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DEPARTMENT OF MEDICINE

Internal Medicine Residency Program

Continuity Clinic and the Ambulatory Week

 

 

Mission Statement

 

The mission of the Residency Program is to develop master clinicians with the skills necessary to become leaders in medical education, research, and service in a variety of health related fields. In today’s healthcare environment, the vast majority of medical care, either primary or subspecialty care, is provided though the ambulatory setting. Our mission is regardless of career choice in medicine, to prepare all of our graduates with the necessary skills to function and succeed in the ambulatory setting.

 

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The Medicine Group Practice

 

Our Medicine Group Practice is now located at 3322 N. Broad Street, across from TUH, in a space specifically renovated for the residency continuity clinic. Besides numerous patient care rooms, the practice has a large space for outpatient precepting, as well as a space for our multidisciplinary Triage team of residents and the practice RN. Ancillary staff work with our residents to facilitate provision of outstanding medical care, including a dedicated social worker, a nutritionist, nurse student educators, and faculty from the School of Pharmacy. As with all of the outpatient practices at Temple, our Medicine Group Practice uses Epic as our electronic health record, enabling access to data from inpatient stays and other subspecialist visits.

 

IM Residency Program - Ambulatory

 

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4+1 System


Our well established 4+1 schedule has improved the overall real-world education of our residents and provides a clear separation between residents’ inpatient and outpatient duties. The system allows for less fragmentation of care in the hospital while maintaining continuity of care in the outpatient practice. By providing regular contact with the Ambulatory continuity practice, this system has improved resident satisfaction and comfort with outpatient medicine. Under the 4+1 system, every fifth week is an Ambulatory Week, devoted to continuity clinic and other outpatient experiences.

 

Structure of the Ambulatory week:

 

5 half-day Continuity Clinic sessions

 

1 half-day Triage (Telephone)

 

1 half-day Subspecialty Clinic

 

1 half-day Quality Improvement Project time

 

1 half –day Outreach to patients

 

1 half-day Administration Time- Reading Time/Independent Study

 

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Ambulatory Week Schedule:

 

 

Monday

Tuesday Wednesday Thursday Friday
AM Clinic Subspecialty QI Clinic

Clinic

PM Triage Clinic Clinic Outreach Admin/Study

 

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Ambulatory Week

 

Curriculum Our ambulatory curriculum is an innovative and comprehensive program that goes beyond providing our residents with basic outpatient medical and procedural knowledge. In addition, the curriculum provides our graduates with valuable skills in quality improvement, electronic medical record management, and cost-conscious high value care that can be applied to all areas of medicine. The ambulatory curriculum is a themed based 18 block curriculum that is repeated approximately twice in an individual’s 3 year residency. Didactic topics are organized based on the theme of the week and cover core topics in outpatient medicine.

 

 

Block Theme
1

Intro to Office Based Practice I

2 Intro to Office Based Practice II
3

Pain Management

4 Cardiology
5 Psychiatric Disease
6 Pulmonary
7 ID/HIV
8 Endocrine
9 Musculoskeletal
10 Gastroenterology
11 Renal
12 Geriatrics
13 Women's Health
14 Neuorlogy/Dermatology
15 ENT/Optho/Derm
16 Palliative
17 High Value Cost Conscious Care
18 Urban Curriculum

 

Every Monday at noon we have an ambulatory grand rounds conference in which a faculty expert gives a talk on a topic that is related to the theme of the week. In addition, during the ambulatory week residents engage in protected didactic time Monday through Friday from 8am to 9am. The faculty and residents engage in ambulatory didactics in a variety of formats:

  • Case based Conferences
  • Physical exam skills review & activities in the Simulation center
  • Health maintenance topic reviews
  • PICO reports
  • Ambulatory Journal Club

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Quality Improvement Curriculum

 

We are very proud of the unique and comprehensive experience we provide in patient safety & quality improvement to our residents. In addition, to the experiences detailed below Dr. Elizabeth Leilani Lee provides a series of didactic lectures on performing quality improvement to provide the residents with a basic foundation in performing quality improvement.

 

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Group Quality Improvement Projects

 

All residents are involved in a group quality improvement project. There are 10 outpatient projects that are conducted by the residents throughout the academic year. The project topics are selected by the residents and mentored by a faculty. Each year our quality improvement projects bring about beneficial change to our practice and scholarly activity to our residents. Many of our projects have been presented at local and national meetings.

 

IM Residency Program - Ambulatory Walk

 

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Individual Quality Improvement Project

 

All upper year residents are engaged in a yearlong individual quality improvement project focusing on improving a quality indicator in their continuity patient panel. Using our Electronic health record, upper year residents are generated a quarterly report card on their patient panel providing them on critical quality measures for their patients. Such as what was their flu vaccination rate in their patient panel, rates of colon cancer screening, or percentage of diabetics with hypertension on an ACE-I or ARB. Based on these report cards our residents devise & implement with their faculty advisor a plan to improve on one of these indicators.

 

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Subspecialty experience

 

Each ambulatory week, residents have a designated half day for a subspecialty outpatient experience. To facilitate their transition to residency, each intern is matched with an attending physician from the various subspecialties including gastroenterology, pulmonology, cardiology, endocrinology, rheumatology and hematology/oncology. As residency progresses, residents are encouraged to choose their own subspecialist experience to suit their interest and career goals. During these sessions, residents are afforded the opportunity to experience practicing subspecialty medicine in an ambulatory setting, as well as form longitudinal relationships with subspecialty physicians.

 

IM Residency Program - Ambulatory Week

 

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Outreach

 

Residents are provided dedicated time each week to provide direct patient outreach to improve the health of their continuity clinic patient panel. Residents are provided with topics which align with the 18 block curriculum, and are supported in their outreach endeavors with guided readings from recent medical literature.

 

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Quotes

 

Cara Heller, PGY-2

“At the Medicine Group Practice clinic, I take care of a diverse panel of patients, many of whom have several complicated medical and social issues. After only one year, I have had enough continuity with my patients to have formed strong, trusting relationships and they truly view me as their primary provider. I have gained confidence in treating some of the most medically complex patients, while always feeling supported by my preceptors. My experience in clinic has been challenging and rewarding, and I know the skills I have gained will benefit me throughout my career.”

 

Jennifer Sheng, PGY-2

“Clinic week is one of my favorite aspects of our program! It's gratifying seeing our patients in a less acute setting and helping them take ownership of their health. Although we have many patients with complex conditions , we have great support from our attending preceptors . There's a warm, friendly environment that allows for a great partnership amongst all of us. This is one if the things that I value the most and drew me to Temple.”

 

Dan Burke, PGY-2

“The continuity we experience in ambulatory clinic is the crux of internal medicine. Following patients month-to-month, day-to-day, we get to monitor and learn from the outcomes of our care. It's incredibly rewarding to witness our patients' improvement. When you watch a patient turn around from being wheeled in devastatingly ill and deconditioned to walking into your office with a smile ear to ear, you start to understand what a drastic impact we can have.”

 

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Contacts:

 

Elizabeth Leilani Lee, MD

Assistant Professor of Medicin

Section of General Internal Medicine Associate Program

Director Internal Medicine Residency Program Temple University elizabeth.lee@tuhs.temple.edu

 

Alia Chisty, MD

Assistant Professor of Medicine

Section of General Internal Medicine

Medical Director of the Medicine Group Practice

alia.chisty@tuhs.temple.edu

 

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