Continuity Clinic and Ambulatory Care

• All residents in the Categorical Program are assigned to faculty mentors who supervise their outpatient ambulatory rotations. Categorical residents are assigned to the Ambulatory Clinic at SVH and Primary Physician Partners.  Our X+Y schedule allows for significant time dedicated to the ambulatory setting with focus on learning the skills necessary for outstanding outpatient medicine performance.
• Residents are assigned a panel of patients, and they care for these particular patients longitudinally over their three years of training.  As they progress through training, residents increase their panel size as well as the number of clinic visits per session with progressive level of responsibility and growth.  By the end of their PGY3 year, residents will be managing their own patient care needs independently with support of their preceptor.
• The ambulatory care and preventive medicine rotation is intended to be an experience where residents focus on chronic disease management, management of acute care issues, assessing and managing patients to preempt hospitalization, identifying and managing patient psychosocial and unique patient characteristics, and progress with a strong focus on preventative medicine.
• During ambulatory blocks, residents are scheduled for an Academic Half Day Session where there are teaching sessions dedicated to topics covering ambulatory medicine, as well as varied topics in professionalism, communication, opioid prescribing, and research.
• During ambulatory blocks, residents are assigned to a Clinical Concentration, which consists of sessions with a subspecialist in the outpatient setting. This allows for ambulatory experience in medical subspecialties, with the subspecialty varying over the course of the year.  Examples include cardiology, urology, dermatology, gastroenterology and geriatrics.
• Residents also audit their own patient panel and care practices, craft solutions to improve their delivery of evidence-based medicine, and re-measure their performance through our Panel Management Initiative.

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.

In addition to their ambulatory care rotation, residents also rotate in specialty clinics like Dermatology, Ophthalmology, Urology, etc. All residents work together to complete a Performance Improvement project and present their findings at a Morning Report during their ambulatory care block months.