The Ambulatory Clinic

Each resident is assigned a panel of patients for whom he/she serves as the primary care physician throughout the three years of training. Patients range in age from eighteen to geriatric patients. Local demographics afford exposure to a large Latino population. The spectrum of visits includes health maintenance and promotion, acute episodic illness, chronic medical illness and pre-operative evaluations. Primary care doctor-patient relationship, preventive care and patient education are emphasized. The ability to practice in an HMO setting provides the resident with an opportunity to learn efficiency and economy in the outpatient setting along with the business and economics of medical practice.

The attending staff of board-certified general internists is committed to providing high quality patient care and teaching. There is an excellent attending-to-intern ratio, which promotes timely feedback, discussion and review of cases.

At the beginning of each first-year resident clinic session, there is a case-based discussion of common ambulatory problems based on the Yale Ambulatory Conference series. Reference articles and case related questions are presented for the residents to review the week prior to the clinic session. Approximately 40 ambulatory conditions are covered including management of common medical issues likely to be encountered in the general internist’s office.

A faculty member from the Wilkes University Nesbitt College of Pharmacy provides guidance and teaching to the residents in clinic on such issues as pharmacokinetics and pharmacotherapeutics. The pharmacy faculty member is also available by consultation to meet with patients to provide education and review medical regimens.

Approximately 20 referral subspecialty clinics are available to assist in patient evaluation and management and to serve as a teaching resource for our residents. Interns and residents interface with certified nurse practitioners, physician assistants and case managers.

Our health clinic is located at St. Luke's Union Station, a new facility conveniently located on Bethlehem's historic south side in close proximity to St. Luke's Hospital - Bethlehem Campus. The health center features state-of-the-art examination rooms and a teaching conference room with multiple computer stations to provide easy access to medical records and on-line references such as "Up-to-Date." St. Luke's Union Station also offers dental, pediatric, physical therapy and wound care services.

Other Ambulatory Training

Over the course of the training, each resident rotates for two weeks on office dermatology, ophthalmology, ENT, orthopedics and physical medicine and rehabilitation. The goal is to develop an appreciation of common clinical entities likely to be encountered by an internist and to understand the indications for referral.

In the second year of training, each resident rotates for one month at St. Luke’s Union Station clinic. During this rotation, the resident attends his/her continuity clinic as well as a number of subspecialty clinics such as cardiology, gastroenterology, endocrinology, rheumatology, neurology and HIV clinic. Under the guidance of board-certified internists and subspecialists, the resident gains experience in evaluating and managing acute and chronic illnesses. Daily case-based discussions focus on the evidence-based approach to common ambulatory problems.

During this month, the resident under faculty guidance begins to develop a quality improvement project. The resident identifies an area for clinical improvement, implements steps to affect clinical changes and monitors changes in clinical practice and patient outcomes. These projects have formed the basis of several poster presentations at regional and national meetings.

Residents also evaluate outpatients on the subspecialty rotations, such as the HIV Clinic and Travel Clinic on the infectious disease rotation, and may elect to rotate in a general internist’s office affiliated with the hospital.