Center of Outpatient Education Pathway Experience

Leland Hull, MD

How did you originally become interested in the pathway?

While I initially chose the Center of Outpatient Education track because of my interest in primary care/general internal medicine, after being a part of the program I would recommend it to anyone regardless of their future career plans. The program allows for an intensive outpatient experience with true continuity for your patients.

The schedule rotates so you do three months of inpatient rotations rotating with three months at a time of outpatient continuity clinic. During your clinic rotations, you have full responsibility over a panel of patients that you share with another resident. Residents develop a patient panel that we not only see in clinic but can proactively manage active issues. For example, I have a panel management half day each week during which I can sort through my patients and identify all of my uncontrolled diabetic patients to either schedule follow-ups, adjust medications with telephone encounters, or contact in other ways.

How has your experience been up until now?

You will work in a team with a dedicated RN and LPN for each team, so that you develop experience delivering patient care via a VA PACT Team model (the VA's version of the Patient-Centered Medical Home), integrating your care with nurses, psychologists, nutritionists, and pharmacists. You also get to do subspecialty clinics during your clinic months and develop a relationship with subspecialty mentors. Finally, the program includes a quality improvement curriculum, and each resident works on a longitudinal quality improvement project to be presented at the Institute for Healthcare Improvement national meeting during their third year.

What is the most gratifying thing about this pathway?

What I like most about Center of Outpatient Education is the relationships I have been able to develop with my patients, and in turn, I feel like this has given me a confidence to take ownership over my patients. I enjoy having dedicated time not to just see patients but to think about their problems. I have the chance to make an initial diagnosis in the clinic -- to be the person who works up the adrenal adenoma or who helps the person with an uncontrolled HbA1c on the sometimes difficult path to glycemic control, rather than reading about these problems on a patient's problem list. The Quality Improvement curriculum is also robust and a special part of this program, and because we work on our QI projects longitudinally, we can truly see the effects in the clinic as we go through our residency. I would recommend this program to any incoming intern, regardless of future plans.