Outpatient Experiences

Ambulatory block rotations

Medicine residents have 2 ambulatory block rotations per year. These rotations take place at the VA and at Dartmouth Hitchcock Medical Center. Residents work in acute care clinics and longitudinal clinic and gain experience in managing the spectrum of illness seen in the ambulatory clinic. The intern experience focuses on the basics of managing a longitudinal practice and the resources available in the ambulatory setting. The Junior experience focuses on Geriatrics. The Senior experience is our “Business of Medicine” block, focusing on the financial, organizational, and practical aspects of practicing medicine at the practice and national levels. Conferences, reading time, and a longitudinal focus on practice improvement complement the patient care experience.

Community practice selective

A Community Practice (CP) elective can be requested during the junior or senior year. The CP affords residents the opportunity to experience the practice of medicine in a non-academic, non-teaching hospital setting. The rotation may be used to try out a practice that the resident later joins, to learn the needs of referring physicians, or to decide on a future career path. Residents may choose from a number of local or regional practices that have hosted many residents over the years, or they may choose a practice beyond the northeast or international settings.

Continuity clinics

Medicine residents begin their continuity clinics no later than August of the PGY-1 year. Residents have clinics at Dartmouth Hitchcock Medical Center or at the VA. Clinics are held 1 half day per week at 1 site or another, except when the resident is on ambulatory rotations when the number increases to 2 half days per week. Interns inherit a panel of patients from an outgoing resident and then add to it while they are on rotations such as the emergency department, ambulatory block rotations, and the inpatient services. Residents are assigned new patients throughout training.


Interns, juniors and seniors have 2, 3 and 4 elective rotations respectively. They may choose electives from each medicine subspecialty and from offerings of other departments. Residents may also select electives at other institutions if Dartmouth Hitchcock Medical Center and the VA do not offer the experiences they want.

Emergency room

As the first health professionals to evaluate patients in Dartmouth Hitchcock Medical Center's medical-surgical ED, medicine residents quickly gain competence in assessing patients with the full spectrum of presenting complaints. The ED is a Level I trauma center and supports a helicopter urgent transport program. Medical, surgical, anesthesia, and OB/Gyn residents are supported at all times by certified Emergency Medicine attendings and they work side by side with the residents in our Emergency Medicine Residency to provide care.