Introduction of ambulatory medical training in a Veterans Administration hospital

Planners of postgraduate medical education in the United States have mandated that training programs include experience in continuing patient care in the ambulatory setting. Idiosyncratic administrative features and limitation of resources present relatively unique problems for the development of such programs in Veterans Administration teaching hospitals. The authors describe the implementation of a continuity of care clinic in a highly subspecialized large VA internal medicine training program. Crucially, all residents attend the clinic on the same day. The internal medicine educational program was altered to prevent conflict of the new clinic with other teaching activities. The program has been well received by the involved house staff members and has achieved some of the intended goals.