VCU Internal Medicine Training Program
PGY1-Ambulatory Medicine-AMBi (2 week rotation)

Revision Date: 6/30/09
Revised by: Stephanie Ann Call, MD, MSPH; Chris Hayes, MD, MS

 

Purpose
Learning Objectives
How Learning Objectives are Met
Reading/Resources
Expectations
Evaluation
Contact
Resident Schedule
Printable version of the Ambulatory Medicine curriculum (pdf)

Purpose:

The purpose of this rotation is to allow the pgy-1 resident a dedicated month’s experience in the ambulatory care setting. During this month, the resident will rotate in both primary care clinics and in primary care-associated clinics such as geriatrics (including home care), pain management, heart failure management, and lipid clinic. The resident will spend dedicated time with pharmacists, nurses, and therapists (PT & OT) gaining an appreciation for the healthcare system in the outpatient setting.  In addition, the resident will participate in Med Tech Tuesdays, and introductory course in Evidence Based Medicine, Information resources, and presentation skills.

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Learning Objectives

At the end of the rotation, residents will be able to:

• Patient Care:
  • Experience additional ambulatory care experiences through various types of outpatient clinics and home care settings
  • Identify and perform an accurate history and physical exam that is appropriate for the primary care setting (chronic management, acute complaint, home care setting, etc) and the presenting medical problems
  • Identify emergent versus non-emergent medical conditions
  • Developing skills in managing common presentations in the ambulatory care setting
  • Order appropriate laboratory, radiographic and other studies as indicated to provide appropriate management and diagnostic testing in the ambulatory setting
• Medical Knowledge:
  • Recognize and be able to compile a differential diagnosis for common medical problems in the primary care setting
  • Be familiar with health care maintenance recommendations (cancer screening, immunizations, diabetes care, safety education and screening, etc) and how to document within a primary care chart for each patient
  • Interpret laboratories and radiographic studies in a clinical setting
  • Be familiar with (and able to identify guidelines and resources) management recommendations for common internal medicine chronic conditions
• Practice-Based Learning and Improvement:
• Recognize and start to utilize available resources to make timely and appropriate diagnostic and management decisions in the ambulatory setting
• Identify and refer to management guidelines for common internal medicine conditions
• Gain some experience in chart review of peer and own patient records
• Interpersonal and Communication Skills:
  • Developing skills in effective communication and utilization of consultative services for appropriate and complete patient care
  • Developing skills in effective communication of medical problems, interventions and therapies to patients and their families to increase awareness and compliance
• Professionalism:
  • Demonstrate respect and compassion in interactions with colleagues, patients, families
  • Clearly communicate clinical questions, medical problems and interventions to consultation services to facilitate continuity of patient care
• Systems-Based Practice:
  • Be familiar with primary care career options and systems-based practice in a clinic setting
  • Be familiar with the components of a health care team in the continuity ambulatory care setting, to include nurses/pharmacists/social workers/consultants/care coordinators/peers
  • Demonstrate effective communication with consultative, in-patient and ambulatory services to provide focused and appropriate cart

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How Learning Objectives are met:

• Participation in multiple primary care ambulatory settings
• Supervisor-facilitated discussions with residents regarding patient presentation and management issues to provide proficiency in differential diagnosis and management of acute and chronic medical problems
• Assigned readings
• Evidence based medicine and Information Resources assignments (pdf)

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Reading/Resources:

• Pfenninger: Procedures for Primary Care Physicians, 1st ed. 1994 Mosby-Year Book, Inc.
• Martz WD: Corticosteroid injections for articular and soft tissue pain. Patient Care. August 2003;37:39-48.
• Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2003 ed. 2003 Mosby, Inc.
• Noble: Textbook of Primary Care Medicine, 3rd ed. 2001 Mosby, Inc.
• Select management guidelines distributed at intern orientation and found in ACC clinic book
• guidelines.gov – as pertains to specific disease states seen in clinic
• Other readings as assigned by attendings

Expectations:

• Attendance and punctuality for all patient care activities
• Completion of patient documentation, including health maintenance records, problem lists, medication lists and prescriptions as needed
• Discuss presentation and proposed management of every patient evaluated with the attending physician supervisor
• Participate in peer chart review through POD work and formally assigned reviews (pending, 2006)

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Evaluation:

• Residents will be evaluated by the supervising attendings on www.newinnov.com
• Rotation will be evaluated by residents through www.newinnov.com

Contact:

• Locations and Contact Information (pdf)
• Housestaff office, Ambulatory care chief medical resident (828-9726)

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Schedules:

• Sample AMBi Block Schedule (pdf)
  • Individual schedules will be assigned by Ambulatory Chief Medical Resident prior to the beginning of the rotation and will include:
    • Continuity Clinic: 1 half days per week
    • Med Tech Tuesdays
    • Tuesday PM Core Conference
    • Chart Stimulated Recall, Monday mornings
    • PAP Smear Clinic, Tuesday 1-3, ACC 2nd Floor
      • Visit Information: ACC 2 Primary Care - PAP Clinic (pdf)
    • VA Clinics: PT and Anti-Coag at the VA
    • ACC Clinic: PT and Anti-Coag at MCV
    • POD Administrative Time for Clinic Follow-Up
• Medical Technology Tuesdays-Schedule and Learning Objectives (pdf)
• Directions to the Beth Shalom Home from MCV and the VA (pdf)

AMBi Block Schedule (all schedules in pdf format)
AMBi Block 1 Schedule	AMBi Block 5 Schedule	AMBi Block 9 Schedule
AMBi Block 2 Schedule	AMBi Block 6 Schedule	AMBi Block 10 Schedule
AMBi Block 3 Schedule	AMBi Block 7 Schedule	AMBi Block 11 Schedule
AMBi Block 4 Schedule	AMBi Block 8 Schedule	AMBi Block 12 Schedule
		AMBi Block 13 Schedule

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