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Ambulatory Curriculum

Overview

We provide a comprehensive ambulatory curriculum to all medical residents.  It is presented over a three-year period and includes lectures, case-based discussions, practical workshops, and seminars.  Primary Care Track and HIV Primary Care Track residents receive additional curriculum for content that is germane to these areas.

The intern outpatient curriculum is delivered during ambulatory block rotations in a one-year cycle.  The PGY2 and PGY3 curriculum is delivered during practice week rotations in a two-year cycle.  General internal medicine faculty members, specialists, and senior medical residents serve as lecturers, discussion facilitators, and seminar leaders.  Learning objectives are presented for each content area, and educational materials are posted on the BIDMC Medical Housestaff Wiki.  Other venues/opportunities for ambulatory curriculum include the Ambulatory Care Conference, Journal Clubs, Primary Care Seminar, General Medicine Grand Rounds, and Hopkins Ambulatory Care Modules.  

Content Areas

Ambulatory curriculum is divided into distinct content domains that are designed to cover all aspects of ambulatory medicine.  These content areas are as follows:

Behavioral Medicine:

Provides training on common mental health conditions and behavioral issues that are managed by internists.  Examples include:

  • Depression
  • Bipolar disorder
  • Suicide
  • Anxiety disorders
  • Psychosis
  • Eating disorders
  • Somatization
  • Domestic violence
  • Addiction
  • Advanced care planning

In the Clinic:

Provides training on the evaluation and management of common chief complaints and problems encountered in ambulatory medicine.  Examples include:

  • Headache
  • Dizziness
  • Upper respiratory symptoms
  • Chest pain
  • Abdominal pain
  • Dermatologic conditions
  • Musculoskeletal complaints
  • Anemia
  • Women’s health topics
  • Men’s health topics

Prevention:

Covers topics relating to primary prevention in primary care, and presents the current evidence and debate regarding various screening guidelines.  Each year begins with an overview of any new topics addressed or updated by the United States Preventive Services Task Force.  Examples include:

  • Cancer screening
  • Cardiovascular disease screening and prevention
  • Fracture prevention
  • Immunizations
  • Perioperative care
  • Contraception and perinatal care

Chronic Disease Management:

Provides training on the management and primary care needs for patients with common chronic diseases.  Each lecture is designed with the help of selected experts in the field.  Examples include:

  • Hypertension
  • Diabetes mellitus
  • Coronary artery disease
  • Congestive heart failure
  • Asthma
  • Chronic obstructive pulmonary disease
  • Hyperlipidemia
  • Chronic kidney disease
  • Osteoporosis
  • Viral hepatitis
  • Nonalcoholic fatty liver disease
  • Primary care of the post-transplant patient
  • Primary care of the cancer survivor
  • Anticoagulation

Physical Diagnosis:

Provides training on the performance of various components of the diagnostic physical exam.  Each workshop is designed with the help of selected experts in the field.  Examples include: 

  • Fundoscopic exam
  • Thyroid exam
  • Lymph node exam
  • Musculoskeletal exams (shoulder, knee, hip, back, foot/ankle)
  • Mental status exam
  • Skin exam
  • Breast exam
  • Gynecologic exam
  • Male genitourinary exam

Evidence-based Medicine:

This resident-led journal club with a faculty facilitator takes place weekly during ambulatory medicine rotations.  Residents learn about a variety of analytic methods, how to interpret measures of risk, significance, and how to assess the validity of medical evidence and utilize it in everyday practice.  The curriculum is designed to promote the use of evidence-based medicine and literature review in the resident's practice.  Residents learn to assess the validity of published evidence by understanding clinical research design and gain critical medical literature appraisal skills.

Ambulatory Report:

Residents are led through a case-based discussion by the primary care chief resident about a common or interesting diagnosis in the ambulatory setting.

Ambulatory Care Conference:

Weekly conference on core topics in ambulatory care that involves specialists and local experts.

Hopkins Modules:

An online learning tool that is used to supplement didactic sessions is available to all residents.  Suggested modules are provided for each teaching block.

Contact Information

Residency Training Program
Internal Medicine
Beth Israel Deaconess Medical Center
West Campus, Deaconess Building, Suite 306
One Deaconess Road
Boston, MA 02215
617-632-8273
617-632-8261
primarycare@bidmc.harvard.edu