Ambulatory Experience

Ambulatory care training is offered in multiple venues and rotation types.

Continuity Clinics

  • Residents are assigned to a single clinic site for the duration of training either at the VA Medical Center (VAMC) or in the VCUHS Ambulatory Care Clinic (ACC)
  • General Internal Medicine Faculty teach at both sites
  • Residents have a defined patient panel at each site
  • Through tandem block scheduling, clinics are held during outpatient blocks only
  • Full day clinic at either VAMC or ACC
  • Quarter day mini-clinic one day a week during outpatient blocks
  • No clinics during inpatient blocks
  • Teaching is emphasized – our ambulatory care curriculum includes:
    • Ambulatory morning report  3 days a week at both VAMC and ACC
    • Ambulatory journal club 1 day a week at both VAMC and ACC
    • Clinical question-based teaching in real time
    • Systems-based practice learning objectives and focus
  • Resident Partners in primary care
    • Partners are assigned by day of clinic
    • Partners are within the same training year to facilitate continuity when possible
    • Partners are responsible for managing patient follow up, phone calls, clinic paperwork – function as a practice group
    • Partners will see each others’ patients as necessary
  • Each resident is assigned a single attending evaluator
    • Ratio: 1 attending to 4 residents maximum
    • Attendings are available for support regarding patient management, as well as some follow-up duties when specifically asked by a partnership
  • Opportunity to work in inter-disciplinary teams with psychologists, nurses, pharmacists, and social workers

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Ambulatory Blocks

  • PGY-1 Ambulatory Block (AMBi Block)
    • Focused introduction to the ambulatory experience
    • Includes time in continuity clinic, geriatrics, psychology clinic, anticoagulation clinic
    • Time for chart review and partnership work
    • Also assigned time with nursing staff, pharmacy, other health care professionals (PT/OT, nutrition) to develop appreciation of functions of other persons in our system
    • Includes Med Tech Tuesdays: an introductory course in evidence-based medicine, information resources and presentation skills
  • PGY-2 Ambulatory Block (AMBr Block)
      • Experience in medicine and non-medicine clinic-based specialties that have a significant clinical overlap with primary care: neurology, adolescent health, Ophthalmology, Geriatric consult clinic
  • Community preceptorships
    • Experiences in the private sector with practicing physicians
    • May be primary care providers or outpatient-based subspecialists
  • Urgent care
    • PGY-3 experience at VCU Medical Center
    • Acute care in the primary care setting – spend time in the faculty practice and in the teaching clinic
    • One-on-one supervision by faculty
    • Combined with primary care call (from-home) duties
    • Teaching role with MSIII med students
  • Student health
    • PGY-3 experience
    • Student health clinic at VCU
  • Women’s health block
    • Primarily for women’s health pathway residents
    • VCU community-based practice at Stony Point
    • Outpatient experiences in gynecology, primary care for women, breast health, osteoporosis, endocrine and others
  • Rheumatology and Endocrinology and Metabolism
    • Incorporated into consultative elective
    • Experience in ambulatory setting in multiple clinics
      • Bone
      • Lipid clinic
      • Diabetes/endo clinic
      • Rheumatology
      • Other
    • Other outpatient-based elective blocks

Other – Episodic Outpatient Experience

  • Community free clinic (Fan Free Clinic)
    • Indigent care community clinic
    • Offered to women’s health and generalist pathway residents
    • Scheduled during AMBi, Urgent Clinic and select elective rotations
    • Chief medical resident supervision

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