Ambulatory Experience

Our goal is to provide internal medicine residents with a strong foundation in ambulatory medicine since the majority of healthcare in the United States occurs in the outpatient setting. In the 4+1 block system, residents will have 1 week of continuity clinic every 5th week. 

Upon matching to our program, residents are assigned to either the Stony Brook Primary Care Center (PCC) or the Northport Veterans Affairs Primary Care Clinic for their continuity clinic. During this outpatient week, residents provide primary care to a panel of patients at their assigned clinics and will spend part of the year working in subspecialty clinics to broaden their outpatient skills. Below is an example of a typical clinic week during each PGY year:

 

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Ambulatory Didactics
 

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During their ambulatory week, residents participate in case-based didactic workshops that focus on a variety of outpatient topics. To supplement these educational workshops, residents also have access to multiple online outpatient education curricula, such as the: Physician Education & Assessment Center- Internal Medicine Curriculum, American College of Physician’s Caring with Compassion, and the Center for Advanced Palliative Care training modules.

Quality Improvement Projects

During their clinic experience, all residents learn how to conduct a quality improvement project and will work in teams to complete an outpatient QI project together. Examples of resident-led QI projects include:

Current Projects at the Stony Brook Primary Care Center

  • Reducing the Cost of Medications for Patients
    Residents are aiming to Improve the utilization of a Real-Time Prescription Drug Benefits (RTPB) Tool in our electronic health record, which displays accurate prescription drug benefit information at the point of prescribing, among the providers at Stony Brooks Primary Care Center
     
  • Improving Preventative Healthcare
    Residents are creating workflows to improve the rate of annual visits, including Annual Medicare Wellness Visits, completed in the resident clinic

Prior Projects at the Stony Brook Primary Care Center

  • Safe opiate prescribing for non-cancer related chronic pain-
    Residents developed and implemented workflows to meet the standards of safe opiate prescribing. Our clinic has been identified as a QI Champion for the American College of Physicians and was highlighted as one of the best education research projects in 2018 by the Alliance of Academic Internal Medicine (AAIM). This project was also published in Pain Medicine:
    • Wong R, Carroll W, Muttreja A, Garcia V, Taub E, Fernan A. Improving Opioid Management and Resource Utilization in an Internal Medicine Residency Clinic: A Before-After Study over Two Plan-Do-Study-Act Cycles. Pain Med. 2019;20(10):1919-1924. doi:10.1093/pm/pny239
    • Improving chronic care management for patients with diabetes
      Residents obtained point of care A1c testing for our clinic and implemented diabetic foot care examination kits in each clinic room.
    • Improving weight loss management for patients with obesity
      Residents created tailored patient education for the EMR and improved referral workflows to Stony Brook’s Weight Management Center.
    • Improving patient portal access
      Residents created education materials and workflows to increase patient participation in our EMR’s patient portal.

VA Projects

    • Improving Coordination of Care of Heart Failure Patients in the Outpatient Setting
    • Utilizing and Increasing access to telehealth
    • Coordinating with prosthetics dept
    • Identifying patients for PACT PharmD CHF Clinic
    • Goal to implement a CHF Menu into EMR
    • Improving Timely and Appropriate Medication refills/renewals in PC Clinic
    • Increasing the number of patients with lab work prior to presenting to PCP Appointment
    • Improving Non-VA Medication Reconciliation
    • Increasing Goals of Care Discussion in an Outpatient Setting
    • Implementation of a lung cancer screening database
    • Increasing HIV and HCV Screening
    • Improving TDap/TD Immunization 

Stony Brook Primary Care Center

stony brook primary care

The Stony Brook Primary Care Center (PCC, aka Tech Park Clinic) is located at 205 N. Belle Mead Road, East Setauket, NY and is the primary outpatient practice for the Division of General, Geriatric and Hospital Medicine. The PCC is a certified Level 3 Patient Center Medical Home that provides primary care to a wide variety of patients in Eastern Long Island. Residents who are assigned to the PCC for their continuity clinic learn how to provide comprehensive preventive and chronic care management via in-office and telehealth visits. Residents also have the unique opportunity to work closely with the clinic’s Integrated Behavioral Health Team, which includes Stony Brook psychiatrists and psychologists to provide mental health services for PCC patients.

To learn more about the General Internal Medicine faculty, please visit: https://renaissance.stonybrookmedicine.edu/medicine/geriatrics/faculty 

Northport Veterans Affairs Primary Care Clinic

Northport VAMC

The Northport VA Primary Care Clinic is located at 79 Middleville Road, Northport, NY 11768 and serves a wide age range of veterans, some of whom are still on active duty. As part of the largest national healthcare network, the Clinic is conveniently located in the same building as the Laboratory, Pharmacy, Radiology, Emergency Department, Subspecialty Clinics, and Inpatient Hospital/Intensive Care Unit, which provides for a convenient and seamless transition for our deserving veterans.

Each clinic is a PACT (Patient Aligned Care Team) with a range of interdisciplinary team members (Social Work, Primary Care Mental Health, PharmD, etc.) to ensure our veterans receive the best possible care. As a pioneer in telemedicine, the VA is also able to provide veterans with an iPad to ensure they continue to receive comprehensive primary care throughout the pandemic and is able to monitor veterans remotely on a daily basis if diagnosed with COVID-19 and self-quarantining at home.

As such, residents are adept at providing care via in-person visits as well as telemedicine visits, ensuring they are well trained for life after residency.  A dedicated VA Chief helps to oversee the resident-run QI curriculum associated with the Office of Academic Affairs and the National Center for Patient Safety, targeting local issues with the aim to improve the care our veterans receive and their overall experience at the VA. 

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