State of the Art Resident Ambulatory Education The University of Rochester has been consistently ranked in the top 20 medical schools for primary care training. Our Internal Medicine Residency has many unique ambulatory curriculum features that lead to exceptional ambulatory training: We have adopted a "6+2" block model, as described previously. Our resident primary care practice has been recognized as a Level 3 Patient Centered Medical Home. This provides a supportive and patient-centered environment for residents to learn primary care and teaches residents how to care for a population of patients. We have a patient Dashboard embedded in our electronic medical record that allows residents to follow outcomes data (e.g., HbA1C,vaccination, mammography, BP control, etc.) for their panel of patients (whether by disease, such as diabetic or hypertensive patients, or their panel as a whole) and those of the residency practice as a whole. Residents get immediate feedback about their practice patterns and the outcomes of their patients. We have dedicated substantial time in our Block Model to quality improvement and patient safety. Beyond a comprehensive curriculum, residents are given time and mentoring support for conducting quality improvement projects. Our patient Dashboard allows residents to conduct meaningful, real-time quality improvement projects involving their panel of patients and the residency practice patients as a whole. The Rochester community was ranked #1 of 306 communities in an Institute of Medicine report for providing healthcare at the lowest cost per Medicare beneficiary. As healthcare costs continue to rise, Rochester is considered a model that other communities are trying to emulate. Our residents learn to practice medicine in this high quality and high value environment, which will prepare them well for practice as cost-containing healthcare reform efforts proceed. Continuity General Medicine Practice Continuity practice experience for all categorical residents takes place in one of our two faculty-resident practices: The Strong Internal Medicine Faculty-Resident Practice in the Ambulatory Care Building attached to Strong Memorial Hospital [58 residents] The Highland Hospital Faculty-Resident Practice in the Doctor's Office Building attached to Highland Hospital (which is a half mile from Strong) [12 residents] At both practices residents have: A panel of 80-120 patients for whom they provide continuous care over the three years of residency On-site faculty preceptors experienced in ambulatory general medicine who have no other clinical responsibilities during precepting sessions - the ratio of residents to faculty is never more than 4:1 and usually closer to 3:1. All of our preceptors receive extremely high teching ratings from our residents. A team approach to care involving not only physicians but also nurses, nurse practitioners, clinical technicians, social workers, dietitians, and pharmacists Integrated quality improvement education and projects based on a robust patient dashboard Subspecialty Ambulatory Electives In our Block Model senior residents choose longitudinal electives that are spread over the course of the year. Residents are paired with a specific specialist (selected for being an outstanding teacher) in the fields of their choice. Each time a resident is in an ambulatory block during the course of the year s/he will spend a half day per week in each of their ambulatory electives. This allows the resident to work closely with a single preceptor in each field and to see some of the same patients over the course of the year in follow up. At the end of the year the specialist will know the resident and her/his strengths well, and will be well-positioned to guide the resident's growth toward independent practice. Residents will be exposed to longitudinal subspecialty ambulatory practice, which makes up the bulk of most subspecialists' practices. PGY1 residents will spend a half day per week in their ambulatory blocks in a community-based primary care office. They will also be given dedicated exposure to clinics in dermatology, gynecology/women's health, and musculoskeletal clinics. In addition to the longitudinal subspecialty electives described above, senior residents can also choose traditional 2- or 4-week elective blocks to be ambulatory subspecialty rotations to provide additional experience and exposure to outpatient subspecialty practice. They can also choose to spend elective time in longitudinal experiences in community-based primary care offices.