Ambulatory internal medicine education: use of an urgent care center

Internal medicine residency programs have increased the time devoted to ambulatory medicine and the range of nonmedical areas in which expertise is expected. Whether existing teaching locations can provide residents with appropriate training in educationally targeted specialty (ETS) conditions (otolaryngology, urology, dermatology, ophthalmology, and orthopedics), is unknown.

An urgent care center (UCC) was developed at a teaching hospital to provide residents with additional experience in ambulatory medicine. To assess the frequency and nature of conditions seen by residents, 500 charts in the UCC, 500 charts in the resident continuity clinic (RCC), and 500 charts in the emergency room (ER) were selected at random and reviewed during a 2-month study period. Complaints were classified into three categories: general medicine, ETS conditions, and miscellaneous (upper respiratory infection, gynecology, and psychiatry).

Four hundred seventy-six (95.2%) patients in the UCC and 491 (98.2%) patients in the ER had acute problems as compared with 236 (47.2%) patients in the RCC (P < 0.001). The number of ETS conditions was 302 (UCC), 104 (RCC), and 89 (ER; P < 0.001). The number in each category was otolaryngology, 88 (UCC), 17 (RCC), 19 (ER); urology, 43 (UCC), 10 (RCC), 14 (ER); dermatology, 41 (UCC), 11 (RCC), 11 (ER); ophthalmology, 25 (UCC), 7 (RCC), 10 (ER); and orthopedics, 105 (UCC), 59 (RCC), 35 (ER).

Patients with ETS conditions were seen more often by residents in the UCC than in the other locations. In our institution, a UCC provides a useful opportunity for the clinical and didactic education of internal medicine residents in areas of acute care that were underrepresented in other rotations. New educational programs may be needed to ensure the education of residents in ambulatory medicine.