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.

The Medicine Group Practice, located on the 4th floor of the Outpatient Building in 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 provide an excellent population for learning ambulatory medicine. Residents follow their patients one-half day per week so that upon completion of the 3-year program, they are prepared to care for patients longitudinally in an outpatient setting.

General Internal Medicine faculty serve as preceptors (1 attending per 4 residents) with no competing patient care responsibility. Two nurse practitioners are designated to facilitate communication and ensure continuity of care.  Dedicated social service support, a nutritionist, a diabetes educator and faculty from the School of Pharmacy work with our residents to facilitate provision of outstanding medical care. Our practice manual (pdf, 89 KB) is available here for you to view.

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A dedicated conference on ambulatory care is held weekly for all medical housestaff. This conference is led by general medicine faculty, as well as 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.

Preceding every weekly clinic session, for 30 minutes, faculty preceptors also facilitate a case-based discussion on an ambulatory topic. The topic is usually tied to the ambulatory care conference that week but can include certain topics more amenable to a small group setting. Like the ambulatory care conference series, this is also organized into an 18 month curriculum.  An archive of topics is available here for you to review.

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A one month Ambulatory rotation is required in each of the three years of residency. Education on practice improvement and methods for self assessment are also central goals of these rotations. 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 during the Ambulatory block . By working together and taking a multidisciplinary approach to quality improvement, projects are developed for how to improve the Medicine Group Practice. Faculty assist the group and instruct them on methods such as root cause analysis. The projects are presented at the conclusion of the rotation and many have been incorporated into the daily routine of the clinic with excellent results.

During the first and third years, each resident does a month- long Ambulatory block. This rotation consists of extra sessions in the Medical Group Practice as well as select opportunities in medicine subspecialties practices or other departments where primary care is emphasized. Residents also participate in a diverse didactic curriculum involving both clinical topics, as well as nontraditional topics such as “Telephone Medicine” and “The Difficult Patient” among others.

During the second year, each resident also participates in a required month-long Outpatient block. This rotation offers residents the opportunity to immerse themselves in an outpatient experience for a full two weeks, then change to another experience for the next two weeks. Residents are asked their preferences for which rotations and most get their first or second choice of experiences. The chart below gives additional information on each rotation. Residents will also participate in the didactic curriculum of the Ambulatory block described previously.

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Besides our inpatient consult elective blocks, many subspecialty elective rotations with a focus on outpatient medicine are also available to housestaff. 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, Ambulatory Cardiology, Ambulatory Pulmonology, Ambulatory Gastroenterology, Rheumatology, Endocrinology, Oncology and Nephrology.

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