Background

The UConn Health categorical Internal Medicine Residency Program is dedicated to the highest level of medical education for our residents who represent the future of internal medicine. Internal medicine itself is a broad subject and many residents choose to specialize by completing subspecialty fellowship training. Other residents may choose to practice primary care or even primary care with a specific concentration in one area of Internal Medicine. To meet the needs of our residents, we have developed a dedicated track for residents planning to have a primary care focus as well as an office based experience for those residents not in the primary care track, but who are interested in exploring primary care as a possible career. The residents in these unique programs will integrate fully with their categorical colleagues.

Beyond Your Continuity Clinic…

Each of your continuity clinics has what you would expect: excellent clinical care and dedicated preceptors. They also have some interesting individual traits:

• The Veterans Affairs clinic has comprehensive team-based care that has been around for more than two decades. They have optimized team huddles and sharing the work needed for patient care by involving clinical pharmacy and nursing colleagues.
• The UConn Health clinic has comprehensive primary care alongside learning experiences in preop assessment, obesity/lifestyle medicine, interdisciplinary pain management, and refugee medicine clinics, allowing residents to develop skills in these areas and modeling how to create a niche in a primary care career. This site has social work, a consult liaison for psychiatry, population health, and clinical pharmacy for team-based care.
• At Hartford Hospital Community Health, taking care of a patient’s mental health is just as important as their physical health. Patients have a whole team of professionals behind them, including Nutritionist, Social Worker Services, Clinical Psychology Services, Cardiac Monitor Placement, I-STAT INR Coumadin Monitoring, Tobacco Cessation, Medical Legal Partnership (MLP), Acupuncture, Pharmacy Consult, Food4Health (Food Bank).
• Saint Francis Hospital and Medical Center has an urgent care clinic unique to this site that allows for management of acute medical problems, hospital discharge transitions, preoperative evaluations, and emergency department follow-up care. The clinic also has an embedded clinical pharmacist and social worker who partner with the residents to provide comprehensive care.
• The Hospital of Central Connecticut clinic offers primary care to the New Britain community and surrounding towns. It is located with other specialties, including OB/GYN, orthopedics, physiatry, and podiatry, for ease of access. The clinic offers preoperative evaluation, emergency department follow-up, and hospital discharge care.
• The Burgdorf Clinic is a collaboration between UConn Health and Trinity providing primary and urgent care to medically underserved and disadvantaged patients. Experiences include preoperative evaluation, transition of care management, procedures in the primary care setting, pain evaluation and multidisciplinary diabetes management. Clinical pharmacy and social workers provide additional support for patients and to medical staff.

The University of Connecticut Internal Medicine Program has a long tradition of graduating accomplished residents who enter Primary Care careers (just look at our current faculty!). Our success began in 2010, when we acknowledged outpatient Internal Medicine requires its own unique skill set that is not learned in the hospital setting. We approached curricular changes with a focus on the needs of a physician in ambulatory practice and expanded training opportunities for our residents interested in Primary Care. Through our primary care learning opportunities – the Office Based Medicine rotation and the Primary Care Residency Education Track – we have enhanced training to create practice-ready physicians who excel in all aspects of care delivery.

The goal of both pathways is to expose residents to true outpatient general medicine in a variety of settings, such as academic, urban, and private practice. In addition, training is structured to provide the additional skill sets needed in outpatient medicine. Residents will have the opportunity to design their own experience to optimize their learning by rotating within subspecialty outpatient clinics such as pulmonary, rheumatology, dermatology, ear, nose and throat, and urology, to name a few. This allows residents to appreciate the full spectrum of care that occurs in the community, from chronic disease management to acute illness or injury. Residents can gain an appreciation of the multi-generational patient population while learning effective means for counseling on smoking cessation, weight loss, and many other issues that require behavior modification. Evidence-based medicine, adherence to guidelines for care, and routine screening tests are all reviewed as important adjuncts to comprehensive care. Training of competent and confident internists is essential to high-quality medical care for all patients.

The Primary Care Centered Medical Home (PCMH) + Primary Care Tracks

The medical home is the future of medicine. It focuses on coordination of care across disciplines and settings. Primary care providers need to be able to coordinate recommendations by specialists, follow recommended care for a panel of patients, review all patient lab/imaging results, and assess and manage social stressors as well as the emotional well-being of their patients. Essentially, we must view the patient as a whole- recognizing the social determinants of health and understanding the context of their illness to help guide patients through shared decision-making. The UConn Health Internal Medicine Associates (IMA) office is a recognized PCMH practice. This is the primary care site for the majority of the primary care opportunities.

Available Opportunities

• Office-Based Medicine (OBM) Rotating Experience
• Primary Care Resident Education (PCRE) Track
  

Key Features

• The residents in these unique programs will integrate fully with their categorical colleagues and be equally adept at inpatient/acute patient care.
• Like a college major, we realize that experience in medicine can shape future career goals. Both of the options allow for change in future career plans without “locking you in” to one choice.
• The PCRE track is appropriate for residents interested in a future career practicing high-quality primary care.
• The OBM experience is directed toward residents deciding between primary care and a primarily outpatient-based specialty such as rheumatology, endocrinology, or infectious disease.
• PCRE - Primary Care Resident Education Track. There is a separate NRMP code available for selection.

Program Overview

The Internal Medicine Program received two federally funded grants focusing on Primary Care. Although the grants have ended, our commitment to Primary Care has only grown. The grants allowed us to implement an innovative internal medicine primary care track based on longitudinal experiences. In addition to the traditional inpatient training, the residents in this unique track are trained to deliver care in a sophisticated, coordinated manner through team-based care in a continuity clinic.

