Longitudinal Ambulatory Experiences

Primary Care Experience

Pacifier girlThe continuity program provides a special experience for residents to foster the physical, intellectual and emotional growth of children, as well as to observe and manage the course of certain diseases and therapies over an extended period of time. Each resident carries a panel of patients specially designed to ensure broad exposure to multiple-age groups and diverse medical problems.

Continuity sites are available in both hospital and community settings. In addition to typical primary care clinic experiences, there are a number of other clinic opportunities including primarily Spanish speaking clinics at Martha Eliot Health Center and East Boston Health Care Center, a young parent continuity clinic at Children's Hospital, as well as several other multi-cultural, community-based health clinics.

Residents in the Categorical track devote one afternoon each week throughout the three years to their continuity practice. Residents are relieved of other clinical responsibilities during their scheduled continuity clinic time. Residents' clinics are rescheduled for an alternate day when the resident is unavailable for their regular clinic day.

In the first year, Urban Health and Advocacy track (UHAT) residents spend one-half day each week in their continuity sites. Beginning with the PL-2 year, UHAT residents select an additional half-day experience to augment their training and often choose a second continuity clinic.

Academic Innovations Collaborative

Children's Hospital Primary Care Center (CHPCC) and Martha Eliot Health Center (MEHC) are two of the continuity sites available to residents. Both are engaged in a patient-centered primary care redesign effort through the Academic Innovations Collaborative (AIC), established by the Harvard Medical School Center for Primary Care. The AIC was created to foster rapid transformations in care delivery and education within Harvard-affiliated primary care teaching practices and BCRP residents are active participants.

CHPCC and MEHC's redesign is focused on four major transformation areas: multidisciplinary patient care teams, population management, complex disease management, and patient empowerment. Some of the major changes to be rolled out over the two years of the collaborative include the creation of primary care teams, development and use of patient registries to facilitate population and complex care management, and the implementation of new technology, including clinical decision support and discharge and care plan summaries.

A chief goal of the AIC is to involve our residents in redesign activities. The resident education curriculum will be rewritten to include topics related to team-based care delivery and population management; residents are integrated into the care teams, attending team huddles and included in team communication regarding patient issues; and residents' input is solicited through surveys and informal feedback sessions.

Longitudinal Subspecialty Experience

The BCRP is invested in developing a longitudinal subspecialty experience whereby residents can achieve early and sustained exposure to outpatient subspecialty medicine. The BCRP is currently piloting this experience for all three residency classes.

During the PL-1 and PL-2 years, a select number of Categorical residents will participate in a subspecialty clinic in addition to their primary care continuity clinic. They will be relieved of their other clinical responsibilities once per month to attend the subspecialty clinic of their choosing. During the PL-3 year, residents may choose to participate in a longitudinal subspecialty clinic in place of their primary care clinic.