Residency Ambulatory Curriculum
Columbia Internal Medicine Residency Program/New York Presbyterian Hospital
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.
Quick Links For Residents and Faculty
Goals and Objectives for the Ambulatory Curriculum
The goals of the Ambulatory Curriculum in internal medicine are for residents to:
- 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
Objectives are based in the ACGME Milestones. Residents will learn to:
- Patient Care: Diagnose and treat a broad range of acute and chronic problems in ambulatory internal medicine and provide preventive care, including the appropriate use of referrals, hospital level care, and transitions of care across settings.
- Medical Knowledge: Develop a broad base of medical knowledge, including the medical and surgical sub-specialties, preventive medicine, and behavioral health.
- Practice Based Learning: Learn to self-assess for gaps in knowledge and/or areas of practice needing improvement, critically assess one’s own practice through panel reviews, and contribute to system level improvement through quality improvement activities.
- Interpersonal Communication Skills: Communicate effectively and compassionately with patients and family members, and effectively with staff, the inter-disciplinary team, attendings, and consultants through organized and efficient presentations and records completed in a timely and professional manner.
- Professionalism: Show commitment to the principals of professionalism such as respect, honesty, compassion, and altruism in interactions with patients and the multidisciplinary team, as well as sensitivity and responsiveness to patients’ and colleagues’ age, gender, culture, religion, sexual preferences, socioeconomic status, education level, beliefs, behaviors and disabilities.
- Systems Based Practice: Understand and navigate the larger system of care, including clinic-based resources and the multidisciplinary team, local referral networks, community resources, payment/insurance systems, and to help educate patients in navigating the system effectively. (Systems Based Practice)
Ambulatory Curriculum Teaching
Residents learn the fundamentals of outpatient internal medicine with the help of multiple resources.
Faculty from the Division of General Medicine as well as invited speakers from many other Divisions teach small groups session during the Outpatient Rotations.
PGY1 Fundamental Didactics:
- Contraception, Brenda Aiken
- Women's Health, Brenda Aiken
- Outpatient Infectious Disease, Ariel Pablos-Mendez
- Hypertension, Walter Palmas
- Anemia, Nancy Chang
- Cancer Screening, Andrew Moran
- Adolescent Medicine, Rachel Bring
- Diabetes, Parts 1-4, Steve Mackey
- Nutrition and Cooking, Jude Fleming
- Tuberculosis, Neil Schluger
- HIV, Peter Gordon
- Evidence Based Medicine, Parts 1-4, Walter Palmas
- Chronic Pain and Somatic Complaints, Nancy Chang
- Note Writing, Beth Anne Scharle
- Psychosocial Medicine, Mark Petrini
- Domestic Violence,
- Smoking Cessation, Anny Eusebio
- Asthma, Bill Fuller
- Obesity, Kelsey Bryant
- Musculoskeletal Review, Bill Fuller
- Joint Review, Parts 1 and 2, Ian Kronish
- Pre-Operative Evaluations, Natalie Moise
- Resistant Hypertension, Natalie Moise
- Osteoporosis, Monica Suarez
- Insomnia, Monica Suarez
- COPD Review, Elizabeth Oelsner
- Smoking Cessation, Elizabeth Oelsner
- Health Policy, Eve Slater
- Diabetes Review, Steven Cohen
- Dermatology Review, Bill Fuller
- Motivational Interviewing, Maria de Miguel
- Gastroenterology Review, Arthur Magun
- Rheumatology Review, Teja Kapoor
- Heart Failure Review, Kelly Axsom
- Chronic Kidney Disease, Maya Rao/Eric Siddal/Andy Bomback/Pietro Canetta
- Narrative Medicine, Beth Anne Scharle
- Working with Interdisciplinary Team, Jessica Singer
- End of Life Care, Kaylan Christianer
Other Outpatient Teaching Conferences:
- Psychosocial Rounds: Weekly during Outpatient rotations for PGY1 and PGY2/3 with Dr. Mark Petrini
- Clinical Epidemiology: Weekly during Outpatient rotations for PGY1, 2, 3 with Dr. Walter Palmas
- Harkness Report: Daily conferences from 1-2pm for residents on outpatient rotations led by Dr. Ralph Blume and invited faculty
- Division of General Medicine Conference: Monday 8-9am, Invited faculty
Practice Improvement and Sub-specialty Clinic Experiences
- PGY1 Sub-Specialty Clinics: Gynecology, Pulmonary Function Testing, Rehabilitation Medicine, Rheumatology Clinic, HIV clinic, Microbiology lab, Palliative Care clinic, Dermatology Clinic
- PGY2/3 Sub-Specialty Clinics: Rheumatology Clinic, Endocrine clinic, Thyroid Clinic, Sleep clinic, Naomi Berrie Diabetes Center
- Panel Management: Biyearly review of panel of patients for diabetes control and continuity of care
- Quality Improvement: PGY3 lecture and didactic exercise on QI methods and practice.
- Clinic Teach Resident: Residents observe and give feedback to interns on their patient interactions and presentation skills.
- Community Based Organization Health Teaching: PGY2 designed and led talk on health topics for community audience
- Inter-Disciplinary Team Exercise: Reviewing high risk patients to lead discussions on team-based care
Clinic Sites and Rotation Structure
The majority of 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. Residents are immersed in the local community and learn its culture, health challenges and opportunities, and local resources.
Resident clinic schedules are a hybrid model of continuity clinics during some inpatient rotations, with outpatient block rotations for 2 weeks at a time interspersed throughout the year. Residents accrue a panel of about 100 continuity patients during their residency. Residents have an inter-disciplinary team of nurses, social workers, and administrators, as well as a designated faculty member, who help provide support for patient care during busy rotations.
Residents also develop broader skills of outpatient internal medicine and help provide patient continuity by participating in extended care clinics during their PGY2 and 3 outpatient blocks:
- Walk-In Clinic
- Hospital Discharge Clinic
- ER Follow up
- Pre-operative Clinic
- Diabetes Management
- Inter-Disciplinary Rounds/Chart Review
Residents transition their panel of patients to new providers at the end of their residency through transition planning exercises and hand-offs.