For those residents that match into the Primary Care Track, the first 18 months and the last 6 months of residency are the same as the categorical residents. However in January of their PGY-2 year, they begin a unique 12 month ambulatory block which fully immerses them in primary care practice. During this ambulatory year, they have an office in our Division of General Internal Medicine suite, they take pager call as attendings (with back-up!) for our primary care practice, and they see patients in their own continuity clinic, in urgent care, in outpatient subspecialty clinics, and one morning per week at Bread For the City, a local community health center and FQHC Look-Alike.
Throughout the ambulatory year, primary care residents develop their teaching skills by leading one journal club and one case conference each week for categorical residents on clinic (+1) week. They maintain inpatient skills by doing a nightfloat admitting shift about once per month. Primary care residents still have a 4+1 schedule so that they continue to do Quality Improvement and ambulatory didactics with their original cohort.
Here is an example of the 4 week block followed by the “+ 1” week during ambulatory year:
4 week example:
|AM||Subspecialty Clinic||Continuity Clinic||Community Clinic||Subspecialty Clinic||Continuity Clinic|
|PM||Continuity Clinic||Subspecialty Clinic||Subspecialty Clinid||Urgent Care Clinic||PrimCare Didactics|
+ 1 week example:
|AM||Neurology Clinic||Didactics||Geriatrics||Admin Time||Neurology Clinic|
|PM||Dermatology Clinic||Dermatology Clinic||Home visits||QI / High Value Care||Prim Care Didactics|
Subspecialty Clinics include: Allergy/ENT, Orthopedics/Rheumatology, GI, Pulmonary/Sleep, Renal/Urology, Cardiology, Endocrine/Podiatry, Heme-Onc/Breast Clinic, Infectious Disease
Elective experiences include: Wound clinic, Adolescent Medicine, Mental Health, Survivorship Clinic, Weight Management Clinic, Health Policy, Global Health, Community Health
This broad exposure to all aspects of ambulatory medicine provides a strong foundation in general medicine that prepares our residents for careers in primary care, academic medicine, general medicine fellowships, or even hospitalist or fellowship positions on rare occasions.