Providence St. Vincent Medical Center:
Ambulatory Clinic

As noted by the Institute of Medicine’s “Crossing the Quality Chasm,” there is tremendous opportunity to improve the quality of care we deliver to our patients. The curriculum of the Department of Medicine Faculty Practice is designed to meet the challenge of educating residents to practice high quality, patient-centered, cost-effective care for the 21st century. Our faculty mentorship program emphasizes a one-on-one relationship to provide our residents with the teaching and support they need to care for their patients. Our use of information technology exposes our residents to new and innovative ways of providing care to patients with chronic illness. I invite you to take a closer look at how our program can meet your professional goals.

Robert Gluckman, M.D., F.A.C.P.
Chief Medical Officer for the Providence Teaching Clinics
Associate Program Director
Faculty, Department of Medicine Faculty Practice 

The Department of Medicine Faculty Practice: The Best of Both Worlds

The vast majority of medical care delivered by generalist or specialist internists is in the outpatient setting. Changes in the practice environment have challenged internal medicine residency programs to redesign their ambulatory training experiences to make them relevant to today’s practice needs. At PSVMC, we completely redesigned our outpatient continuity clinic experience to meet those challenges.

In 1993, the Department of Medicine Faculty Practice was created specifically to provide the best possible educational environment for our internal medicine residents. The department provides a:

1) unique, innovative teaching model
2) diverse patient population that more closely resembles the patients our residents are likely to encounter in clinical practice
3) state-of-the-art facility with extensive experience in using information technology in the exam room

The cornerstone of our educational model is the creation of a "patient-centered resident faculty team." Our residents are assigned a panel of patients when entering the residency and have a weekly continuity clinic in the PGY-1 year. Residents are paired with a specific faculty member upon entering the residency. At the beginning of PGY-2 year, the clinic experience expands to two half-days per week, and residents are assigned a second faculty preceptor. Patients are paired with a faculty member, as well as a resident. This pairing relationship offers several significant advantages over more traditional clinic models.

Residents have their own panel of patients. With sufficient autonomy, guidance and continuity, they become skilled in the total care of patients and disease management. Residents also benefit from the personal, one-on-one relationship with an experienced faculty mentor. Many of the "teachable moments" in ambulatory practice take place outside the clinic encounter, in between clinic visits. In more traditional programs, many of these educational opportunities are lost. Our program links the patient, resident and faculty member, providing our residents with an experienced clinician, familiar with the patient, who can guide them in their patient care decisions. With this model, we can better teach both the art and the science of medicine. Our residents receive the best of both worlds: the autonomy of managing their own patients, and the guidance and professional development of a faculty member also familiar with the patient.

Our residents also have a patient panel that more closely resembles the patients they are likely to care for in the future. We place great emphasis on community service, and approximately 25 percent of the Department of Medicine Faculty Practice patients are from underserved populations. Our full-time social worker and part-time internist/psychiatrist assist in the management of patients challenged by the co-existing burdens of poverty, personality/psychiatric issues and illness. While most residencies provide opportunities to care for underserved populations, many struggle to provide a balanced mix of the patients residents are likely to encounter later in their careers, especially the elderly and women. Over 40 percent of the department's patients are elderly, and over 50 percent are women.

While it is important for residents to provide community service and understand the relationship between poverty and illness, it is just as important to be able to manage patients with higher levels of medical sophistication. In today’s practice, many patients expect their physicians to communicate by e-mail and to be familiar with Internet resources. Patients themselves are often highly skilled and informed through these resources. Once again, our residents receive the best of both worlds – the opportunity to care for the underserved, while developing communication skills necessary to meet the needs of patients with a variety of life experiences.

Lastly, our residents practice in a state-of-the-art facility on the hospital campus. Easy geographic access to the clinic staff and faculty allows our residents greater autonomy over their patients, allowing them to see their patients beyond the confines of a once- or twice-a-week clinic schedule. Our program relies heavily on information technology. We have one of the longest experiences using an electronic medical record of any residency program in the country. Our entire faculty is expert in the use of an electronic medical record. Each examination room is equipped with a computer and Internet access to allow the use of information technology at the bedside, truly allowing our residents to develop the skills necessary to practice in the future.