A 4TH YEAR OF TRAINING IN AMBULATORY MEDICINE - THE UNIVERSITY-OF-WASHINGTON EXPERIENCE

Postresidency training in ambulatory general internal medicine has bee n proposed as a means to enhance the generalist skills of internal med icine graduates. At the University of Washington, a fourth year of tra ining in ambulatory medicine has been offered since 1967. The resident training year provides a core experience in general internal medicine as well as the opportunity for elective experiences in subspecialties and other allied specialties. Graduates of this year of experience in ambulatory training were surveyed to determine current practice patte rns and retrospective evaluation of the program; responses were receiv ed from 36 of 52 graduates (69%). Among respondents, 50% are general i nternists, 39% subspecialists, and 11% in other practice specialties. Eight respondents (22%) are practicing in rural communities. Responden ts identified the specialized training in outpatient medicine as the p rimary strength of the additional training year. Many reported using t he year to gain additional training tailored to their future practice. The fourth year of ambulatory training thus represents an efficient m eans to provide additional training to internists planning careers in general internal medicine. It can serve a variety of purposes, includi ng preparation for practice in rural and other settings with unique cl inical demands, training of clinician educators, and retraining of sub specialists seeking to shift to generalist practice.