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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, physical diagnosis, and clinical skills workshops, and seminars.  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 junior and senior resident curriculum is delivered during practice week rotations in a two-year cycle.  A select group of skilled clinician educators on the faculty at BIDMC 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 Club, Primary Care Seminar, General Medicine Grand Rounds, and Hopkins Ambulatory Care Modules. 

Content Areas

Ambulatory curriculum is divided into domains that are designed to cover all aspects of ambulatory medicine. These content areas are described below.

Behavioral Medicine

Provides training on the evaluation and management of common psychiatric and substance use disorders that are generally managed by internists. Content is delivered by experts in addiction medicine and psychiatry. Examples include:

  • Alcoholism
  • Anxiety disorders
  • Depression
  • Domestic violence
  • Eating disorders
  • Opioid use disorder
  • Somatization
  • Suicide

In the Clinic

Provides training on the evaluation and management of common urgent care issues encountered in ambulatory medicine. Examples include:

  • Abdominal pain
  • Anemia
  • Chest pain
  • Dermatologic conditions
  • Dizziness
  • Headache
  • Men’s health topics
  • Musculoskeletal complaints
  • Upper respiratory symptoms
  • Women’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
  • Contraception and perinatal care
  • Fracture prevention
  • Immunizations
  • Perioperative 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:

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

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: 

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

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