by Erin Snyder, MD

It is an exciting time for ambulatory education in the Tinsley Harrison Internal Medicine Residency Program. We have two excellent primary care clinic sites at The Kirklin Clinic and the Birmingham VA Medical Center.

The Kirklin Clinic and the VA Medical CenterOur program has moved to block scheduling, with alternating inpatient and outpatient months of clinical responsibility. This reduction of competing interests affords upper level residents freedom from outpatient duties while on wards, and it allows them to be more fully “present” in clinic, without being pulled back to the wards to care for a critically ill patient.

On their non-ward months, residents have two clinics per week, which improves efficiency and allows them to see patients back in short term follow-up. All residents are paired with a practice partner of the opposite schedule, so patients have a touchstone within the clinic, even if their resident is out for the month.

Faculty preceptors are more and more frequently directly observing residents in the care of their clinic patients. Faculty report they are learning more by going into the exam room with the residents, and residents in turn receive valuable feedback on their clinical skills. Patients have also told us they enjoy the direct observation experience, and appreciate that a team is caring for them. With all of these changes, clinic morale is high and we are seeing more residents enter primary care practices after training. 

For those residents who are planning a career in primary care, we maintain one of the nation’s longest running Primary Care Tracks for Internal Medicine Residency. Residents in this track participate in continuity clinic at both the VA and Kirklin, so they experience two very different models of health care delivery. 

Erin Snyder, MD, Assistant Program Director for Ambulatory CareAdditionally, we have started a Primary Care Track lecture series, focusing on some of those things that, as practicing physicians, our faculty wish we had learned during residency. This fall we have brought in guest speakers to talk about a variety of primary care practice models, including concierge medicine, primary care in an academic health center, and traditional inpatient/outpatient private practice internal medicine. The series has been well received by both residents and faculty. If you are interested in participating in this lecture series, please let me know. We would love to hear from both general internists and specialists about “real world” practices.

Erin Snyder was a UAB Internal Medicine resident from 2003-2006. She joined faculty in the Division of General Internal Medicine after residency, and she is now an Assistant Program Director, focusing on ambulatory education. If you are interested in joining in the excitement of ambulatory residency training, please email Erin.