Ambulatory Experiences

In 2007, over 300,000 outpatient visits were made to the Department of Internal Medicine clinics in the University of Michigan Health System . Residents participate in a broad range of clinical experiences in outpatient medicine at many different sites. Competency in ambulatory medicine is developed in both the general medicine and subspecialty domains, through both internal medicine and non-internal medicine clinics.

There are three types of clinical rotations through which residents rotate: (1) continuity clinics, (2) ambulatory block rotations, and (3) subspecialty electives.

Resident Longitudinal Continuity Clinic: General Medicine Primary Care Practice

Residents are assigned based on preference to one of two continuity clinic models. Half of residents have their continuity clinic at the Taubman Outpatient Center , based adjacent to the main University Hospital . The other residents see their continuity clinic patients at two different sites: (1) one of three community-based University primary care centers ( Canton , Brighton , and East Ann Arbor), and (2) at the Ann Arbor VAMC Ambulatory Care Clinic. The Taubman clinic space and the VAMC have both been newly renovated. All centers are full equipped and staffed by nurses and medical assistants, and provide electronic medical records for all patients and providers.

In either model, residents are truly the primary physicians for a broad group of patients, managing health and disease problems driven by gender, racial and socioeconomic diversity. Residents develop competence in management of many common primary care conditions, including coronary artery disease, chronic obstructive pulmonary disease, hypertension, diabetes, hyperlipidemia, and cancer, among other disorders. Emphasis is placed on developing longitudinal professional relationships with patients over three years, utilizing support services provided by a team of allied health professionals. During these clinics, residents also participate in an ambulatory care curriculum, using Internet-based materials to discuss core primary care topics in small groups.

Full-time General Medicine faculty serve as the primary mentors for residents at all continuity clinic sites, providing a balance of evidence-based clinical education with practical teaching based on their clinical experience.

Ambulatory Blocks

Residents rotate through several of the 14 ambulatory month-long block experiences during their three years of training. These rotations have been created to provide concentrated learning in the outpatient setting. The clinics are based at the Taubman Outpatient Center at the University Hospital , the Cancer Geriatrics Center , the Ann Arbor Veteran's Affairs Outpatient Center , and many of the community-based clinics located in Ann Arbor and the surrounding areas. The individual schedules are designed to provide a balance between both primary care and subspecialty clinics, offering experiences in Geriatrics, Women's Health, Endocrinology, Infectious Disease, Pulmonology, Rheumatology, Cardiology, Hematology-Oncology, and Allergy. In addition, residents actively care for patients in non-internal medicine settings, including Dermatology, Sports Medicine, Urology, Neurology, exercise stress testing and Psychiatry. Also, residents have the opportunity to rotate through several clinics designed to provide care to underserved populations, including those with HIV, the homeless and socioeconomically disadvantaged. Residents actively participate in Ambulatory Morning Report during these rotations, and they take part in weekly small group seminars designed to foster interactive, hands-on learning in a variety of core curricular topics: Evidence-Based Medicine, Medical Informatics, Women's Health, Cultural Competency, Patient Safety, Dermatologic procedures, and Arthrocentesis.

Subspecialty Electives

Residents rotate monthly through ambulatory clinics and consult services for each of the individual medical subspecialties as part of elective rotations at both the University Health System and the VA. Residents are directed toward the initial evaluation of patients who are newly referred to these clinics and receive excellent instruction from the supervising subspecialty faculty. The elective rotation for each of the subspecialties is coordinated to include scheduled time in the outpatient clinic, along with daily rounds on the consult service. Each subspecialty also has a separate schedule of weekly conferences to supplement topics relevant to that particular specialty.

Emergency Room

Each House Officer spends 4 weeks in the Urgent Care or Emergency Room Service under the direction of the Department of Emergency Medicine at the University Hospital . This level 1 Trauma Center provides exposure to a wide variety of patients with acute medical and surgical problems. Close collaboration of Internal Medicine Residents with Residents from other disciplines results in excellent training in acute care medicine.