Reflection on learning on ambulatory internal medicidine

March 6, 2020

Reflecting on my experiences on ambulatory internal medicine, I found it to be quite different from my clerkship experiences on the Clinical Teaching Unit (CTU). On CTU, I found that there was much more time to look up information to manage your patient compared to ambulatory clinics where the pace is much faster. I found that I had to accommodate for this by looking up patients ahead of time to prepare in order to feel comfortable in clinic. 

On CTU, there is also a sense of hierarchy as there are many different levels of learners and because of the larger team, I found it harder to be able to get one on one time with staff. I appreciated being able to work directly with my preceptors and felt that I had more supervision during my ambulatory clinics. This experience really allowed me to refine my skills in being able to take a history, physical, and coming up with my own management plans as I had could be directly observed and had time to discuss my thoughts on a case. 

I also found that I had more time to focus on the clinical aspects of patient care in ambulatory clinics compared to CTU where there are more administrative tasks to manage (e.g. consulting multiple specialties, arranging investigations, and liaising with allied health). It also allowed me to reflect on things like what happens when I discharge a patient from CTU or which patients should be sent to hypertension clinic. 

Another aspect that I enjoyed about my rotation was that my preceptors gave me opportunities to see my patients longitudinally. I had several patients that I worked up (e.g. palpitations, hypertension) and was able to see them in follow-up. This allowed me to see the impact of my management plans. I think this helps reinforce my clinical judgement and gives me the chance to recalibrate my plans for the future. 

Overall, the variety of ambulatory internal medicine and its subspecialty really gave me exposure to the breadth of internal medicine, which I think came at an appropriate time in my training to help me transition from being a medical student to a resident in the next few months. I am looking forward to continuing my training in Internal Medicine!

-JT-