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Ambulatory Training

NYU Winthrop Internal Medicine Residency Program 4 +1 System

NYU Winthrop’s internal medicine residency program has long been a leader and innovator in block model ambulatory education. Our 4+1 block schedule is lead by an expert supervisory ambulatory teaching faculty at multiple campus-based clinical sites.

The educational advantages of an uninterrupted inpatient and outpatient 4+1 block schedule are all well recognized. The first 4 weeks of the 4+1 block are spent on a particular inpatient or elective rotation with no interruptions in the rotation schedule or daily work day of the resident. Residents can concentrate on their inpatient services or electives and this leads to optimal patient care, teamwork, and education.

Having a dedicated week block for ambulatory clinic time permits residents to focus, without interruption, solely on outpatient medicine. Each clinic week, the resident participates in didactic workshops every morning and five half-days of primary care continuity clinic. Didactics during the ambulatory blocks include presentations given by subspecialists in various topics in all of the non-internal medicine primary care disciplines (dermatology, ophthalmology, podiatry, ENT, etc.) Residents on all levels also present general internal medicine topics with board relevant question review on a daily basis. We also discuss practical approaches to behavioral medicine issues and advanced interview skills.

House staff can elect to spend two additional half-days in the ambulatory subspecialty clinics of the residents’ choice based on fellowship or career goals or spend the other five half-days on studying or research. Interested residents can elect to spend a half day in the onsite urgent care center, or in the sports medicine clinic.

Residents care for a wide spectrum of patients of all ages ranging from acute illnesses and urgent care visits to a focus on continuity of care for chronic disease management, prevention, and wellness. Residents learn both evidence based ambulatory medicine as well as a practical approach to clinical practice, billing, and referrals. The residents appreciate their exposure to the way office based medicine really works.

The 4 +1 system thus provides an uninterrupted optimal inpatient and elective experience, and provides dedicated clinic weeks to focus on continuity of patient care in residency education.

Sessions are precepted by experience senior generalist faculty that includes the program director, the associate program directors, primary care fellowship trained preceptors, sports medicine boarded preceptors and experts in prevention and wellness and women’s health. Many of our attending physicians have held the position of chief resident in years past. They understand the importance of the mentor as well as the proper balance of patient care and education in successful residency training.