SCHOOL OF MEDICINE

Department of Medicine

Internal Medicine Residency

Ambulatory Training

At Indiana University, we strive to provide our residents with a well-rounded training program. Our ambulatory program is designed to not only train future primary care physicians, but also subspecialty physicians who will spend a significant amount of time practicing in the office setting and treating chronic diseases. Ambulatory education is a vital aspect of every resident's training, and we continually explore innovative ways to improve our residents' outpatient experience.

We have designed our ambulatory curriculum to insure that each resident, upon graduation, is proficient in caring for outpatients. We do recognize that some residents, particularly those choosing to practice primarily in the outpatient setting, may wish to pursue additional ambulatory training experiences. Our program is flexible, and the format offers those residents the opportunity to choose primary care electives and allocate up to fifty percent of their time in the outpatient arena.


Continuity Clinics

Beginning with the first week of internship, our residents have their own continuity clinics one half day a week. Clinic sites include IU hospital and affiliates, Methodist hospital, VA hospital and affiliated with Wishard Hospital include the Primary Care Center, Blackburn, Forest Manor, North Arlington, Grassy Creek, Westside, and Cottage Corner. Other clinic sites include the Veterans Hospital or Methodist Hospital Outpatient Clinics.

Each resident sees his/her own patients in the same site at the same time each week for all three years, and is generally staffed by his/her preceptor who also is familiar with the patients. In addition to ambulatory medicine, residents are also encouraged to learn important skills such as billing and coding, time management, and office procedures. Continuity clinics are cancelled for residents during the night float and ICU rotations. Through our EIP - REACH program, the Patients First initiative has allowed us to integrate a one-week "immersion week" in which residents spend a dedicated week in clinic without the distraction of ward responsibilities.


Ambulatory Medicine Rotations

Residents will have one ambulatory rotation per year with slightly different emphasis during each. In addition, all residents in the rotation participate in a number of workshops and "academic half-days." These twice-weekly didactic sessions are case-based and interactive and based on a three-year rolling curriculum of outpatient topics. The speakers are a mix of specialists and general internists dedicated to teaching. Special physical exam skills are provided through cardiovascular auscultation workshops run by senior cardiology faculty. A coding and billing workshop allows residents to hone this important set of skills. Great emphasis is also placed on doctor-physician skills education. First and second year residents participate in a one-month rotation each year devoted solely to ambulatory care. During these months our residents spend their days in the outpatient clinics located in the campus hospitals and also in private offices in Indianapolis. The first year rotation focuses on a core curriculum in order to expose interns to medical issues less often addressed on the inpatient wards including endocrinology, gynecology, infectious disease, urgent care, and dermatology. During the second year rotation each resident may tailor his or her experience according to personal interests and goals. Specialty clinics include pulmonary, cardiology, rheumatology, infectious diseases, endocrinology, hematology, oncology, renal, dermatology, neurology, radiology, sports medicine, pre-op clinic, allergy, adolescent medicine, occupational medicine and gastroenterology.

Third year residents participate in a one-month rotation called Advanced Ambulatory Care. This month provides our residents with exposure to many aspects of ambulatory care not covered elsewhere in the program. Residents spend multiple days in clinics focused on topics including neurology, office management, dermatology, cardiology/CHF, wound care, complementary and alternative medicine, women's health, public health and cardiac and pulmonary rehabilitation. In addition to the required early ambulatory care rotation, many ambulatory based electives are available. These include Dermatology, PM&R, Public Health, Sports Medicine, Endocrinology, hematology/oncology clinics, and Women's Health. Residents who are considering a career in outpatient general medicine may choose to arrange a special elective where they spend time in one or more outpatient practices. Two other ambulatory-based rotations, geriatrics and rheumatology, are required for everyone.