Training internal medicine residents in the community: the Minnesota experience

The University of Minnesota Internal Medicine Residency Program has developed ambulatory general medicine rotations in rural community settings and urban managed care settings in Minnesota. Based on what had been learned from community focus groups, from discussions with residents about what they perceived to be training holes in the traditional curriculum, and from resident evaluations of pilot rotations, an educational framework for the rotations was established. The authors describe the process of developing these rotations, their educational rationale and objectives, the structure of the rotations, teaching strategies, faculty development, and the evaluation system, and outline the important elements of the successful implementation of these new rotations. The community practice setting has offered a unique, important, and previously untapped resource for residency training, and the community rotations have been highly valued both by housestaff and by community preceptors. As residency programs begin to offer more community-based ambulatory care opportunities for their trainees, the impact of this trend on quality of training, residents' career choices, and patient outcomes will need to be evaluated.