Ambulatory Care - Community Medicine

PREREQUISITE: Requires completion of all third year clerkships.

Suzanne El-Sayegh, M.D., is Director of Ambulatory Care Medicine

The division of Ambulatory Care is dedicated to the constant improvement of the residents' outpatient training, and works closely within the Department of Medicine to continually build on the ambulatory experience.

The resident's ambulatory experience occurs primarily in University Hospital's Medical Arts Pavilion, (MAP) and the teaching faculty's practice locations in the Staten Island Community. The MAP, a 55,000 square-foot technologically advanced facility housing a broad array of primary and subspecialty clinics with convenient on-site laboratory and radiology services, serves as an ideal site for the training of residents. Additional training sites include the private offices of many of our teaching faculty, where the intricacies of the private practice of medicine are taught. A faculty of over 50 full-time and part-time General Internists compose the primary care teaching staff and are dedicated to the ambulatory training of residents. As a New York State designated Primary Care Program, categorical residents will spend over 40-45% of their residency in our outpatient settings.

Patients recognize both their assigned resident and the teaching faculty as their primary care physicians. In the event of the resident's absence, the assigned faculty and another resident within the group practice will maintain continuity. A 24-hour patient answering service enables our medical residents to gain experience in telephone consultation, render total continuity of care, and reduce emergency visits and acute hospital admissions. When a patient does require hospitalization, the patient is admitted to the service of the Medical Faculty Practice. Residents are notified of the admission and are encouraged to follow that patient's progress through their acute illness. Upon discharge, the patient is given a follow-up appointment to his/her usual continuity clinic and assigned resident.

In addition to the resident's continuity experience, all medical residents, (preliminary and categorical) will rotate 1-2 months per year in the Primary Care Block Rotation. During these rotations, residents will expand their existing panel of patients by attending extra medical sessions. In addition, residents will be assigned to a variety of subspecialty clinics to provide exposure to ENT, Adolescent Medicine (including school-based health sessions), Medical Gynecology, Ophthalmology, Orthopedics, Sports and Rehabilitation Medicine, Behavioral Medicine, Dermatology, Geriatrics, Allergy and Immunology, Pulmonary Medicine, Cardiology, Rheumatology, Neurology, and Nephrology. This progressive coordinated rotation also includes a daily morning conference covering topics in Ambulatory Medicine, as well as several new projects including Resident Community Involvement and the Practice Based Learning Experience (PBLE). The Community Involvement Exercises will send residents into the community during their Primary Care Block Rotation to provide a wide range of educational and preventive services. The PBLE will actively educate medical residents in topics in Healthcare Quality, and will also entail a reflective analysis of the care they had been rendering in their continuity clinics via a series of detailed chart reviews.

Medical Residents on Subspecialty Electives will also gain ambulatory experience by attending the corresponding subspecialty clinics once or twice per week. Ambulatory subspecialty clinic exposure during electives will allow residents to simultaneously experience both inpatient and outpatient aspects of the practice of an individual subspecialty, and therefore aid in the formulation of their career choices.

At the conclusion of three years, the resident will have rotated in a complementary fashion through all of these diverse experiences, and will be better prepared to serve their community regardless of their individual career paths.