Internal Medicine Residency
Ambulatory Education Program
All residents receive extensive training in ambulatory care, including continuity
medical clinics, ambulatory blocks, walk-in clinics, emergency rooms, private practices
and health maintenance organizations. Residents are exposed to a broad variety of patients
under close supervision of faculty with expertise in primary care and preventive medicine.
Through the weekly Ambulatory Care Seminars and weekly core curriculum during Morning Report,
residents expand their knowledge of primary care and its related disciplines.
Dr. Nikki Southall, Associate Program Director, along with the Primary Care Chief Resident
are responsible for development and implementation of the ambulatory curriculum.
Continuity Medical Clinics
Residents participate in a weekly continuity medical clinic starting in the
beginning of their residency. Clinic sites include University Health Center
(UHC), the Primary Care Clinics at the VA, Mercy Medical Center and the Waxter
Center for Senior Citizens.
Categorical residents alternate clinic sites between
the VA and UHC every week, allowing residents to have broad exposure to a variety
of patients. Residents with an interest in geriatrics or community practice
may choose the Waxter Center or Mercy Medical Center, respectively, for their
weekly continuity clinic. In the upper years, residents can opt for a second
continuity session at these sites or at an off-campus private practice, HMO
At each site, residents develop a close working relationship with their
colleagues and the general medicine faculty, who are adept at providing one-on-one
supervision in primary care. All clinic sites provide easy access to laboratory and
radiologic studies, medical records, textbooks and electronic resources, such as Up-to-Date,
Medline and Ovid.
Ambulatory Block Rotations
By completing four Ambulatory Block rotations, residents attain expertise in
primary care and are exposed to important skills for achieving competency in internal
medicine. Residents rotate through various sites, both at the academic medical center
and in the community. Residents may also choose to attend various medical subspecialty
clinics. Select attendings at private practice sites, in managed care organizations and
in public clinics precept residents during the rotation.
The blocks are divided into 4 groups, each with a clinical theme. Special emphasis
is placed on community service and public health, geriatrics, rehabilitative medicine,
women's health and psychiatry.
- The Women's Health/Subspecialty Block is devoted to specialty clinics
outside of internal medicine. During Women's Health, residents receive
instruction by general internists in pelvic and breast examinations and discuss
hormone replacement therapy, vaginitis, abnormal PAP smears and identification
of domestic violence. Residents participate in Psychiatry Seminars,
where they learn skills in treating common outpatient psychiatric
problems. Residents also participate in a problem-based learning (PBL)
quality improvement project, where they perform a self-assessment exercise
of patient care provided in their clinic and formulate an improvement plan
based on the results. In addition, residents acquire skills in Dermatology,
Ophthalmology and Otolaryngology.
- The Geriatrics/Rehabilitation/Neurology Block exposes residents to
a combined program in these three disciplines. During Geriatrics, residents
learn how a multidisciplinary approach addresses the elderly's medical, psychological
and social concerns. Residents care for patients in senior citizen and assisted
living communities, where they are exposed to the full spectrum of health
care needs of the geriatric population. During the
sessions, residents assess the needs of patients who require long-term rehabilitative
services. In the Neurology clinic, residents evaluate and manage problems
such as chronic seizure disorders, peripheral neuropathy and headaches. During
the Community Service and Public Health component, residents can participate
in a community hospice program, investigate
outbreaks of communicable diseases through the health department, or care
for patients at Health Care for the Homeless or Shepherd's Clinic. Sessions
in Outpatient Orthopedics / Rheumatology are also included in this block.
- The Managed Care Block allows the resident to experience medicine in
a managed care setting and gain more exposure to the appropriate cost-effective
care of common outpatient problems. During this block, residents may also
participate in the PBL project as described above, or in a follow-up exercise
to measure how well the changes have been implemented.
- The Private Practice Block places residents in a private general
internal medicine practice to gain exposure to a different patient mix as well
as principles of continuity and episodic care from experienced practitioners in
Training in Procedural Skills and Practice Management
Since the addition of a Chief Resident in Primary Care in 1998, a wide spectrum
of new educational opportunities is offered to the residents. The Primary Care Chief
Resident runs a variety of workshops and seminars to teach residents skills important
for general internal medicine.
Primary Care Procedure Workshops:
- Joint aspiration and injection: Led by faculty in Rheumatology, residents
use cadavers to practice aspirating joint fluid and injecting anti-inflammatory
- Skin biopsy and suturing: Residents use pig's feet and other models
to learn these dermatologic skills.
- Management of strains and sprains: Taught by faculty in orthopedics
and sports medicine, residents learn basic techniques.
Practice Management Seminars
- Getting ready to apply for a job: Early in the year, senior residents
learn the proper timeline for applying for positions, updating their CV and
using the internet and headhunters to begin the job search process.
- The job interview: Issues discussed include basic approach to the
job interview, what to know before you go, key questions to ask during the
discussion, and appropriate follow-up.
- Assessing a private practice: Residents need to be aware of many
aspects of the practice when determining whether it will be a suitable setting
Among the many topics discussed are how the practice approaches
patient care, triages phone calls, manages charts and documents, arranges
call schedules and manages workload distribution among the physicians.
- Your first job contract: Lawyers join a group discussion to help
residents in evaluating their first contract and understanding the key terms
for their future practice.
- Office management: Sessions include information on patient medical
insurance, billing, ICD-9 coding, interaction of office personnel and telephone
medicine, among other topics.
- Seminars with recent graduates: During this popular evening session, graduates
of our program return who are practicing in a variety of different settings return to
talk with residents about what "it's really like out there" and help them get started
in the process.
Episodic Ambulatory Care Experiences
Through the Emergency Room at University Hospital and the Emergency Care Services
(ECS) at the VA, residents receive additional training in outpatient medicine.
The Emergency Room experience is described under the
University of Maryland Hospital.
The rotation in ECS at the VA provides different experiences for residents.
In this high volume center, upper level residents manage patients with acute
illnesses that often require immediate intervention or admission to the hospital.
This page was last updated on:
September 11, 2008.