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 (SUDs) 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. The Step One Service (SOS), which takes place in UT Health Henderson, provides residents exposure to the inpatient management of patients who are experiencing withdrawals from alcohol or narcotics. The resident then rotates in the Intensive Outpatient Program (IOP) at the HSC North Campus where they participate in outpatient group therapy and learn about Medication-Assisted Treatment of opioid addiction. The resident also rotates 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 resident will also complete the eight hour online Buprenorphine Waiver Training during the SUDs rotation.
Continuity Clinic
In July 2021, the Health Science Center at UT Tyler’s (HSC) Internal Medicine Resident Continuity Clinic 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 (FQHC), 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 will also participate in Ambulatory Didactics, which are interactive sessions led by both faculty and residents in order to encourage leadership and teaching experience. The curriculum extends over two years.
Didactic Schedule:
12:00 – Institutional Grand Rounds
1:00 – Yale Office Based Curriculum
2:00 – General Ambulatory Didactics
3:00 – Ambulatory Basics Curriculum (ABCs)
Institutional Grand Rounds
Grand Rounds are held virtually for the entire HSC institution every Friday at noon. The presentation is projected for residents on a large video monitor in the ambulatory conference room for group participation. The topics are vast and are often presented by guest speakers with specialized knowledge in their fields.
Yale Office Based Curriculum (OBM)
The program utilizes the Yale OBM, including lectures covering a multitude of common outpatient internal medicine topics. These lectures are led by interns and residents and include interactive case-based presentations.
General Ambulatory Didactics
The general didactics cover a variety of topics including the American College of Physicians High-Value Care Curriculum, Quality Improvement Workshops, resident-led Ambulatory Journal Club, Board Review, Business of Medicine, Coding, and multiple other topics relevant to the practice of outpatient internal medicine.
Ambulatory Basics Curriculum (ABCs)
The ABC lectures are reserved for the intern class, though upper-class residents are welcome to attend. These lectures cover the basics of outpatient internal medicine, including proper note documentation, physical exam review, performing pre-operative evaluations, social determinants of health and a variety of common clinical patient presentations. The ABC lectures are led by both faculty and upper-level residents.