Since our inpatient experience emphasizes the care of acutely ill patients and complex medical problems, we have developed our outpatient program to maintain the breadth of experience internists need and resemble the experience of an internist practicing in a real-world outpatient environment. One-third of resident training time is spent in a variety of outpatient settings.
Our 3 outpatient ANGMA internal medicine clinics have different patient populations and residents spend time in each of the clinics. Each clinic facility is new and designed optimally for both patient care and resident education. All residents have their 3 years of continuity clinic at our clinic across the street from the hospital (below).
The continuity clinic experience occurs in the ANGMA-Medicine Clinic that is our on-campus clinic where residents care predominantly for patients from our multicultural inner-city neighborhood. Caring for these often challenging and needy patients is an important mission of the hospital and the department. While in clinic, residents are given outstanding supervision and education by the full-time faculty, with at least one faculty member present for every two or three residents in clinic -- a ratio found in very few programs. Faculty members are fully devoted to resident teaching and supervision during their clinic attending time and do not have personal patients of their own. Residents develop a long-term relationship with their own group of patients during the three years of the program. G1s see an average of 4-5 patients and G2s and G3s an average of 5-6 patients each clinic half-day.
Residents learn to perform a wide range of outpatient procedures during this clinic experience. All 3 of our outpatient internal medicine clinics including our resident continuity clinic are fully equipped with ultrasound and experienced ultrasound faculty to supervise. The IMBUS program is as much a part of outpatient learning and patient management as it is inpatient.
While on inpatient teaching service rotations residents' clinic afternoons occur in rotation with the admitting schedule so that a resident is neither post-call nor admitting patients on a clinic day. The clinic schedule also assures that G1s and G2s from the same teaching service team are in clinic on separate afternoons. This allows each resident to have a clinic session that is uninterrupted by calls concerning inpatients on their team.
G1 residents have a separate outpatient block that includes individualized training and experience in general internal medicine at our ANGMA-COC clinic as well as experience in outpatient subspecialty clinics. The rotation also includes education in chemical dependency and experience working in a transitional care unit (TCU) setting, as well as palliative care. In addition to outpatient subspeciatly experience, G1 residents spend 2 weeks in the emergency department.
G2 residents have an outpatient block rotation devoted to experiences in subspeciatly outpatient clinics as well. They also have a dedicated 5-day a week rotation at the ANGMA-COC clinic including 3 half-days of 1-on-1 outpatient bedside ultrasound with an ultrasound faculty mentor in clinic.
G3 residents participate extensively in outpatient medicine during the various required subspecialty rotations. They also have an outpatient block rotation at ANGMA-COC, which is a combination of dermatology, and general medicine patients who have conditions that require them to be seen relatively urgently. A variety of other outpatient experiences may also be pursued during elective time in the G2 and G3 years. In addition to outpatient subspeciatly experience, G3 residents spend 4 weeks in the emergency department.