An Ambulatory Clinical Teaching Unit: Filling the Outpatient Gap in Internal Medicine Residency Training

Main Article Content

Mohamed Panju MSc MD
Ali Kara MD
Akbar Panju MB
Martha Fulford MD
Paul O'Bryne MB
Shariq Haider MD



The majority of time in a core General Internal Medicine (GIM) residency is spent focusing on inpatient medicine, with relatively little time devoted to ambulatory medicine. The Royal College of Physicians and Surgeons of Canada has mandated an improvement in ambulatory exposure. Unfortunately, most ambulatory experiences tend to lack formal structure, a dedicated educational curriculum, and graduated learner-specific responsibilities. The recent Royal College recognition of GIM as a subspecialty places renewed emphasis on core IM training providing a more comprehensive exposure to outpatient medicine as management of patients with multiple complex conditions may be best managed by a general internist. In July 2015, McMaster University opened an outpatient medicine clinic which is designed to be an Ambulatory Clinical Teaching Unit (A-CTU). The A-CTU provides a structured clinical environment which is focused on the management of medically-complex patients. It uses a multidisciplinary model, graded learner levels of responsibility and a dedicated educational curriculum. The unique structure of the A-CTU allows for the assessment of milestones and EPAs (entrustable professional activities) pertaining to consultation skills and chronic disease management, in keeping with competence by design.
Abstract 484 | PDF Downloads 259 HTML Downloads 493


1. AFMC. A Collective Vision For Postgraduate Medical Education in Canada - AFMC FMEC [Internet]. [cited 2012 Dec 28]. Available from: pdf/FMEC_PG_Final-Report_EN.pdf
2. Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: from Flexner to competencies. Academic Medicine. 2002 May;77(5):361–7.
3. Weinberger SE, Smith LG, Collier VU, Education Committee of the American College of Physicians. Redesigning training for internal medicine. Annals of Internal Medicine. 2006 Jun 20;144(12):927–32.
4. Durning SJ, Artino AR. Situativity theory: A perspective on how participants and the environment can interact: AMEE Guide no. 52. Med Teach. 2011 Mar;33(3):188–99.
5. Dent JA. AMEE Guide No 26: clinical teaching in ambulatory care settings: making the most of learning opportunities with outpatients. Med Teach. 2005 Jun;27(4):302–15.
6. Williams CK, Hui Y, Borschel D, Carnahan H. A scoping review of undergraduate ambulatory care education. Med Teach. 2013 Jun;35(6):444–53.