Ambulatory Education

AMBULATORY EDUCATION

IN CORE INTERNAL MEDICINE

An Overview

Experiential learning in the workplace is a fundamental attribute of medical training.

However, as the major volume of patient care migrates from inpatient to outpatient settings, it has been widely noted that most medical training programs have not adapted sufficiently to bring learners into the ambulatory setting. There will always be a need for inpatient rotations as a central part of medical training in the workplace, particularly in Internal Medicine. The best way to integrate ambulatory education alongside inpatient rotations has been far from clear.

The Core Internal Medicine training program at the University of Toronto uses two educational structures in the ambulatory setting.

Rotation Based: Many rotations offer excellent short-term teaching, in which trainees experience a limited number of encounters in office settings related to that rotation's subspecialty. The number and type of ambulatory experiences on each rotation is determined by that rotation's educational coordinator, usually at the local hospital level.

Longitudinal: Trainees in their PGY1 and PGY3 years have half day longitudinal clinics along with their inpatient rotational assignments.

The Division of General Internal Medicine operates five Ambulatory Internal Medicine Group Practices (AIMGPs) across the teaching hospitals, where PGY1 trainees return from their rotations one half day per week, to a group learning environment, in which they follow patients referred from wards, Emergency departments, and community offices. Further information on the AIMGPs can be found on their home page.

The PGY3 trainees attend two 6-month longitudinal ambulatory experiences in the offices of preceptors, usually one-on-one, in which they learn the more expert-level aspects of ambulatory practice. The preceptors come from all subspecialties of Internal Medicine, including General Internal Medicine. More information on the PGY3 Ambulatory Experience can be found on its home page.

The history of ambulatory education in the Core Internal Medicine is one of continuous evolution, characterized both by "drifts" (small scale innovations, locally and city-wide) and by "shifts" (larger program developments). The impetus for evolution has been the need to address known issues in the ambulatory settings, and in the program as a whole. The ambulatory education system has been responsive to message from current trainees, graduates from training, and external bodies such as the Royal College.

There is a robust group of clinician educators in the Department of Medicine who take an academic interest in ambulatory education, both in its delivery (as teachers) and in its design (as program developers and evaluators).

As a program, we look forward to continuing to develop our models of ambulatory training in response to the changing needs of our trainees, and our patients.

Last updated:7/8/2010 1:04:40 PM