Ambulatory-Based Education in Internal Medicine: Current Organization and Implications for Transformation. Results of A National Survey of Resident Continuity Clinic Directors

Abstract

This national survey demonstrates that the continuity clinic experience varies widely across IM programs, with many sites not yet meeting new ACGME requirements. The combination of disadvantaged and ill patients with inadequately resourced clinics, stressed residents, and clinic directors suggests that many sites need substantial reorganization and institutional commitment.New paradigms, encouraged by ACGME requirement changes such as increased separation of inpatient and outpatient duties are needed to improve the continuity clinic experience.

Transforming Primary Care Training—Patient-Centered Medical Home Entrustable Professional Activities for Internal Medicine Residents

“…20,25 Residency programs with fewer resources can still use this framework to take these steps in moving forward. First, program leaders may use these EPAs to guide curriculum needs assessment.…”

“…[15][16][17][18][19][20] Early residency education redesign initiatives, including the Academic Chronic Care Collaborative, 21,22 Health Resources and Services Administration (HRSA) efforts, 23 and Veterans Affairs Centers of Excellence in Primary Care Education, are significant investments. 24 However, most residents still train in poorly organized practices, with few, if any, PCMH elements.…”

“…24 However, most residents still train in poorly organized practices, with few, if any, PCMH elements. 20,25 Thus, they continue to face a mismatch between today's clinical education and tomorrow's health care practices.…”

Academic General Internal Medicine: A Mission for the Future

“…28,29 At the same time, medical education is in a time of transition with duty hour restrictions for residents, 30,31 a shift to ambulatory settings for both residency and medical student training, increasing concern about student debt burden, 32 and a focus on teaching practice competencies rather than medical knowledge. 33,34 This transition is occurring as the physician workforce also changes, with a growing proportion of women (30 % of practicing physicians and 52 % of medical students) 35 , slow shifts in racial and ethnic diversity (17 % of current medical students identify as a racial or ethnic minority), 35 and a growing focus on work life balance.…”

Interval Examination: Building Primary Care Teams in an Urban Academic Teaching Clinic

“…We needed to transform our clinic in order to address weaknesses in access, continuity, coordination, and resident experience-but how? We were not alone; the literature shows that academic clinics are often dysfunctional for patients and trainees alike, [1][2][3] and that teaching clinics face significant challenges to medical home transformation. [4][5][6] However, we found no clear roadmap in the literature for how to transform a large, complex teaching clinic like ours.…”