Rationale And Special Features of Ambulatory Care Education

Work in ambulatory care requires a distinct set of practice skills

To be effective in the ambulatory care internal medicine, generalists and subspecialists need skills that pertain broadly to the organization and delivery of office-based and community-based care. These key skills are best taught where they are applied – in the office. Such skills include:

• orchestrating a brief office visit,
• maintaining an office record,
• working with other members of the office-based health care team,
• assuring proper follow-up for acute and chronic conditions,
• managing patient contact between visits,
• making subspecialty referrals,
• communicating with other health care providers and community health workers outside the office,
• and performing quality assurance.

Internists are specially trained to care for patients with advanced, complex chronic illness (e.g. CRF, diabetes, advanced CHF, hypoxemic respiratory failure). Office-based management strategies for these sicker patients typically include frequent visits, between visit phone and e-mail contact, use of non-physician providers and home care agencies, and extensive patient self-monitoring. Medical students need to understand intensive office-based care and develop basic competencies in this area.