While the majority of healthcare delivery occurs in ambulatory settings, internal medicine residency training remains largely hospital-based. To address this imbalance between training and practice, the Yale Primary Care Program is committed to providing expanded and uncompromised ambulatory training. Innovative curricula ensure continuity of care with patients, continuous relationships with supervising faculty, diverse clinical settings, and experiential learning with graduated autonomy. In developing ambulatory experiences, we are guided by the insights of medical education science, a continual evaluation of our work, local community health care needs, and residents’ feedback and individual goals. A commitment to advancing the science of graduate medical education is one of the important ties that bind the primary care program faculty. Indeed, our own research findings often directly inform our curriculum (see references throughout this section).
Our curriculum's broad objectives reflect the knowledge, skills, behaviors, and attitudes exemplified by effective primary care physicians. In addition, we have developed curricula to cover newer areas of proficiency for internists, including quality improvement, disease management, evidence-based practice, shared decision-making, and patient-centered, interprofessional team-based care.
The residents’ weekly continuity clinic and ambulatory block rotations represent the cornerstones of their ambulatory experience. In addition, about half of the activities on elective rotations take place in outpatient venues. A full-time Associate Program Director for Ambulatory Education, Dr. Stephen Holt, along with Assistant Director, Dr. Sarita Soares, coordinates the overall ambulatory medicine curriculum.
1 Green ML. Identifying, appraising, and implementing medical education curricula: a guide for medical educators. Ann Intern Med. 2001;135(10):889-896.