Introduction

You are about to spend a month learning internal medicine in the office setting. You may be placed in a subspecialty practice for a portion of your time, but your main assignment will be in general internal medicine/ primary care. A strong system of primary care is an essential platform for a modern health care system. In the U.S., however, the system is struggling to meet the needs of our changing population. Policy makers and professional groups are calling for significant restructuring in primary care finance and delivery. In these circumstances of crisis and evolution, the importance of training in the ambulatory care environment is particularly important for physicians who will inherit and shape our health care system.

Rationale And Special Features Of Ambulatory Care Education

• Most interactions between internists and patients occur in ambulatory care
• Most patients with medical illness do not require hospital admission
• Core competencies for internal medicine can be learned efficiently in the office
• Work in ambulatory care requires a distinct set of patient care skills
• Ambulatory care internal medicine has a central role in the US health care system
• Students need broad specialty experience to guide career choice

The Department of Medicine recognizes that the care of hospitalized patients is a key skill for general internists or subspecialists whose responsibility to the patient must not stop at the onset of severe illness.  With the Ambulatory Component of the Internal Medicine Clerkship, however, the Department has established a balanced curriculum that includes instruction in the distinct skills required for the care of patients who do not require hospitalization and patients who have been discharged to resume life in their communities.  The Curriculum in Ambulatory Care will improve students' preparation for practice in internal medicine itself and other specialties that interface with it.  Very importantly, it will also help students acquire a more accurate understanding of modern internal medicine within our current health care system