Ambulatory Education

Jennifer Lukela, MD
Associate Program Director

"We provide all our residents with the knowledge and skills necessary to practice as excellent outpatient general internists in academic or community practice settings." - Jennifer Lukela, MD

The majority of medical care occurs in the ambulatory setting. As a result, internists must be comfortable evaluating and managing both acute complaints and chronic conditions outside the hospital.

A goal of the University of Michigan Internal Medicine Residency Program is that all our graduates will be comfortable with the practice of general internal medicine in the outpatient setting. While some of our residents will elect to pursue further training after residency in subspecialty practice, we believe these core skills in outpatient general medicine will serve them well in aspects of their future practice and in their overall development as internists. 

Ambulatory Education

Outpatient Clinical Experiences

Our residents gain clinical experience in the practice of Internal Medicine in the outpatient setting through three main rotations or longitudinal experiences:

  • Continuity Clinics
  • Ambulatory Block Rotations
  • Outpatient Clinical Electives

Continuity Clinics

Residents will be assigned to a continuity clinic in one of three locations: 

  1. Taubman General Medicine Clinic (located in an outpatient building adjacent to University Hospital)
  2. General Medicine Clinic at the VA Ann Arbor Healthcare System
  3. One of five University of Michigan Health System clinics located in our local community:
    • Briarwood Medical Group
    • Brighton Health Center
    • Canton Health Center
    • East Ann Arbor Health Center
    • Northville Health Center

A primary goal of our continuity clinic experience is for residents to maintain longitudinal relationships with patients throughout their training. Since all of our continuity clinic sites serve as Patient Centered Medical Homes, this is an opportunity for our residents to gain experience in panel management and general quality improvement (QI) principles in population health.

On average, residents are scheduled for one half day of continuity clinic per week with additional time in their assigned clinic during their ambulatory block rotations.

Curriculum

  • All interns participate in an “immersion week” in clinic early in their training to improve comfort in their clinic setting.
  • Emphasis on experiential learning from patient encounters with guidance from expert clinician-educator and research-based general internal medicine faculty.
  • Direct observation of clinical and communication skills
  • Monthly outpatient teaching sessions with your continuity clinic faculty:
    • Yale Office-Based Medicine Curriculum module
    • Case vignette presentations
    • Evidence-based literature reviews
    • Quality Improvement/Panel Management

Ambulatory Block Rotation

All House Officers participate in Ambulatory Block rotations as part of their outpatient training. 

The Ambulatory Block Rotation is a 4 week outpatient rotation made up of both primary care and subspecialty clinics. The experience involves extra time in residents’ own continuity clinics to build their patient panel as well as a variety of medicine and non-medicine clinics (dermatology, gynecology, ophthalmology, and neurology). Residents have an “academic half-day” during this rotation during which they receive high-yield didactics from a variety of faculty.

Upon successful completion of these rotations, residents will be able to diagnose and manage a wide range of acute and chronic internal medicine disease states. Residents will understand the logistics of care in the ambulatory setting and have the ability to work in a variety of practice environments. They will also be familiar with the care of a variety of patient populations in the ambulatory setting.

This rotation is mandatory for residents at all house officer levels. All interns will complete at least one ambulatory block rotation (primary care track residents may have the opportunity for two rotations). Senior residents will complete one to two ambulatory block rotations per year with additional outpatient training opportunities for residents participating in the primary care track.

Teaching to Teach

Residents have several opportunities to hone skills in medical education during residency. From July-September, the academic half day of ambulatory is devoted to teaching high-yield topics in medical education, including developing teaching scripts, giving feedback, and effective lecture techniques.

Senior residents may also elect to participate in the medical education outpatient elective. During this experience, residents participate in several teaching experiences, including Sub-I report, VA chief rounds, and VA physical exam rounds. The residents also develop several teaching scripts during this rotation which they can use to enhance their teaching on inpatient rotations.