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Ambulatory Training Since Duty Hour Regulations: A Survey of Program Directors

      Ambulatory care is an important part of clinical practice for most internists, regardless of whether they pursued subspecialty training. Consequently, the Accreditation Council for Graduate Medical Education requires that internal medicine residents spend at least 33% of their clinical time in the ambulatory setting. Despite this requirement, research suggests that internal medicine residencies do not do a good job of preparing their learners for ambulatory practice.
      Association of Program Directors in Internal Medicine
      Redesigning residency education in internal medicine: a position paper from the Association of Program Directors in Internal Medicine.
      Education Committee of American College of Physicians
      Redesigning training from internal medicine.
      • Holmboe E.S.
      • Bowen J.L.
      • Green M.
      • et al.
      Reforming internal medicine residency training: a report from the Society of General Internal Medicine's Task Force for Residency Reform.
      • Bowen J.L.
      • Salerno S.M.
      • Chamberlain J.K.
      • et al.
      Changing habits of practice: transforming internal medicine residency education in ambulatory settings.
      There is considerable interest in improving the quality of ambulatory training in internal medicine residency programs. A reasonable first step would be to examine current practice: the educational and clinical activities currently used to develop resident skills in ambulatory medicine.
      • Internal medicine program directors were surveyed about ambulatory education, with particular attention to clinical experiences, innovative curricula, and the impact of duty hour regulations.
      • Most programs fill out their residents' ambulatory clinical experience with mixed inpatient–outpatient subspecialty rotations, ambulatory blocks, and emergency department rotations.
      • Many programs have adopted technologic approaches or other innovative methods to enhance the ambulatory education of their residents.
      • More than one half of program directors report that duty hour regulations affected ambulatory training, most commonly the cancellation of post-call continuity clinics.
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