Primary Care Training Pathway

Anyone who might consider keeping career options open for primary care, academic general internal medicine fellowship, geriatrics fellowship or other primarily ambulatory-based subspecialty fellowships.

Also, to clarify, all residents training for three years in our program are “categorical” residents, regardless of the pathway chosen. This means all residents successfully completing our residency qualify for the same American Board of Internal Medicine (ABIM) certification exam and complete the program with the same credentials. Thus, all residents in any of our pathways are equally capable of entering any type of internal medicine practice, subspecialty fellowship training, academics and medical education.

There are additional training and peer collaboration opportunities unique to the Primary Care Pathway. These opportunities include:

• Your continuity practice will be in the Primary Care Center, a hospital-based Level 3 NCQA-accredited patient centered medical home where residents and attendings practice in an innovative setting that focuses on team-based care, population management, patient engagement, and quality improvement. The practice serves a diverse patient population. Roughly 20 residents have their practice in this site, with about 10 preceptors. Most days there are 5-7 residents per afternoon session working with 2 preceptors. While residents may work with several preceptors on a regular basis, they are also paired with a Primary Preceptor who helps provide individualized feedback and guidance.
• You will have one Primary Care Rotation in each year of training, with an additional Primary Care Selective Rotation in your junior year. These four 4-week Primary Care Rotations are in addition to the 30 Ambulatory Y weeks (10 Ambulatory weeks/year) that all categorical residents have during training. The Primary Care Rotations combine practice in your continuity practice with training in ambulatory subspecialties selected to enhance knowledge and skills in primary care practice. The Primary Care Rotations are also designed to immerse you in your continuity clinic, so that you can better experience what it’s like to practice as a primary care physician and have more time to get to know your panel of patients.

Your schedule as a primary care intern or resident includes additional PC Rotations. For instance, as an intern, the PC1 rotation replaces either a cardiology or MICU rotation. However, you will still have ample opportunities to work in these inpatient rotations during your training. For example:

• Primary Care Rotations – You will be immersed in your continuity clinic and have experiences in outpatient ambulatory medicine during the Primary Care Rotations:
• Primary Care 1 Rotation: PGY-1
  • Complex Care Management sessions once/week: clinical pharmacy, social work, case management, transition of care, elder services
  • Housecalls: geriatric primary care for homebound patients
  • AM continuity clinic: one session/week
  • PM continuity clinic: four sessions/week
• Primary Care 2 Rotation (Dermatology): PGY-2
  • Dermatology: 3 full days/week
  • Community-based practice session once/week: opportunity to form mentorship relationship with a PCP from an affiliated practice
  • Walk-In-Center: urgent care clinic once/week
  • AM continuity clinic: one session/week
  • PM continuity clinic: two sessions/week
• Primary Care 3 Rotation (Spine Center): PGY-3
  • New England Baptist Hospital Spine Center: 3 full days/week
  • Community-based practice session once/week: opportunity to form mentorship relationship with a PCP from an affiliated practice
  • Walk-In-Center: urgent care clinic once/week
  • AM continuity clinic: one session/week
  • PM continuity clinic: two sessions/week
• Primary Care Selective Rotation: PGY-2
  • Options for morning sessions (choose 1 or 2 of the following):
    • Ortho, GI, Rheumatology, Physical Therapy, Physiatry
    • Urology/Urogyn, Integrative Health, ENT, Ophthalmology
    • Psychiatry, Neuropsychology
    • Other (elective)
  • PM continuity clinic four sessions/week
• Primary care dedicated seminar - You will be given the time and coverage during your PGY1 and PGY3 years to attend Harvard Medical School’s Department of Continuing Education five day national conference, PRIMARY CARE INTERNAL MEDICINE: Principles and Practice.
• Primary Care Mentor - You will be provided a list of primary care clinicians and educators who have volunteered to be mentors.
• Leadership Conferences – You are invited to participate in a highly-rated 4-week leadership elective from HMS, “Navigating the Complex Seas of Health Care: The Physician as Leader.”
• Quality Improvement - You will participate in projects related to quality and/or innovation in health care delivery systems. You will have formal training and supervision of your projects during the Primary Care and Ambulatory Rotations. These projects can be the source of your residency scholarly project and/or lead to poster presentations local/national meetings.
• Networking – As a member of the Harvard Medical School community, you are invited to join the Center for Primary Care at HMS. You will also have the opportunity to participate in Primary Care Progress at Harvard, the founding chapter of a national network of students, clinicians and educators working together to revitalize primary care delivery and education.
• Society of General Internal Medicine – Junior residents are provided coverage and receive funding to attend the annual or regional national meeting.
• Primary Care Quarterly Meeting – The primary care residents and faculty meet quarterly to discuss upcoming events, meet with practicing primary care physicians and recent alums from the Pathway who have gone into primary care, and provide an open forum for residents to give feedback on their experiences in the program.

The advantage of pathways, and not separate tracks, is that from year to year, residents have the flexibility to participate in any of our pathways without limiting any potential career options in the field of Internal Medicine.

Learn more about opportunities within the Pathway at the Center for Primary Care at Harvard Medical School.