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Original article

Vol. 142 No. 2728 (2012)

How to fulfill residents’ training needs and public service missions in outpatient general internal medicine?

  • Noelle Junod Perron
  • Jean- Paul Humair
  • Jean-Michel Gaspoz
Cite this as:
Swiss Med Wkly. 2012;142:w13620


QUESTION UNDER STUDY/PRINCIPLES: Ambulatory care is a mandatory component of post-graduate training in general internal medicine. Academic outpatient clinics face challenges in training residents in terms of exposure to sufficient patient case-mix, diversity of clinical activities and continuity of care while fulfilling their mission to provide care to vulnerable populations. We report the development and evaluation of a new postgraduate curriculum in ambulatory care in Geneva, Switzerland, designed to overcome such challenges.

METHODS/DESCRIPTION: The content of learning activities was adapted to core competencies and learning objectives. In the new 2-year curriculum, residents had their working week divided into 2½ days of continuity clinic over two years, and 2½ days of 6 to 12 months rotations (e.g., walk-in clinics). Team work was consolidated through the creation of subunits including an attending physician, 1–2 senior residents during one year and 6- to 8 residents, who met in bi-monthly meetings with other health professionals.

RESULTS/EVALUATION: In both local and national surveys, residents and senior residents expressed an overall global satisfaction with the new curriculum. Nursing and administrative staff were less satisfied, because of reduced residents’ time in each unit. Interprofessional meetings were highly appreciated for both patient care and team building. Management of residents’ absences became more complex.

CONCLUSION: The new curriculum met its goals in gaining residents’ satisfaction and in reinforcing interprofessional collaboration although management of human resources became more complex. It also gave insights into challenges to be addressed when disseminating a new curriculum, such as strong leadership, educational expertise and management skills and tools.


  1. Perkoff GT. Teaching clinical medicine in the ambulatory setting. An idea whose time may have finally come. N Engl J Med. 1986;314(1):27–31.
  2. Wiest FC, Ferris TG, Gokhale M, Campbell EG, Weissman JS, Blumenthal D. Preparedness of internal medicine and family practice residents for treating common conditions. JAMA. 2002;288(20):2609–14.
  3. Holmboe ES, Bowen JL, Green M, Gregg J, DiFrancesco L, Reynolds E, et al. Reforming internal medicine residency training. A report from the Society of General Internal Medicine’s task force for residency reform. J Gen Intern Med. 2005;20(12):1165–72.
  4. Junod AF. Will there be room for the teaching of internal medicine in a university hospital? Swiss Med Wkly. 2002;132(1-2):4–6.
  5. Bowen JL, Salerno SM, Chamberlain JK, Eckstrom E, Chen HL, Brandenburg S. Changing habits of practice. Transforming internal medicine residency education in ambulatory settings. J Gen Intern Med. 2005;20(12):1181–7.
  6. Fédération des Médecins Suisses. Programme de formation postgraduée du 1er janvier 2011: spécialiste en médecine interne générale 2011 [20th June 2011]. Available from:
  7. Brinkley B, Viret JD. Assistanat au cabinet médical: le modèle genevois. Primary Care. 2001;1:454–5.
  8. Feller S. L’assistanat au cabinet médical: «... la période la plus instructive de ma formation!». Bulletin des médecins suisses. 2005;86(39):2237–43.
  9. Conférence suisse des directrices et des directeurs cantonaux de la santé. Rapport final: financement «formation postgrade spécifique»:; 2006 [20th June 2011].
  10. Gilchrist V, Miller RS, Gillanders WR, Scheid DC, Logue EE, Iverson DC, et al. Does family practice at residency teaching sites reflect community practice? J Fam Pract. 1993;37(6):555–63.
  11. Marti C WH. Inégalités sociales et accès aux soins: conséquences de la révision LAMal (article 64A). Rev Med Suisse. 2006;2:2503–7.
  12. Wolff H, Besson M, Holst M, Induni E, Stalder H. Inégalités sociales et santé: l’expérience de l’Unité mobile de soins communautaires à Genève Rev Med Suisse. 2005;1:2218–22.
  13. Bodenmann P, Althaus F, Carbajal M, Marguerat I, Kohler D, Jackson Y, et al. «La enfermedad del millionario» («la maladie du millionnaire») Prise en charge transculturelle d’une patiente équatorienne. Forum Med Suisse. 2010;10(6):102–7.
  14. Nutting PA, Goodwin MA, Flocke SA, Zyzanski SJ, Stange KC. Continuity of primary care: to whom does it matter and when? Ann Fam Med. 2003;1(3):149–55.
  15. Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med. 1995;70(10):898–931.
  16. Bischoff A, Tonnerre C, Loutan L, Stalder H. Language difficulties in an outpatient clinic in Switzerland. Soz Praventivmed. 1999;44(6):283–7.
  17. Royal College of Physicians and Surgeons of Canada. The CanMEDS 2005 Physician Competency Framework 2011 [20th June 2011]. Available from:
  18. The European Academy of Teachers in General Practic and Family Medicine. The European definition of general practice/family medicine 2005. Available from:
  19. Working group under a mandate of the Joint Commission of the Swiss Medical Schools. Swiss Catalogue of Learning Objectives for Undergraduate Medical Training 2008 [20th June 2011]. Available from:
  20. The Accreditation Council for Graduate Medical Education (ACGME). Common program requirements: General competencies 2007 [20th June 2011]. Available from:
  21. Pruitt SD, Epping-Jordan JE. Preparing the 21st century global healthcare workforce. BMJ. 2005;330(7492):637–9.
  22. Hays RB, Davies HA, Beard JD, Caldon LJ, Farmer EA, Finucane PM, et al. Selecting performance assessment methods for experienced physicians. Medical education. 2002;36(10):910–7.
  23. Primary Care Division GUH. Training, supervision and evaluation:; page 13-19 and 20-33; 2008 [4th March 2012].
  24. Schultz KW, Kirby J, Delva D, Godwin M, Verma S, Birtwhistle R, et al. Medical students’ and residents’ preferred site characteristics and preceptor behaviours for learning in the ambulatory setting: a cross-sectional survey. BMC Med Educ. 2004;4:12.
  25. Ogrinc G, Mutha S, Irby DM. Evidence for longitudinal ambulatory care rotations: a review of the literature. Acad Med. 2002;77(7):688–93.
  26. Saultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004;2(5):445–51.
  27. Price D, Howard M, Hilts L, Dolovich L, McCarthy L, Walsh AE, et al. Interprofessional education in academic family medicine teaching units: a functional program and culture. Can Fam Physician. 2009;55(9):901–1 e1-5.
  28. Group de Travail de l'Association Suisse des Sciences Médicales. Les futures profils professionnels des médecins et des infirmiers dans la pratique ambulatoire et clinique. Bulletin des médecins suisses. 2007;88(46):1942–52.
  29. Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2009(3):CD000072.
  30. Coleman MT, Roberts K, Wulff D, van Zyl R, Newton K. Interprofessional ambulatory primary care practice-based educational program. J Interprof Care. 2008;22(1):69–84.
  31. Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. Quality in health care: QHC. 1998;7(3):149–58.
  32. Mintzberg H. Patterns in strategy formation. Management Science. 1978;24:934–48.

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