Ambulatory Curriculum Design and Delivery for Internal Medicine Residents

The Accreditation Council for Graduate Medical Education (ACGME) issued significant changes in the common program requirements effective July 2022 for 10 months of residency training to occur in the ambulatory setting (Accreditation Council for Graduate Medical Education. ACGME common program requirements, 2021). The Alliance for Academic Internal Medicine (AAIM) and ACGME have long advocated for decreasing the conflict between inpatient and outpatient experiences (Accreditation Council for Graduate Medical Education. ACGME common program requirements, 2021; Meyers et al. Acad Med 82(12):1211-1219, 2007). These changes emphasize the need for the graduate medical education (GME) system to revitalize residents’ ambulatory education. Reform of ambulatory training in internal medicine is twofold. First, it requires improving the system infrastructure of clinic itself, and secondly, it mandates enhancing the educational experience of residents within the clinic (Nadkarni et al. J Gen Intern Med 26(1):16-20, 2011). Part of that movement includes a longitudinal ambulatory curricular design that enhances the resident continuity clinic experience and provides residents with a foundation for learning ambulatory medicine. Most ambulatory medical education is delivered into three clinic models-ambulatory block rotations (typically referred to as X + Y model), longitudinal continuity clinics, and ambulatory long blocks. Many resident continuity clinics provide some type of on-site instructional modality, usually as a preclinical conference or an ambulatory case-based discussion, to disseminate a core curricular thread of high-yield ambulatory topics (Nadkarni et al. J Gen Intern Med 26(1):16-20, 2011). The COVID-19 pandemic has elevated the need for instructions in digital learning and telemedicine education in the ambulatory curriculum. Residency clinic directors and program leadership have a responsibility to ensure a well-rounded longitudinal ambulatory experience focused on achievable learning objectives.