Residents receive several afternoon lecture series based on educational gaps in “traditional Internal Medicine training” as well as a unique public health curriculum. Clinical care covers acute issues, preventative health, and chronic disease management. In addition, mentors and preceptors share learning on health care leadership, optimization of the electronic health record, fee for service and quality-based reimbursement, and efficiency in the ambulatory setting. Residents will participate in longitudinal electives in the second and third years, ensuring comprehensive knowledge in these specialties with alternating traditional in-patient rotations. Our residents will be equipped with skills for treating patients from all backgrounds and cultures with a focus on under-served, marginalized patients from a team-based approach. Upon graduating, these residents will be leaders in a new age of practicing primary care.

Details

• Ambulatory Primary Care Rotations: approximately every other 4-week block of PGY2 and PGY3 year
  • Of the 10 half-day sessions (see sample schedule below)
    • 3 are dedicated to primary care (one being continuity clinic)
    • 1 session is reserved for quality improvement work (research and patient panel quality metrics)
    • 6 sessions are longitudinal electives
  • Residents participate in longitudinal electives second and third year ensuring comprehensive knowledge in these specialties with the expectation they will graduate skilled in management of common chronic conditions. Residents will have the freedom choose from traditional elective options such as the core Internal Medicine specialties (cardiology, endocrinology, etc.) and specialty topics outside of internal medicine such as psychiatry, addiction medicine, ophthalmology, dermatology, non-operative orthopedics/sports medicine, and ENT. This allows for a more comprehensive ambulatory training in preparation for a career in primary care.
• Resident continuity clinic housed at the University of Connecticut IMA office for experience practicing in a recognized PCMH. The UConn Health site continuity clinic is embedded within our own faculty practice. This allows for superior coordination of social work, adjunct services, nursing, communication during and after inpatient admissions, and coordination of care across specialties.
• All residents in this track will have their primary continuity clinic days together in the same clinic site to create a robust learning community.
• Core set of dedicated, experienced Primary Care Internal Medicine faculty serve as mentors and continuity clinic preceptors.
• Residents will be trained to deliver care in a sophisticated, coordinated manner through team-based care in continuity clinic.
• A Wednesday afternoon lecture series on public health, marginalized communities, outpatient care gaps, and chronic disease care paths.
• Residents will have the opportunity to work with our population health team to learn about improving the quality of care for an entire patient population.
• Clinical teaching will include the business of medicine, general office management, time management (between urgent patient needs, office visits, and primary care panel metrics), and systems-based practice in both urban and suburban settings.
• Completion of a mentored quality improvement project is expected.
• Residents will also have the option to serve as mentors for students in our School of Medicine’s Urban Services Track.
• When possible, residents will be offered time in different practice settings. Residents can choose one locale or both in order to experience medicine in a real-world setting prior to finishing training. This option allows a resident to enter into the workforce with a realistic impression of primary care. In addition, having experienced multiple systems of practice, residents are better equipped to join a practice, set-up their own practice, or take on a leadership role in the future.
  • Urban Health Rotation - Residents interested in urban medicine will be able to rotate through local community health centers. This rotation can create a skill set for addressing the unique needs often seen in urban health populations.
  • Suburban Medicine - Residents will also have a choice of our suburban outpatient medicine practices to rotate through. As in the urban health rotation, residents will have the opportunity to “try-on” a future career.

Office Based Medicine (OBM) Rotation

Program Overview

The benefit of Internal Medicine is in the options you have to craft and redefine your career over a lifetime of practice. OBM provides an opportunity for outpatient skill development for residents who are interested in primary care or an ambulatory-based specialty looking for more ambulatory experience than a traditional Internal Medicine residency program would offer. Rather than the longitudinal electives utilized in the PCRE track, OBM has dedicated ambulatory blocks at the UConn Health Internal Medicine Associates office.

Details

• OBM Primary Care Rotations: Residents will have dedicated blocks to primary care internal medicine each of PGY1, 2, and 3 years, respectively. Residents identify their desire to join OBM towards the end of their intern year. Rotations consist of two weeks at the UConn Health IMA clinic, seeing patients for chronic, preventative, and acute issues. Residents will learn skills such as office triage and may see a variety of other physicians’ patients for acute issues, as would happen in a group outpatient office. Ambulatory rotations will be structured to increase exposure to special ambulatory medicine topics commonly encountered by primary care physicians. Residents will have the freedom to structure these blocks to ensure they receive exposure to as many aspects of primary care medicine as possible. Rotations may include specialty topics outside of internal medicine, such as ophthalmology, dermatology, non-operative orthopedics/sports medicine, and ENT.
  • Morning sessions are dedicated to primary care clinics.
  • Afternoon sessions are dedicated to outpatient specialty experiences such as urgent care, ENT, hypertension clinic, and urology.
• The large majority of subspecialty electives are done in the ambulatory setting.
• Core set of faculty for ambulatory rotation precepting and mentoring.
• Continuity Clinic can be at any of our 4 sites.
• When possible, residents will be offered time in different practice settings. Residents can choose one locale or both in order to experience medicine in a real-world setting prior to finishing training. This option allows a resident to enter into the workforce with a realistic impression of primary care. In addition, having experienced multiple systems of practice, residents are better equipped to join a practice, set up their own practice, or take on a leadership role in the future.
  • Urban Health Rotation - Residents interested in urban medicine will be able to rotate through local community health centers. This rotation can create a skill set for addressing the unique needs often seen in urban health populations.
  • Suburban Medicine - Residents will also have a choice of our suburban outpatient medicine practices to rotate through. As in the urban health rotation, residents will have the opportunity to “try on” a future career.

If you are interested in any of these exciting opportunities, feel free to contact our Program Director, Dr. Rebecca Andrews, at reandrews@uchc.edu or 860-679-2562.