BWH Medicine Residency Categorical Ambulatory Program 

Our residency program is committed to providing outstanding ambulatory training.  Because medical care is increasingly provided in the outpatient setting, even for sub-specialties, we have significantly increased the amount of time that residents spend on ambulatory rotations.  All categorical residents now receive ambulatory training for ten weeks during intern year, ten weeks during junior year, and four weeks during senior year.  In addition, residents can gain more ambulatory experience through elective and research time. 

Ambulatory rotations are scheduled as two-week blocks that are evenly spaced throughout the year.   This structure gives residents dedicated time to focus on their continuity clinic patients and provides regularly scheduled clusters of clinic sessions that facilitate patient care.  The same cohort of residents will rotate on ambulatory blocks together.  These small groups of residents typically become quite close, as they spend much time together during conferences, as well as extra-curricular activities such as potlucks and nights out!

Each two-week ambulatory block follows a similar structure; a typical day includes morning report, a morning half-day ambulatory session, noon conference, and an afternoon half-day ambulatory session.  During each block, residents can expect to have six sessions at their continuity clinic sites, two sessions of ambulatory conferences with their class, two sessions of experiential, hands-on learning sessions with residents from other classes, two sessions of patient follow-up time, and multiple sessions working with specialists. 

We provide additional skill-based teaching sessions called special didactics during many of our ambulatory blocks.  During these sessions, we teach interns about performing quality improvement projects, incorporating social justice principles into their practice, and talking to patients with serious illnesses.  For juniors, we hold sessions specifically aimed at teaching skills for use in their new roles of teacher and team leader, and we also cover advanced social justice topics. 

All residents spend some of their ambulatory time doing “deep-dives” into five specialty areas.  These deep-dives, called Directives, give our residents dedicated time to focus on a specialty area and to meet and work with faculty in that specialty. During Directives, residents attend multiple specialty clinics, do self-directed learning, and take-part in specialty teaching sessions.  Interns rotate through Directives in Rheumatology, Neurology, and Endocrinology.  Juniors rotate through Directives in Dermatology and Nephrology. 

The charts below demonstrate the curriculum for this year’s interns and juniors:

Overview of Intern Ambulatory Blocks
Overview of Junior Ambulatory Blocks


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