In This Section

Outpatient Experience and Curriculum

Aim of the Internal Medicine Program Continuity Experience

  • Provide high quality outpatient primary care to our patients that include the North Philadelphia Community and Temple University staff and employees through excellence in education and innovation.
  • Prepare our graduates & learners regardless of their generalist or specialist career path with the  necessary skills to be successful clinicians and leaders in the ambulatory setting

Learning objectives 

  1. Gain knowledge and skills of common outpatient clinical issues
  2. Gain knowledge of health maintenance guidelines and standard practice
  3. Learn an approach to resolving clinical questions that arise in outpatient practice
  4. Appreciate complexity of providing high quality outpatient continuity care to a panel of adults

 

Core Values of the Internal Medicine Residency Continuity Experience: 

  • Diversity
    • We value the diverse backgrounds of our staff, nurses, providers and patients. We believe each person’s unique perspective is important in contributing to our daily clinical practice and exceptional care we provide.
  • Collaborative interdisciplinary TEAM based care
    • We are a Patient Centered Medical Home, and we believe that the best care we can provide to our complex patients struggling with chronic illnesses includes interdisciplinary team members such as pharmacist, nurses, nutritionist, and/or community health workers. 
  • A supportive and collegial environment 
    • We believe we provide better care when we are enjoying the work we do. We work hard to make the clinic experience educational and a positive experience for everyone in the practice. 
  • Education focused on evidence based, high value, cost-conscious care
    • We recognize health care spending in the U.S. is at an unsustainable level for our country and does not produce better health outcomes. More specifically, we recognize the low-income population we serve. Our focus is to teach our residents the most up-to-date information in outpatient internal medicine and to train them to utilize evidence and best practices in patient care.
  • Quality improvement & Patient safety
    • We strive to provide the best quality of care for our patients. The process of quality improvement is a continuous cycle in our practice by which we continue to evaluate our performance and make improvements for the safety of our patients. 
  • Innovation
    • The health care environment is constantly changing and providing new challenges. As educators, we value creativity and problem solving to provide our residents with innovative curriculum and resources to help them meet their dynamic learning needs. 
  • Promote Career development and scholarship through mentorship
    • Mentorship is a key ingredient to a successful and fulfilling career as a physician. The ambulatory curriculum and clinic experience promotes longitudinal clinical mentorship and values the importance of providing opportunity for variety of scholarship in the outpatient setting. 

Temple Internal Medicine Associates

Temple Internal Medicine Associates (TIMA) is a combined resident and faculty practice that is located at 3322 N. Broad Street, across the street from TUH. We are a patient centered medical home and provide primary care to adult patients. Our interdisciplinary staff includes nurses, community health workers, a social worker, nutritionist, nurse student educators, and faculty from the School of Pharmacy. Providers that include faculty, residents, and CRNPs are divided evenly into interdisciplinary care teams that include a nurse, medical assistants, and phone/administrative staff who work together to provide care for our patients. We use Epic as our electronic health record, enabling access to data from inpatient admissions and subspecialty visits. 

4+1 System

The Internal Medicine program moved to a 4+1 system in 2011 and we have found it to overwhelmingly positive. The 4+1 schedule has improved the overall real-world education of our residents and provides a clear separation between residents’ inpatient and outpatient duties. The system allows for less fragmentation of care in the hospital while maintaining continuity of care in the outpatient practice. By providing regular contact with the Ambulatory continuity practice, this system has improved resident satisfaction and comfort with outpatient medicine. Under the 4+1 system, every fifth week is an Ambulatory Week, devoted to continuity clinic and other outpatient experiences.

