Residency Ambulatory Curriculum
Columbia Internal Medicine Residency Program/New York Presbyterian Hospital
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Residency Ambulatory Curriculum
Residents in the Columbia Internal Medicine Residency Program spend one third of their residency training in the outpatient setting, which provides a rich and unique opportunity to develop a broad set of skills for holistic, long-term care and navigating the medical system. The Ambulatory Curriculum consists of caring for a longitudinal panel of primary care patients with close one-on-one teaching and supervision combined with small group teaching conferences and exercises, as well as clinical experiences around the medical center.
A critical part of residency training is the outpatient continuity clinic, which allows residents to care for a panel of continuity patients over the three years of residency, a rich and unique opportunity to develop a broad set of skills for holistic, long-term care. Residents learn to manage acute and chronic illnesses, take care of high-risk patients after discharge from the hospital and ED. Over the course of a three-year residency, residents form close bonds with their patients and become part of the community.
Goals and Objectives for the Ambulatory Curriculum
- Independently provide continuous care for a panel of patients that is patient-centered, evidence-based, comprehensive, and efficient
- Develop therapeutic relationships with patients and caregivers, understanding and addressing the biopsychosocial aspects of disease
- Practice effectively within a changing health care system to actively manage the health of a panel of patients by learning to work with a team of health care providers, coordinate care, and navigate the health care system, and improve the quality of their own practice and the system they work within
Residents have continuity weekly during some clinical rotations, during elective, and during outpatient blocks. The outpatient blocks contain the ambulatory curriculum, with blocks increasing in number as the patient panel size grows through the years of residency. Residents assist each other in covering patients through the Walk-In Clinic and an Epic In-basket resident who covers messages for residents on the wards.
Clinical Settings and Support
Most internal medicine residents have their continuity clinic at the Associates in Internal Medicine practice at 168th street, and a small group of residents have clinic at the Washington Heights Family Health Center on 181st Street. Both sites are part of the NYP Ambulatory Care Network, with patients from the surrounding neighborhoods of Washington Heights/Inwood, Harlem, and the Bronx, and primarily referred from the hospital. Residents are supported by a team of inter-disciplinary support for patient care: administrators, nurses, social workers, care managers, nutritionists, pharmacists, and community health workers. Centralized resources support patient calls, refill medications, and obtain prior authorizations. A panel manager assists with scheduling to ensure continuity between patients and residents.
Residents learn from one-on-one teaching from a range of clinician-educators during patient care sessions. Residents care for continuity patients, learning acute and chronic management, prevention, and interacting with specialists. Residents also learn specific skills in dedicated clinic sessions for diabetes management, pre-operative evals, hypertension management, walk-in clinic, and hospital/ER follow up. Resident graduate extremely well-prepared to manage complex internal medicine patients.
During outpatient blocks, residents learn in small group didactic sessions on a wide range of outpatient medicine topics. Outpatient report is a daily conference where faculty and residents work together to discuss common topics and integrate evidence-based medicine into clinical practice. Protected half days offer didactic sessions on a range of topics, as well as longitudinal curriculum in evidence-based medicine and psychosocial medicine. Residents learn skills in panel management, deliberate practice, quality improvement. Residents have the opportunity to learn about, explore, and serve during community health experiences.