The didactic component of the ambulatory curriculum includes the pre-clinic conferences, which provide practical, case-based reviews of common outpatient topics. During the ambulatory block, residents also participate in an Ambulatory Core Curriculum that includes a resident/faculty-taught evidence-based medicine series, and workshops on physician-patient communication skills, minor office procedures, and physical diagnosis. Also included are seminars in preventive medicine, psychosocial medicine, women's health, preoperative consultation, and outpatient management of common chronic diseases. There is a weekly ambulatory morning report in medicine, and a weekly series of outpatient pediatrics conferences which housestaff can attend when on outpatient rotations.
Residents also have an opportunity to participate in community projects including a medical clinic established by Program faculty in a homeless shelter, a free-care van for the uninsured in Waterbury, and community health promotion and disease prevention projects. Residents may also contribute to an annual month-long basic science review/career counseling course for minority college students who will be applying to medical school that is sponsored by the Primary Care Residency Program and the Office of Multicultural Affairs.
There are several other educational activities of relevance to ambulatory medicine and pediatrics. Some examples include high quality journal club series in both the Medicine and Pediatrics departments, a quarterly ethics series in Pediatrics, and a monthly Med-Peds noon conference.
Residents learn to assess and manage common problems in ambulatory care in clinic under the supervision and guidance of their faculty preceptors. To enhance this clinical experience and supplement any gaps in their firsthand encounters, we developed a literature-based curriculum that covers a wide span of primary care topics in pediatrics.
The YOBM and PCPC serve as the basis for the weekly pre-clinic conference that takes place in the half hour prior to resident continuity clinic. This conference is led by either a faculty preceptor or a resident under faculty supervision. Residents read the cases and key reference materials prior to coming to pre-clinic conference, which minimizes the amount of didactic information to be covered and enables vigorous discussion of the questions posed in the cases. The groups are small (including only residents, students, and faculty who have clinic that day), which facilitates active discussion and personalized education.
The curricula serve as a guide for organized, case-centered, evidence-based discussions of core topics in outpatient medicine and pediatrics as well as issues relating to the ethical, legal, and business aspects of healthcare. Through use of the curriculum, we ensure the quality, content, and accuracy of pre-clinic conference sessions from week to week. The curricula are available to Yale housestaff and faculty in both paper and online versions, both of which contain internet links to reference articles and useful resources.
Each chapter of both YOBM and PCPC is arranged in a standardized format: a case vignette followed by a series of questions. A moderator's version (“answer key”) also contains suggested answers to the questions, teaching pearls, and suggestions for group exercises to reinforce key points.
These innovative curricula were collaboratively developed by Yale housestaff and faculty to fortify evidence-based learning in our clinical conferences. All original content was in fact written by Yale housestaff and faculty, and continues to be updated annually. The curricula are used by over a 100 Med-Peds, Internal Medicine, Pediatrics, and Family Medicine residency programs nationwide, and have met with a high level of satisfaction based on surveys of residents and faculty. Med-Peds residents frequently serve as chapter co-authors with faculty, an opportunity that allows for scholarship, mentorship, and a richer understanding of a specific topic of interest. A full list of topics available can be found at the websites for each curriculum: yobm.yale.edu and pcpc.yale.edu.