The Burlington Adult Primary Care Clinic, located near the University of Vermont and University of Vermont Medical Center campuses, is the main continuity clinic site for both categorical and primary care residents. A second continuity clinic occurs at the Veterans Administration in Burlington. A total of 10 categorical residents have their continuity clinic at the VA.
All of our residents receive an education that is steeped in innovation, passion for primary care, and the pursuit of clinical excellence. Founded in 1971 as a model internal medicine practice, it is now a National Committee for Quality Assurance (NCQA) Level 3 Patient Centered Medical Home. Our internationally known faculty have been leaders in primary care since the 1970s with the birth of the SOAP note. The goals of this practice are to provide high quality, cost-effective medical care to patients from Chittenden County and northern New York State. During their three years of training, residents are assigned their own panel of patients from a graduating resident who they then follow for three years. The resident is identified in the electronic health record as the primary care physician and provides care under a supervising physician. During the first two years of training, residents can take new patients from the community and patients from the hospital without a primary care physician. Residents see a diverse array of patients from Chittenden County and northern New York and provide care to those with chronic diseases, provide preventive care, provide acute care and often see New-Americans, as Burlington is a refugee resettlement center. Residents can also manage small (1-3) patients with opioid use disorder who are on Suboxone for recovery under the supervision of a Suboxone waivered faculty member. The two faculty members responsible for running the clinic are Dr. Richard Pinckney, clinic director and Halle Sobel MD, associate program director and primary care track director. Nancy Blow serves as the resident clinic operations director.
The ambulatory curriculum is a three-year curriculum delivered on Tuesday’s mornings from 9:30-11:30. Residents are excused from direct patient care during this time. The conference is taught by a variety of academic faculty members. An active learning format is used in keeping with adult learning theory and how learners best learn. In addition, an education session occurs on Wednesday am from 8:00-9:00 am based on the Yale Office-Based Medicine Curriculum (https://medicine.yale.edu/intmed/obm/nonyale/). This is a case-based interactive conference.
There are five groups of residents divided in to 5 firms of 8-9 residents who represent each PGY class. The firms remain constant for 3 years, which provides for collegiality among the group. In addition, one faculty member is assigned to each firm as the firm leader. The firm leader serves as a preceptor, mentor and evaluator. The firm leader precepts regularly so as to provide resident-centered advice on how to thrive in the clinical setting. In addition, a core group of preceptors rotate through the clinic on a regular basis and are dedicated to the teaching mission as well as primary care excellence. During the second and third year, residents can choose to attend a ½ day per week of a subspecialty ambulatory clinic of their choice. This enhances expose to ambulatory subspecialty medicine that may not occur elsewhere during residency training.
In addition to a robust education series, residents are also introduced to key concepts of panel management. Panel management (also called population health) is a proactive approach to care for patients outside of an office visit and in conjunction with the health care team. Residents devote ½ day a week to panel management activities while they are in clinic. The residents receive detailed instructions on how to reach out to patients who have gaps in their care and are overdue for care along with an interprofessional team. Residents learn how EHR registries can be used to identify patients who are overdue for care and how to work with support staff to care for patients outside of office visits.