Ambulatory Block
The Ambulatory Block consists of resident continuity clinic and specialty ambulatory rotations. Residents are assigned to continuity clinic on the same weekdays during each ambulatory block throughout the year. By dedicating time away from inpatient rotations, the 4+2 curriculum allows the residents to focus their efforts on their clinic patients without interruption.
Curriculum
Each week during the two-week ambulatory block consists of 1.5 continuity clinic days and 2.5 days in a specialty ambulatory rotation. Throughout the residency program, the resident will participate in multiple specialty rotations including all of the internal medicine sub-specialties, as well as geriatrics, non-internal medicine electives (such as dermatology and gynecology along with others), wound care and a substance use disorder rotation.
Sample Intern Ambulatory Block Schedule
| Monday | Tuesday | Wednesday | Thursday | Friday | |
| AM | Continuity Clinic | Hem/Onc | Hem/Onc | Hem/Onc | Continuity Clinic |
| PM | Continuity Clinic | Hem/Onc | Didactics | Hem/Onc | Ambulatory Diadactics |
Wound Care
During the wound care rotation, residents will spend time at the UT Health Tyler Wound Healing Center, with specialty physicians trained in the treatment of complex wounds. The resident will gain experience in the primary management of nonhealing wounds including debridement, selection and application of wound dressings, as well an introduction to hyperbaric medicine.
Geriatrics
Residents will participate in a geriatric rotation during their ambulatory blocks that involves care of nursing home residents at a local skilled nursing facility in Tyler. The residents gain first-hand experience in the care of this special population by performing admission assessments as well as managing the care of long-term residents in the facility.
Substance Use Disorders
The substance use disorders rotation takes place during the second year of residency. The resident will rotate through a variety of treatment settings to gain a greater understanding of the treatment of addiction and to break the stigma surrounding drug-addicted patients. Residents rotate through Cenikor, a local inpatient detoxification and rehabilitation center, where they learn about the psychosocial aspects of substance use and participate by leading group sessions. Residents all rotate with a pain management physician at UT Health Tyler, gaining a greater understanding of the many treatment options available for chronic pain including injections and various surgical procedures. The residents will also complete the eight-hour online Buprenorphine Waiver Training during the substance use disorders rotation, which satisfies the opioid training requirements for obtaining a DEA license upon graduation.
Substance Use Disorders
During their third year of training, residents participate in two rotations at the Tyler VA clinic. During this rotation, residents are exposed to the multi-disciplinary focus of a veteran affairs healthcare system, working alongside different care teams.
Continuity Clinic
In July 2021, the internal medicine residency program partnered with Tyler Family Circle of Care to create a collaborative, primary care clinic serving the underserved populations of East Texas. Family Circle of Care is a Federally Qualified Health Center, which provides increased access of quality healthcare services to all patients, regardless of ability to pay. At the Family Circle of Care – West Gentry Health Center, the internal medicine residents provide care to a diverse population of patients, including chronic disease management for patients with complex and multiple comorbid disease processes, geriatric care, general wellness exams for all adult patients and walk-in acute care visits. Each resident is assigned as a primary care physician to their own panel of patients and provides continuity of care throughout their residency program.
Conferences
During the ambulatory block, all residents continue to participate in the Wednesday afternoon didactic lectures with all other residents. On Friday afternoons, the ambulatory residents have protected time which is spent either meeting with their ambulatory QI teams, participating in self-directed studying or in team-based learning lectures on an ambulatory medicine topic.
Longitudinal Ambulatory Quality Improvement Curriculum
On Friday afternoons, each ambulatory block is dedicated to longitudinal ambulatory quality improvement projects. Residents are placed into teams with a faculty advisor and develop a quality improvement project. Following a curriculum based on the ACP Quality Improvement module, residents work on their projects throughout the year and present them at the annual GME QI & Research Day. The curriculum is designed so projects are completed over the course of the academic year.