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Ambulatory Care Rotation

During each of the three years of residency training, the Ambulatory Care Rotation (ACR) is devoted to training residents to care for patients in the outpatient setting. As part of ACR, residents spend three or four half days each week seeing general medical patients in their own continuity practices. Categorical and Primary Care residents also attend dedicated sessions in subspecialty clinics including thyroid, breast, Ob/Gyn, orthopaedics, rheumatology, dermatology, HIV, pulmonary medicine, neurology, opthalmology, ENT, and geriatrics.

Community medicine experiences are incorporated into ACR blocks. These include opportunities to work with Boston Healthcare for the Homeless (led by MGH's Jim O’Connell, MD), the TB/HIV and Hepatitis C/HIV clinics at the Shattuck Hospital, and a variety of other community medicine sites.

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Ambulatory requirements are specified below for Categorical, Primary Care, and Preliminary residents.

Categorical

Intern (PGY-1 Year)Junior (PGY-2 Year)Senior (PGY-3 Year)
10 weeks10 weeks10 weeks
6 weeks ACR/4 Weeks ASR6 weeks ACR/4 Weeks ASR6 weeks ACR/4 Weeks ASR

Primary Care

Intern (PGY-1 Year)Junior (PGY-2 Year)Senior (PGY-3 Year)
12 weeks12 weeks16 weeks
three 4 week blocks combination of ACR/ASRthree 4 week blocks combination of ACR/ASRfour 4 week blocks combination of ACR/ASR

Preliminary

Preliminary (PGY-1 Year)
Preliminary interns have approximately two months per year of elective time in lieu of ACR rotations

Example Weekly ACR Schedule for IMA Continuity Resident

MondayTuesdayWednesdayThursdayFriday
Continuity ClinicACR ConferenceContinuity ClinicDermatologyPractice Organizing
Continuity ClinicNeurologyQuality ImprovementGynecologyContinuity Clinic

Ambulatory Curriculum

ACR Conferences

Ambulatory care conferences are integrated into ACR blocks and draw from a variety of topics in outpatient medicine. There is a bilevel curriculum, with one curriculum for interns and another two-year expansive curriculum for residents. Regardless of the level of training, the academic year is divided into three learning blocks. Each learning block covers topics that advance as the year progresses. During each block, there are daily lectures from 8am to 9am and on Tuesday mornings; didactic lectures extend from 8am to noon. In addition, interns have 7am patient case discussions with the ambulatory chief resident and teaching senior once a week.

Dermatology Case Conference

Dermatology Case Conference is a monthly conference where cases are discussed with a dermatology attending physician. Residents are encouraged to photograph any interesting or perplexing dermatological findings seen in clinic to present during these monthly conferences. This conference is not only helpful for resident education, it also assists in patient care as it often leads to an expedited dermatology consultation.

Ambulatory Intern Report

This is a weekly conference for interns to discuss difficult clinic cases or challenges in their continuity clinic practice with the ambulatory chief resident and the teaching senior. The conference is informal and interns are welcome to ask any questions that have come up during the course of their clinic experience.

Evidence-Based Medicine

This workshop is devoted to the critical review of the medical literature relevant to certain clinical issues. A recent peer-reviewed study is selected by the presenter (resident or faculty) and circulated in advance to attendees. During the conference, the study design, methodology, and biostatistical methods are reviewed in detail.

Senior Resident Talk

Senior residents in the Primary Care Program are required to give a presentation to ACR residents on topics of their choosing. Senior talks provide an opportunity for residents to develop skills in public speaking and teaching.

Specialty Conferences

These occur two to three times per week on the ACR rotation. Specialists, both medical and non-medical, present discussions on the current clinical management strategies of commonly encountered problems from their respective fields. These conferences cover topics in cardiology, gynecology, psychiatry, orthopaedics, gastroenterology, pulmonary, and geriatrics, among others.

Mini-Courses

During each ACR block, certain topics are presented in-depth, such as teaching techniques for residents, approaches to multicultural care, public health, diabetes, women’s health and evidence-based medicine. Each course is usually given three times throughout the year (once within each learning block).

Women’s Health Workshop

The Women’s Health workshop provides a dedicated morning for discussion and instruction on topics in Women’s Health, including a focus on HPV, breast exams, and pelvic exams.

Preclinic Conference

This is a monthly conference during a pre-continuity clinic protected time for most residents (several of the off campus clinics cannot accommodate this into the schedule due to travel time, but these clinics have their own dedicated learning time). Topics this year include back pain, Dermatology – what the PCP needs to know, osteoporosis, the knee exam, thyroid nodules, Psychiatry – what you can treat and when to refer, allergic rhinitis, and care of the noncompliant patient.

For more information about the Ambulatory Care Rotation, Continuity Practice, Practice Sites, and Outpatient Medicine, please click on the following page links below:



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Massachusetts General Hospital
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Detailed Contact Information

Categorical NRMP Number: 1261140C0
Preliminary NRMP Number: 1261140P0
Primary Care NRMP Number: 1261140M0
Global Primary Care NRMP Number: 1261140M1
Neuro Prelim NRMP Number: 1261140P1