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.

Ambulatory Week

As we have a 4+1 scheduling system, after 4 weeks on an inpatient, ICU, or elective rotation, all interns (preliminary and categorical) and residents are on Ambulatory week.

During this week, categorical interns and residents will have:

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

New in 2016-2017, we incorporated our preliminary interns into the 4+1 schedule. During their ambulatory week, preliminary interns will have:

  • 4 days of elective of resident's choice
  • 1 morning of Didactic/Ambulatory Core Curriculum sessions
  • "Golden Weekend" off
  • 1 independent learning sessions to complete ("Green Block")
    • Independent online learning modules (John Hopkins, and Institute for Healthcare Improvement)
    • 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 and is located on the University campus. More than one third of our residents train at this academic site. The clinic serves a very large, diverse, and medically complex patient population. Seventeen experienced faculty preceptors guide 35 residents in the practice of primary care internal 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 and teaching for the residents, faculty and 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. Four 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 - Elizabeth Murphy, MD & Laura Hallett, MD

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

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

patient satisfaction

Our robust 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. Residents are given time to complete the IHI Open School Modules during their residency and receive their IHI Basic Certificate in Patient Safety and Quality Improvement. All residents receive their White and Yellow Belts in Lean Process Improvement.

Finally, each resident is expected to participate in a QI Project from the ambulatory, inpatient, or educational setting, including completing an A3 form with multiple PDSA cycles.  Project posters are presented at the Annual Resident Poster Day, with awards given in multiple categories. We expect all our residents to be able to lead Quality Improvement projects in their future area of practice. 



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 a home visit on one of their own geriatric clinic patients and also makes emergency home visits with Elder Services.

Subspecialty Clinic Experiences

The majority a patient’s medical care 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 many Medical Specialties (GI, Cardiology, Heme Onc, Pulmonary, Rheumatology, Nephrology, Endocrinology/Diabetes, Dermatology, ID/HIV) over the course of their training. We are also fortunate enough to offer experiences in many other ambulatory settings such as Gynecology, Urology, Ophthalmology, Behavioral Medicine, Vascular Surgery, Physiatry, ENT, Nutrition, Palliative Care, Travel Clinic, and Multiple Sclerosis clinic, to name a few.





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