Ambulatory Block Rotation

Ambulatory Block

The Ambulatory Block consists of resident continuity clinic and specialty ambulatory rotations. Residents are assigned to continuity clinic on the same weekdays during each ambulatory block throughout the year. By dedicating time away from inpatient rotations, the 4+2 curriculum allows the residents to focus their efforts on their clinic patients without interruption.

Curriculum

Each week during the two-week ambulatory block consists of 1.5 continuity clinic days and 2.5 days in a specialty ambulatory rotation. Throughout the residency program, the resident will participate in multiple specialty rotations including all of the internal medicine sub-specialties, as well as geriatrics, non-internal medicine electives (such as wound care) and a substance use disorder rotation.

Sample Intern Ambulatory Block Schedule

	Monday	Tuesday	Wednesday	Thursday	Friday
AM	Hem/Onc	Continuity Clinic	Hem/Onc	Hem/Onc	Continuity Clinic
PM	Hem/Onc	Continuity Clinic	Didactics	Hem/Onc	Ambulatory Didactics

 

Geriatrics

Residents will participate in a geriatric rotation during their ambulatory blocks that involves care of nursing home residents at a local skilled nursing facility in Tyler. The residents gain first-hand experience in the care of this special population by performing admission assessments as well as managing the care of long-term residents in the facility.

Substance Use Disorders

The substance use disorders rotation takes place during the second year of residency. Residents gain a greater understanding of the treatment of addiction and how to break the stigma surronding drug-addicted patients. The rotation is located at Cenikor, a local inpatient detoxification and rehabilitation center, where residents learn about the psychosocial aspects of substance use and participate by leading group sessions. The residents will also complete the eight-hour online Buprenorphine Waiver Training during the substance use disorder rotation, which satisfies the opioid training requirements for obtaining a DEA license upon graduation.

Veterans Administration Clinic

During their third year of training, residents participate in two rotations at the Tyler VA clinic. During this rotation, residents are exposed to the multi-disciplinary focus of a veteran affairs healthcare system, working alongside different care teams.

Continuity Clinic

In July 2021, the internal medicine residency program partnered with Tyler Family Circle of Care to create a collaborative, primary care clinic serving the underserved populations of East Texas. Family Circle of Care is a Federally Qualified Health Center, which provides increased access of quality healthcare services to all patients, regardless of ability to pay. At the Family Circle of Care – West Gentry Health Center, the internal medicine residents provide care to a diverse population of patients, including chronic disease management for patients with complex and multiple comorbid disease processes, geriatric care, general wellness exams for all adult patients and walk-in acute care visits. Each resident is assigned as a primary care physician to their own panel of patients and provides continuity of care throughout their residency program.

Conferences

During the ambulatory block, all residents continue to participate in the Wednesday afternoon didactic lectures with all other residents. On Friday afternoons, the ambulatory residents have protected time which is spent either meeting with their ambulatory QI teams, or participating in self-directed studying.

Longitudinal Ambulatory Quality Improvement Curriculum

On Friday afternoons, each ambulatory block is dedicated to longitudinal ambulatory quality improvement projects. Residents are placed into teams with a faculty advisor and develop a quality improvement project. Following a curriculum based on the ACP Quality Improvement module, residents work on their projects throughout the year and present them at the annual GME QI & Research Day. The curriculum is designed so projects are completed over the course of the academic year.