Teaching of primary care in an internal medicine residency program

A teaching module in ambulatory internal medicine has been added to a residency program in a large referral hospital. The effort was directed to structure a program of instruction reflecting common problems seen by primary care internists. Patients were screened by supervising staff to make the rotation an efficient learning experience. Experienced nurse clinicians were used to monitor patients with stabilized medical problems, thus freeing the housestaff for problems more suited to their level of training. The nurses also served as role models with which the housestaff could interact and provide continuity and accessibility of care to patients being followed up by transient physicians-in-training. Various teaching conferences based on traditional inpatient models were conducted. Self-assessment and peer review techniques were structured around monthly conferences in which medical records were assessed by each participant.