The Ambulatory Clinic
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. 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. The resident clinic is co-directed by Drs. Richard Pinckney and Halle Sobel. 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 patient care duties 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 Monday from 12:15 – 1 pm, the Yale Office-Based Medicine Curriculum is used to generative interactive case-based discussions.
Residents have electronic access to this curriculum as well as to the Patient Education and Assessment Center Curriculum. This self-directed ambulatory curriculum covers a variety of ambulatory topics, which are updated annually, and allows the resident to work at his/her own pace to help fill in knowledge gaps or gain more expertise in a given topic. Participating in the PEAC curriculum has been tied with improved board pass rates.
There are 5 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. A second continuity clinic occurs at the Veterans Administration in Burlington. Residents spend one day or two half days at the VA during their clinic week.
In addition to a robust education series, residents are also introduced to key concepts of panel management. Panel management is a proactive approach to care for patients outside of an office visit and in conjunction with the health care team. Residents devote Â½ 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.
Residents are taught to keep up with important changes pertinent to practice such as prescribing acute and chronic opioids to be in compliance with state laws. This allows residents to become more comfortable with the regulations involved in prescribing controlled substances.