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.

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 or clinic.

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 and Interviewing 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 Rehabilitation Medicine 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 may make home visits with nurses, 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 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 the community.

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 medications.
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.
Auscultation of heart sounds: Supplementary training in cardiac auscultation is provided by cardiology faculty.

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.
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: July 18, 2008.