpatient topics of significant importance and which residents will encounter commonly. Further, during the month they are expected to review national consensus guidelines on screening for common diseases as part of an education in preventive medicine. It is expected that they will read around the topic by researching current literature (and not a textbook or electronic data source like Up-To-Date alone) so as to both master current peer reviewed information as well as learn how to perform a relevant and focused literature search. All house officers are required to attend their outpatient clinics, except for interns rotating through the CCU and MICU, on vacation, or during night float rotations.

Dedicated ambulatory blocks (with the assigned preceptor) are required of all categorical residents. Each resident shall work one-month every year. Outpatient electives (dermatology, ophthalmology, etc) are scheduled on Wednesdays and Fridays. Other outpatient electives (such as rheumatology) may take the place of up to two of the six required outpatient months. All residents are expected to complete a Performance Improvement project and present their findings at a Morning Report during their ambulatory care block months.

Dr. Jane Lochrie, Program Director volunteers at a Free Medical Program on Tuesday evenings from 6 . 8 pm. Residents are assigned to join in on select days in the month, to give them a feel of the practice of medicine in the setting of limited resources, no access to investigations, etc. As part of the educational experience, raw of the literature on the topic and a conclusion/summary with recommendations. References should be properly used, quoted and annotated at the end.