Upon graduation, residents are prepared for inpatient medicine but not for primary care (PC) careers in part due to limited ambulatory time and opportunities during training. Through an Affordable Care Act grant we created additional ambulatory time/experiences outside of the core ambulatory training clinic for our PC residents. We eliminated month-long inpatient electives and transformed them into year-long ambulatory continuity experiences. Residents spend 7-8 months a year in ambulatory rotations during which they participate in traditional continuity sessions as well as spending substantial time in subspecialty ambulatory electives and community advocacy projects. Residents commit to 4-5 subspecialty electives during each calendar year. Through extra ambulatory time, trainees enhance their learning of complex disease management from subspecialists, improve their ability to formulate appropriate consults and form collaborative networks with subspecialty providers.
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