1. Jacobi Ambulatory Care Service Jacobi Primary Care Internal Medicine Track Steven R. Hahn, MD Director

2. Jacobi Ambulatory Care Service Primary Care Internal Medicine Track Formed in 1982 Directed by Dr. Steven Hahn (steven.hahn@nbhn.net) Intensive focus on ambulatory medicine & principles of primary care medicine Focused training especially useful for: –Primary care medicine –Continuity of care specialties –Health outcomes research, health policy & administration

3. Jacobi Ambulatory Care Service Primary Care Program Perspective Psycho-social factors influencing adaptation to chronic disease Advanced doctor-patient communication skills Mental disorders and behavioral dimension of disease including –Depression & anxiety –Substance abuse –Cognitive disorders –Adherence to medication and lifestyle management Emphasis on a learning community

4. Jacobi Ambulatory Care Service Primary Care Ambulatory Block Curriculum Behavioral sciences seminars – four 8-week courses, one per semester in a two-year rotation –Epidemiology and management of psychopathology (psychopharmacology) –Counseling and behavior change in primary care –Family-systems medicine in primary care –Healthcare systems and the determinants of health Team meeting – weekly block-time lunch meeting –Moral support and camaraderie –Case discussion and mini-didactics –LUNCH “Balint” case discussion group – weekly block time activity –Facilitated peer discussion of emotionally and professionally challenging cases Ambulatory Morning Report – case discussion and self-learning session Outpatient specialty rotations

5. Jacobi Ambulatory Care Service Primary Care Block Schedule: All Primary Care Residents Scheduled Concurrently YearSummer/FallWinter/Spring PGY 11 contiguous month: 2 weeks ambulatory 2 weeks primary care elective 1 contiguous month: 2 weeks ambulatory 2 weeks primary care elective PGY 22 contiguous months: 1 month ambulatory 1 month primary care elective 2 contiguous months: 1 month ambulatory 1 month primary care elective PGY 32 contiguous months: 1 month ambulatory 1 month primary care elective 3 contiguous months: 1 month ambulatory 2 months primary care elective

6. Jacobi Ambulatory Care Service Primary Care Special Features Gero-Med-Psychology and Medicine-Psychology clinic –Available to all residents, but integrated into PC curriculum –Patients evaluated in collaboration with 2-3 graduate psychologists participating in a gero-psychology externship Hazelden substance abuse training program –Available to all residents, integrated into PC curriculum –World-famous substance abuse treatment center in Manhattan with structured week-long training program Opportunity to do relevant research during each of the six Primary Care Blocks Collaborative research projects – this year, a study of cycle-time in our medical clinic