Structure of the Ambulatory week

  • 5 half-day Continuity Clinic sessions
    • Upper year residents may have 1 session be an urgent care session during their week for a total of 4 continuity clinic sessions and 1 urgent care session for the week. This is where an upper year resident provides urgent care for patients whom their PCP is not in the office such as sick visits or post-hospital discharge visits.  
  • 1 half-day Telephone Triage
    • Residents answer incoming urgent phone calls to the practice and provide coverage to residents whom are on vacation or designated electives such as night rotations or ICU rotations.
  • 1 half-day Subspecialty Clinic
    • Residents spend one session a week with a subspecialty attending with the goals of gaining experience, knowledge, and procedural skills relevant to outpatient medicine practice. Residents also use this time to gain mentorship/exposure to possible fellowships.
  • 1 half-day Quality Improvement Project Time
    • Dedicated time in the residents schedule to work on their individual and longitudinal QI projects 
  • 1 half-day Outreach to patients
    • Residents have dedicated time in their schedule to provide panel management to their panel of patients. The outreach typically involves one of the major outpatient quality indicators that include cancer screening and preventive care. A topic is picked for the week and residents utilize our web-based patient registry to view their performance on the specific quality indicator and identify patients that are in need of a particular screening test or preventative care. We support our outreach endeavors with an innovative up to date patient registry and guided readings from recent medical literature.  
  • 1 half-day Administration Time - Reading Time/Independent Study

Example Ambulatory Week Schedule

Monday

  • 8 AM - 8:50 AM - Didactics
  • 9 AM - 12 PM - Clinic
  • Noon - 1 PM - Conference
  • 1 PM - 5 PM - Clinic

Tuesday

  • 8 AM - 8:50 AM - Didactics
  • 9 AM - 12 PM - Subspecialty
  • Noon - 1 PM - Conference
  • 1 PM - 5 PM - Administrative Time

Wednesday

  • 8 AM - 8:50 AM - Didactics
  • 9 AM - 12 PM - Clinic
  • Noon - 1 PM - Conference
  • 1 PM - 5 PM - Outreach

Thursday

  • 8 AM - 8:50 AM - Didactics
  • 9 AM - 12 PM - Quality Improvement Time
  • Noon - 1 PM - Conference
  • 1 PM - 5 PM - Clinic

Friday

  • 8 AM - 8:50 AM - Didactics
  • 9 AM - 12 PM - Telephone Triage
  • Noon - 1 PM - Conference
  • 1 PM - 5 PM - Clinic

Ambulatory Week Curriculum

Our ambulatory curriculum is an innovative and comprehensive program that goes beyond providing our residents with basic outpatient medical and procedural knowledge. In addition, the curriculum provides our graduates with valuable skills in quality improvement, electronic medical record management, and cost-conscious, high value care that can be applied to all areas of medicine. The ambulatory curriculum is a themed based 18 block curriculum that is repeated approximately twice in an individual’s 3 year residency. Didactic topics are organized based on the theme of the week and cover core topics in outpatient medicine.

  • Block 1 - Theme: Intro to Office Based Practice I
  • Block 2 - Theme: Wellness and Career Development
  • Block 3 - Theme: Pain Management
  • Block 4 - Theme: Cardiology
  • Block 5 - Theme: Psychiatric Disease
  • Block 6 - Theme: Pulmonary
  • Block 7 - Theme: ID/HIV
  • Block 8 - Theme: Endocrine
  • Block 9 - Theme: Musculoskeletal
  • Block 10 - Theme: Gastroenterology
  • Block 11 - Theme: Renal
  • Block 12 - Theme: Geriatrics
  • Block 13 - Theme: Women's Health
  • Block 14 - Theme: Neuorlogy/Dermatology
  • Block 15 - Theme: ENT/Optho/Derm
  • Block 16 - Theme: Palliative
  • Block 17 - Theme: High Value Cost Conscious Care
  • Block 18 - Theme: Urban Curriculum

Every Monday at noon we have an ambulatory grand rounds conference during which a faculty expert gives a talk on a topic that is related to the theme of the week. In addition, during the ambulatory week residents engage in protected didactic time Monday through Friday from 8am to 9am. The faculty and residents engage in ambulatory didactics in a variety of formats:

  • Case based Conferences
  • Physical exam skills review & activities in the Simulation center
  • Health maintenance topic reviews
  • PICO reports
  • Ambulatory Journal Club
  • Problem Based Learning Conferences
  • Team Based Learning Conferences

Contacts

Elizabeth Leilani Lee, MD
Associate Professor of Clinical, Medicine
Section of General Internal Medicine Associate Program
Director, Internal Medicine Residency Program, Temple University
elizabeth.lee@tuhs.temple.edu

Karen Lin, MD, MPH
Associate Professor of Clinical, Medicine
Section of General Internal Medicine
Medical Director, Temple Internal Medicine Associates
Karen.lin@tuhs.temple.edu