The Ambulatory Experience
Continuity Practices
Residents are active participants in the primary care practices at Boston medical center (BMC) and the affiliated Neighborhood Health Centers and the VA. Our residents functioned as the primary care physicians for a panel of patients, working closely with a multidisciplinary team over the three years of training. This team includes faculty preceptors, a continuity care nurse, psychiatrist, clinical psychologist and social worker. Through this multidisciplinary team approach, residents learn to provide comprehensive care for an extraordinarily diverse patient mix in a supportive environment. Each clinic session begins with a 45 minute lecture and discussion of a current topic in outpatient medicine.
Throughout residency, the residents’ patient panel will grow in size and complexity as their skills mature. In addition to direct referrals from the community, residents may self-refer patients whom they care for on the wards, the emergency department, and ambulatory block rotations to their own practice.
The Extended Ambulatory Experience
Ambulatory block rotations, described below, complement the resident’s inpatient and continuity clinic experiences. Additionally, opportunities exist for subspecialty clinic experiences in: Rheumatology, HIV, Nephrology, Hematology/Oncology, Gastroenterology, Cardiology and Pulmonary. A curriculum of daily morning outpatient conferences including ambulatory morning report enhances the educational experience.
PGY-1 Ambulatory Block: PGY-1 residents have the opportunity to rotate through the Pulmonary Acute Care Ambulatory service at the VA, as well as the outpatient cardiology clinics. In addition the ambulatory block at BMC was redesigned to enhance and expand the resident’s experience in the ambulatory setting, emphasizing the development of core skills and providing a foundation for subsequent ambulatory experiences. Components of this rotation include:
- Communication skills exercises, with debriefing of video-taped patient encounters.
- Physical exam skills workshop
- Episodic care and an expanded continuity clinic experience
PGY-2 Ambulatory Block: The goal of this block is to enhance and expand the resident’s experience in the ambulatory setting. This experience provides a highly structured and closely mentored outpatient experience in selected subspecialties, complementing the emphasis on inpatient management in the existing curriculum. The rotation includes extended time in continuity clinic. Each subspecialty has developed specific learning objectives, and the resident works closely with core faculty.
