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. The Associate Program Director for Ambulatory Education and the 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, the Faculty Practice Office (FPO), and Mercy Medical Center.

At each site, residents develop a close working relationship with their colleagues and the general medicine faculty, who are expert 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. The electronic medical record system, EPIC, is used at UHC and the FPO, while CPRS is used by residents at the VA Primary Care Clinic. A weekly pre-clinic conference provides residents with a comprehensive curriculum in primary care and preventive health.

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.

Residents have a wide range of choices during their Ambulatory Block rotations. If they are planning on a career in a subspecialty, they can attend outpatient clinics in that field or in one that complements that area of study. For example, a resident interested in oncology may choose an outpatient clinic in infectious diseases, in addition to attending clinic sessions and Tumor Board at the Greenebaum Cancer Center. Residents interested in primary care choose components to enhance their skills in women's health, sports medicine, rheumatology, ENT, travel medicine, ophthalmology, and dermatology. All residents spend time in a private practitioner's office to get exposure to "real life" primary care and learn the business of medicine.

Required components of the Ambulatory Blocks include geriatrics, neurology, psychiatry, literature in medicine, and completion of practice based learning exercises.

During Geriatrics, residents learn how a multidisciplinary team addresses the elderly patient's medical, psychological and social concerns.
In the Neurology clinic and private practices, residents evaluate and manage problems such as chronic seizure disorders, peripheral neuropathy, movement disorders and headaches.
Residents participate in Psychiatry Seminars, where they learn skills in treating common outpatient psychiatric problems, such as depression and personality disorders.
A very popular component of the Ambulatory Blocks is the weekly Literature in Medicine Seminar. Led by a faculty member, the residents read and discuss the works of various authors and poets, reflecting on how the writings apply to the practice of medicine and the humanistic aspects of our profession.
During Women's Health, residents receive instruction by general internists in pelvic and breast examinations and discuss hormone replacement therapy, abnormal PAP smears and identification of domestic violence.
During the Community Service and Public Health component, residents can participate in a community hospice program or care for underserved patients at various inner city clinics and practices.
Residents also participate in a problem based learning (PBL) project, where they perform a self-assessment exercise of the patient care they provide in their clinic and formulate an improvement plan based on the results. At the conclusion of the Ambulatory Block, the Primary Care Chief Resident meets with the group to review their PBL results and the literature that supports the standard of care.
Most residents spend time in a private general internal medicine practice in the community where they gain exposure to a different patient mix and learn the principles of continuity and episodic care from experienced practitioners.

Training in Procedural Skills and Practice Management

Through the Ambulatory Blocks and seminars held by UMMC, residents have the opportunity to hone specific skills useful for a career in primary care and general internal medicine. In addition, exposure to the practical business of medicine is provided through a lecture series.

Residents can enhance their skills in:

Joint aspiration and injection
Skin biopsy and suturing
Management of strains and sprains

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 for them. 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.

Episodic Ambulatory Care Experiences

During the PGY-2 year, all residents rotate through our Faculty Practice Office (FPO), where they work alongside our general medicine faculty in a private practice setting. During their first year of training, residents rotate through the Emergency Room at UMMC and the Emergency Care Services (ECS) at the VA. They return to ECS in the 2nd and 3rd years, where they receive additional training in outpatient urgent care medicine. The Emergency Room experience is described under the University of Maryland Medical Center.

This page was last updated on: August 2, 2012.