Ambulatory Training

The University of Massachusetts Medical School and the UMassMemorial Health Care system have a strong history of valuing Primary Care as the core of a patient’s health care experience and coordination. We are fortunate to be able to train our residents in such an environment. Each categorical resident will be assigned a continuity clinic site, where they will become a valued member of a health care team and co-manage a panel of patients. Residents attend continuity clinic during their Ambulatory weeks, but not during inpatient or ICU service weeks. In this 4+1 system, we are able to separate inpatient and outpatient responsibilities, allowing for a more concentrated and enhanced experience in each environment. Residents also have amble opportunity to experience other ambulatory clinic experiences in subspecialty clinics (Medicine/Surgery), community clinics, and interprofessional environments (Visiting Nursing, Hospice Nursing, Elder Protective Services, Home Visits, PT/OT).

Ambulatory Week

During this week, residents will have

  • 5 Continuity Clinic sessions
  • 1 Didactic/Ambulatory Core Curriculum session
  • 2 Subspecialty clinic sessions
  • 2 Independent learning sessions to complete
    • Clinic documentation and lab/radiology follow up
    • Independent online learning modules (Johns Hopkins, Geriasims, Institute for Healthcare Improvement, American Academy of Dermatology)
    • Longitudinal Quality Improvement Project

Continuity Clinic Sites

Benedict Adult Primary Care Clinic –Site Director: Richard Palken, MD

The Benedict Primary Care Clinic is the largest ambulatory clinic supporting outpatient residency training. More than one-third of the residents train at this site. 20 Faculty preceptors guide 35 residents in the practice of  ambulatory medicine. Residents are paired with individual faculty members (primary preceptors) for their 3 years of training. Residents have their own sub panel of patients that are under the care of their academic faculty primary preceptor. This permits continuity of care for the residents, faculty and patients. During resident clinic sessions, precepting faculty are not permitted to have other direct clinical responsibility beyond that of teaching residents and caring for the residents' patients.

Tri-River Family Health Center - Site Director: Andrew Siber, MD

Tri-River Family Health Center (TRFHC) is a UMass Memorial multi-specialty clinic located in Uxbridge, Massachusetts approximately 30 minutes from Worcester. Founded in 1978, TRFHC has become a paradigm for fulfilling the respective interests of medical education and community health care. The Internal Medicine Department is staffed by 8 Board-certified UMass faculty, many of whom are graduates of the UMass Internal Medicine Residency Program. The clinic serves as a training site for both residents and medical students. UMass medical students from all four classes participate in TRFHC programs, and 16 medical residents have their continuity clinic at TRFHC.

Worcester VA Clinic

The Worcester VA Clinic provides comprehensive outpatient care for veterans. It is situated in a modern facility 5 minutes from UMass Memorial Medical Center. On-site services include radiology, laboratory, physical therapy, mental health, pharmacy, and many medical subspecialties. State-of-the-art medical informatics services and infrastructure greatly facilitate the care of the patient and enrich the experience of staff and residents. Residents have the opportunity to be primary care providers with support of full-time staff.

Community - Based Faculty Sites

A variety of community-based practice locations have collectively become a popular choice for ambulatory education over recent years. Each site generally accommodates 1-2 residents and offers a patient population reflective of those encountered in the private practice setting. Driving distances vary from 10 to 40 minutes. Residents may choose a clinic site convenient to where they are living. The preceptors at each site have been chosen for their strong commitment to medical education.

Ambulatory Core Curriculum - Gertrude Manchester, MD

Thursday Morning  didactic sessions are held for all Ambulatory Week Residents. A three year curriculum includes Primary Care Core Curriculum (Prevention/Screening, Acute Care, Chronic Care), Geriatrics Core Curriculum, Quality Improvement, Medical Specialty Curriculum (Rheumatology, Dermatology, Endocrinology, GI), High Value Care, Evidenced Based Medicine, Hospice & Palliative Care, Behavioral Medicine & Motivational Interviewing, Communication & Professionalism, and Occupational Health. A variety of teaching formats are used, including Case-based, MKSAP embedded questions, Medical Jeopardy, workshop format. All curriculum is housed on a wiki to provide mobile access for our residents.

Quality Improvement Curriculum - Gertrude Manchester, MD & Elizabeth Murphy, MD

patient satisfactionOur QI Curriculum involves classroom, independent study, and hands-on project participation. A three-year QI didactic curriculum is delivered during the Ambulatory week didactic sessions. Topics include but are not limited to Process Analysis, Measurement, Lean Training, and PDSA Cycles. We have developed a fun, interactive, Lean Process Training Workshop using Mr. Potato Head which is well received by residents and has been presented regionally and nationally by Drs. Murphy and Manchester. Residents are given time to  complete the IHI Open School Modules during their residency. Finally, each resident is expected to do an annual QI Project ranging from a clinic chart review to a longitudinal process improvement activity. Several residents present their projects at the UMass Memorial Annual Peter Levine Quality and Patient Safety Symposium. We expect all of our residents to be able to lead Quality Improvement projects in their future areaof practice.
    QI QI sorting

Geriatrics Training - Erika Oleson, DO 

In addition to the Geriatrics Core Curriculum delivered during Ambulatory weeks, residents have online  independent learning assignment expectations. Our trainees have a robust Geriatrics clinical experience as well. During PGY1, residents rotate through area Skilled Nursing Facilities with our geriatrics faculty members. During PGY2, they rotate in the Geriatrics Clinic where they participate in consultative and chronic care of elderly patients. During their PGY3 year, each resident does an home visit on one of their own geriatric clinic patient and also makes emergency home visits with Elder Services.

Subspecialty Clinic Experiences

The majority of medical care of patients is experienced in the ambulatory setting and we insure our residents are well prepared to practice medicine in whichever discipline they choose. Residents will have amble opportunity to rotate through ambulatory clinics in all of the Medical Specialties (GI, Cardiology, Heme Onc, Pulmonary, Rheumatology, Endocrinology/Diabetes, Dermatology, ID/HIV) over the course of their training. We are also fortunate enough to offer experiences in many other ambulatory areas such as GYN, Urology, Ophthalmology, Behavioral Medicine, Vascular Surgery, Physiatry, ENT, Occupational Medicine, Pre-Op Clinic, Nutrition, PT/OT, Palliative Care, Weight Clinic, Travel Clinic, and Multiple Sclerosis clinic, to name a few.



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