Over the course of three years of training, our primary care residents benefit from numerous robust clinical experiences within outpatient general internal medicine and its subspecialties. This experience is gained through rotations in a variety of settings including private general internal medicine, private practice and university subspecialty offices, and their own weekly continuity clinic practice.
Interns have a minimum of 18 weeks of ambulatory time that is composed of eight weeks of “Immersion Blocks” at their continuity site, two weeks on an urgent care/quality improvement rotation, two weeks on an outpatient neurology rotation, four weeks on a predominantly outpatient geriatrics rotation, and two weeks in the York Street Campus Emergency Department. The continuity site Immersion Blocks include weekly continuity clinics, hospital follow-ups, urgent care, an in-depth psychosocial curriculum, rotations through several core outpatient specialty clinics either on-site or at local outpatient offices, protected time for practice-based reflection and continuity panel quality improvement, and participation in our celebrated Ambulatory Friday curriculum. Outpatient subspecialty offerings during these blocks include our on-site addiction medicine and diabetes clinics, dermatology clinic at a New Haven-based Federally Qualified Health Center, addiction medicine at the local methadone maintenance center, women’s health at Planned Parenthood, ophthalmology, nutrition counseling, otolaryngology and podiatric medicine at local affiliated private practice sites, and our own warfarin anticoagulation clinic. Described in more detail elsewhere, the intern psychosocial curriculum is a cornerstone of the Yale Primary Care Program and includes a psychiatry consult clinic, behavior change clinic, and a medical interviewing practicum that includes review of videotaped patient encounters. Lastly, in addition to protected time for practice-based reflection and a quality improvement project, our Immersion Blocks feature a novel interactive curriculum co-authored by faculty and residents that is designed to cultivate the Systems-Based Practice core competency prescribed by the ABIM. This self-directed workbook bolsters interns’ knowledge of their continuity practice site, exposes them to the logistics of accessing the local resources available for our underserved patients, and builds upon essential outpatient medicine skills such as billing and coding, procedure documentation, and navigating our evolving health care system. Interns are required to develop and implement a practice innovation at their training site by the end of their second 4-week immersion block. Intentionally, all interns benefit from their first immersion block within the first four rotations of intern year to ensure that they are developing proficiency at their continuity site.
The two-week neurology rotation incorporates some inpatient, and mostly outpatient practical experiences that enhance the clinical care of neurologically complex patients in the primary care setting.
Second year residents spend a minimum of 16 weeks devoted to ambulatory training. This includes a total of 14 weeks in dedicated ambulatory block rotations and at least 2 weeks of elective in an ambulatory setting. Residents may also select ambulatory settings for all 8 weeks of scheduled elective bringing the ambulatory training total up to 22 weeks. In addition, the required non-CCU cardiology rotations during the PGY-II year incorporates both hospital-based and outpatient-based experiences.
The ambulatory block rotations for PGY-II residents include four 4-week rotations in various settings including community primary care teaching practices and continuity clinic immersion blocks. These immersion blocks include continuity clinics, urgent care clinics, several specialty clinic options, protected time for research, community and/or advocacy programs, and time dedicated to quality-improvement and systems-based practice. While on the ambulatory specialty block, residents have two continuity practice sessions weekly, participate in our diabetes disease management, joint injection, and dermatology clinics and attend specialty practices of their choosing to round out the experience.
During third year, residents spend a minimum of 20 weeks devoted to ambulatory training. This includes a total of 16 weeks in dedicated ambulatory block rotations (four rotations of 4 weeks each), at least 2 weeks of elective and 2 weeks of Emergency Medicine. Residents may select ambulatory settings for all 8 weeks of scheduled elective bringing the total ambulatory training opportunities up to 26 weeks.
The ambulatory block rotations for PGY-III residents include four 4-week rotations in various settings including community primary care teaching practices and continuity clinic immersion blocks with protected time for research, peer teaching, or quality improvement projects if desired, and a 2-week rotation that, depending on the interest of the resident, can focus on areas such as policy and advocacy, narrative medicine, business of medicine, home visit experiences, quality improvement, or a clinician educator elective.
While on ambulatory block, residents at all PGY levels maintain their weekly continuity clinic. In addition, all of the residents on ambulatory block convene on Fridays for our dedicated ambulatory medicine curriculum, which includes lectures, interactive seminars, peer teaching, self-directed learning, workshops, and off-site experiences.