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DEPARTMENT OF MEDICINE

Internal Medicine Residency Program

Ambulatory Curriculum

 

Temple University Hospital provides care for a large segment of the North Philadelphia community in both the inpatient and outpatient settings. Outpatient care is provided in private offices, subspecialty clinics and the Medicine Group Practice where the medical residents serve as primary care providers.

 

In today’s healthcare environment, the vast majority of medical care, either primary or subspecialty care, is provided through the ambulatory setting. Therefore, our philosophy is that no matter the career choice in medicine, all of our graduates will have obtained the skills necessary to function in the ambulatory setting. Our ambulatory curriculum is comprehensive and constantly being improved to accomplish this goal.

 

In November 2010, our Medicine Group Practice implemented the EPIC electronic health record. This has greatly improved our ability to coordinate patient care with our consultants and our ability to access patient information. EPIC has also improved our mechanisms to give house staff real-time feedback about their practice quality and design quality improvement projects for the entire residency program.


 

Continuity Clinic


Clinic teaching

The Medicine Group Practice, recently renovated in 2012 and located on the 4th floor of the Outpatient Building attached to Temple University Hospital, is the principal site for resident ambulatory primary care services. It is a dynamic educational venue whose large number of culturally diverse patients provides an excellent population for learning ambulatory medicine. Residents see patients during one week blocks that occur every five weeks in our innovative "4+1" system. Upon completion of the 3-year program, they are prepared to care for patients longitudinally in an outpatient setting.

 

General Internal Medicine faculty members serve as preceptors (1 attending per 4 residents) with no competing patient care responsibilities. A nurse practitioner is designated to facilitate communication and ensure continuity of care. 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.

 

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Ambulatory Care Conferences


A dedicated conference on ambulatory care is held weekly for all medical house staff. This conference is led by senior residents, general medicine faculty and subspecialty physicians with expertise in the field. Topics are wide ranging and organized on an 18 month curriculum although certain “core” primary care topics are reviewed each year at the start of the new residency year.

 

During the ambulatory week, faculty preceptors also facilitate daily case-based discussions on an ambulatory topic. The topics are organized to fulfill the 18 month curriculum.

 

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Ambulatory Block Rotations

 

Clinic group


Every five weeks residents are assigned to an ambulatory block, throughout the three years of residency (See 4+1 Block Schedule). Outpatient care, patient outreach, education on practice improvement and methods for self assessment are central goals of the outpatient curriculum. Residents perform chart audits of their own clinic patients and receive feedback from the rotation faculty. They also develop a systems-based practice improvement project as a team. By working together and taking a multidisciplinary approach to quality improvement, resident-run projects are developed with the goal of improving the Medicine Group Practice. Faculty members assist the group and instruct them on methods to approach quality improvement projects, such as root cause analysis. The projects are presented to the entire residency program, and many have led to changes that have been incorporated into the daily routine of the clinic with excellent results.


Residents are also given opportunities to have further outpatient experience during elective Outpatient blocks. These rotations offer residents the opportunity to immerse themselves in an outpatient experience for a full two weeks. The rotations are often organized with non-medicine specialties (such as orthopedics or psychiatry), or any of the following:

 

Rotation

Description

Curriculum

Palliative Medicine

In conjunction with Keystone Hospice, this rotation offers a detailed look at the care of patients with terminal illnesses through experiences in inpatient and outpatient hospice through home visits.

 

    PDF (90 KB)

Acute Care

This rotation takes place in the Yellow Zone of the Emergency Department.  This area is for acute cases too complicated for the Fast Track but not serious enough for the main ED.  Residents work one on one with an ED attending.  There are no overnight or weekend responsibilities

    PDF (20 KB)

Rehabilitation Medicine

This will include experiences with Temple’s PM&R physicians and physical therapists. Experience with EMG will also be included.  1 week will be spent in the ambulatory setting and 1 week on the inpatient consult service.

    PDF (21 KB)

Philadelphia District Health Centers

An opportunity to spend time in the Philadelphia District Health Centers – often the safety net for healthcare in the city.

    PDF (19 KB)

Esperanza Health Center

A federally funded clinic with a large proportion of Spanish-speaking patients.

    PDF (232 KB)

Healthcare Finance

Intended to allow residents to gain unique access into the thinking of some of the top financial players at Temple as well as at a national health maintenance organization. 

    PDF (23 KB)

Nutrition

This rotation allows you to learn issues of nutrition in many different types of situations by working with the Department of Nutrition at Temple Hospital.  Residents can choose where to spend their time from a list of choices that includes dialysis, obesity surgery clinic, general nutrition, diabetes clinic, and inpatient TPN, among others. 

    PDF (22 KB)

Private Community Practitioner

An opportunity to spend time in a community physician’s office.

    PDF (17 KB)


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Ambulatory Subspecialty Electives


Besides our inpatient Consult elective blocks, many subspecialty elective rotations with a focus on outpatient medicine are also available to house staff. These rotations allow residents interested in a particular specialty to gain additional experience in preparation for fellowship, while allowing others to simply broaden their overall knowledge base. Popular rotations available include electives in HIV, Rheumatology, Endocrinology, Hematology/Oncology, Cardiology, Nephrology, Pulmonary and Gastroenterology. New rotations are currently being developed and all reasonable requests for an ambulatory elective block not currently offered will be considered.

 

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