Over the past several years, the ambulatory training has greatly expanded. Interns have several weeks of concentrated primary care in our on-site Internal Medicine practice (Tufts Primary Care Boston). This is done under the 3+1 model mentioned above. Residents also have opportunities to work in Dermatology Clinic, Orthopedics Clinic, Ophthalmology Clinic, and many others. There is a primary care core curriculum in the form of conferences, online learning modules, and QI projects during ambulatory blocks.
In the weekly continuity clinic, interns and residents are expected to follow their own patients many of whom they took care of on their inpatient services. Each house officer has an assigned preceptor in primary care under whose supervision they manage their panel of patients. To minimize conflicts with inpatient responsibilities, house officers rarely have continuity clinic during their ward blocks.
Our Tufts Primary Care practice is located on site at the hospital which facilitates the ability of our house officers to become primary care providers. Almost all house officers rotate through Endocrinology and Rheumatology which are predominantly ambulatory rotations. In addition we have numerous three week subspecialty ambulatory blocks which are scattered throughout the three years. Our goal in these blocks is to expose the house staff to the common problems for which a general internist might seek a subspecialty consultation. House officers have the ability to choose which of these subspecialty blocks they rotate through which allows them to learn more about subspecialties they may be considering for careers. We also have a new community based practice which will give our house officers exposure to primary care outside of the academic center.