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Ambulatory Training

The University of Massachusetts Medical School and the UMass Memorial Health Care system have a strong history of valuing Primary Care as the core of a patient’s health care experienceEach categorical resident will be assigned a continuity clinic site, where they will become a valued member of a health care team and co-manage a panel of patients. Residents attend continuity clinic during their Ambulatory weeks, but not during inpatient or ICU service weeks. In this 4+1 system, we are able to separate inpatient and outpatient responsibilities, allowing for a more concentrated and enhanced experience in each environment. Residents also have ample opportunity to experience other ambulatory clinic experiences in subspecialty clinics (Medicine/Surgery), community clinics, and interprofessional environments. 

Ambulatory Week 

After 4 weeks on an inpatient, ICU, or elective rotation, all interns (preliminary and categorical) and residents are on Ambulatory week. 

ambulatory week.jpg

During ambulatory week, categorical interns and residents will have:

  • 5 Continuity Clinic sessions
  • 1 morning of Didactic/Ambulatory Core Curriculum sessions
  • 2 Subspecialty clinic sessions
  • "Golden Weekend" off
  • 2 Independent learning sessions ("Green Blocks") to complete:
    • Clinic documentation and lab/radiology follow up
    • Independent online learning modules
    • Longitudinal Quality Improvement Project

During ambulatory week, preliminary interns will have:

  • 4 days of elective of resident's choice
  • 1 morning of Didactic/Ambulatory Core Curriculum sessions
  • "Golden Weekend" off
  • 1 independent learning session ("Green Block") to complete
    • Independent online learning modules
    • Longitudinal Quality Improvement Project

Ambulatory Core Curriculum - Laura Hallett, MD and Elizabeth Murphy, MD (Program Director, Primary Care Residency)

Thursday Morning academic half-day sessions are held for all Ambulatory Week Residents. A three-year revolving curriculum includes Primary Care Core Curriculum (Prevention/Screening, Acute Care, Chronic Care), Geriatrics Core Curriculum, Quality Improvement, Medical Specialty Curriculum, High-Value Care, Health Care Disparities, and Evidence-Based Medicine. A variety of teaching formats are used including traditional didactic lectures, case-based, MKSAP embedded questions, Medical Jeopardy, flipped-classroom, and workshop format. Independent Online Modules are assigned to supplement curriculum not delivered live. All schedules and curriculum are housed on a Google Site to provide mobile access for our residents. 

Geriatrics Training - Erika Zimmons, DO 

In addition to the 3 year Geriatrics Core Curriculum delivered during Ambulatory weeks, residents have required online independent learning assignments to supplement their education. Our trainees have a robust Geriatrics clinical experience as well. During PGY1, residents rotate through area Skilled Nursing Facilities with our Geriatrics faculty members. During PGY2, they rotate in the Geriatrics Clinic where they participate in consultative and chronic care of elderly patients. During their PGY3 year, each resident does a home visit on one of their own geriatric clinic patients and also makes emergency home visits with Elder Services. Finally, to meet the 4 week-required ACGME Geriatrics experience requirement, we have added a new Geriatrics curriculum enhancing the PGY3 rotation on Medical Consults.  Residents will address geriatric inpatient topics by reviewing landmark papers as well as performing a mini-CEX on falls with a geriatric Orthopedic patient. Residents are required to participate in a 1-week Palliative Care Elective in PGY2 or PGY3 year and participate in a Goals of Care simulation during PGY2 year.

Continuity Clinic Sites

Benedict Adult Primary Care Clinic –Site Directors: Richard Palken, MD & Jeeva Subramanian, MD

Javeen.jpgThe Benedict Primary Care Clinic, located on the University Campus, is the largest ambulatory clinic supporting outpatient residency training. More than one-third of our residents train at this academic site. The clinic serves a very large, diverse, and medically complex patient population. Residents are paired with experienced faculty members (primary preceptors) for their 3 years of training. Residents have their own panel of patients that are co-managed with faculty primary preceptor. This close pairing promotes continuity of care for patients as well as education and mentoring opportunities for residents.

Tri-River Family Health Center - Site Director: Andrew Siber, MD

Tri River Ambulatory.pngTri-River Family Health Center (TRFHC) is a UMass Memorial multi-specialty clinic located in Uxbridge, Massachusetts approximately 30 minutes from Worcester. Founded in 1978, TRFHC has become a paradigm for fulfilling the respective interests of medical education and community health care. The Internal Medicine Department is staffed by 8 Board-certified UMass faculty, many of whom are graduates of the UMass Internal Medicine Residency Program. The clinic serves as a training site for both residents and medical students. UMass medical students from all four classes participate in TRFHC programs, and 20 medical residents have their continuity clinic at TRFHC.

Worcester VA Clinic - Site Director: Radhika Koneru, MD

VA.pngThe Worcester VA Clinic provides comprehensive outpatient care for veterans. It is situated in a modern facility 5 minutes from UMass Memorial Medical Center. On-site services include radiology, laboratory, physical therapy, mental health, pharmacy, and many medical subspecialties. State-of-the-art medical informatics services and infrastructure greatly facilitate the care of the patient and enrich the experience of staff and residents. With the support of full-time VA faculty, eight residents are the primary care providers for their panels of patients. A new VA Clinic is being built on the University Campus, with a projected opening in 2021.

Community-Based Faculty Sites

Community Based Sites 2.png
A variety of community-based practices participate in ambulatory education and are among our most popular sites.  Each site generally accommodates 1-2 residents and offers a patient population reflective of those encountered in the private practice setting. Driving distances vary from 10 to 40 minutes. Residents may choose a clinic site convenient to where they live. The preceptors at each site have been chosen for their strong commitment to medical education.

Subspecialty Clinic Experiences

Subspecialty clinic exposure is crucial to resident education given that most medical care is delivered in the ambulatory setting.  Our residents have the opportunity to rotate through ambulatory clinics in Medical Specialties (GI, Cardiology, Heme Onc, Pulmonary, Rheumatology, Nephrology, Endocrinology/Diabetes, Dermatology, or ID/HIV) over the course of their training. We also offer experiences in other ambulatory settings such as Gynecology, Urology, Ophthalmology, Vascular Surgery, Physiatry, ENT, Nutrition, Palliative Care, Travel Clinic, and Multiple Sclerosis clinic. If a resident has chosen to pursue a fellowship, when possible, we attempt to give them increased ambulatory clinic time in their career area of choice.

Subspecialty Clinic 1