Program Structure

The residency program employs a competency-based curriculum for all rotations.

In areas that overlap with the categorical program, the 2 tracks share common curricula. The highlights of the PCT curriculum are to develop knowledge and skills in:

  • Appropriate subspecialty competencies (e.g. dermatology, orthopedics, women's health, geriatrics)
  • Assessing and meeting community health needs
  • Communication skills
  • Evidence-based medical decision making
  • General ambulatory and inpatient internal medicine
  • Information management
  • Lifelong learning
  • Population approach to health care
  • Practice management (clinical and business)
  • Quality improvement in health care (including working in teams)

Ambulatory electives

Ambulatory subspecialty electives and subspecialty clinics are a valuable setting in which to learn skills necessary to be a practicing general internist. 5 ambulatory elective rotations per year (4 in PGY-1) provide intensive training in managing the complexities of outpatient clinical problems and medical practice. Each 1 month rotation combines intensive subspecialty ambulatory clinical elective experiences with an expanded resident continuity clinic. Subspecialty electives can be scheduled in flexible and creative ways based on the needs of the resident.

Longitudinal clinical experiences

PCT residents see their own patients in continuity clinic 1 to 2 half-days per week throughout their 3 year residency. This intensive longitudinal involvement provides a true "continuity" clinic experience. Residents may conduct their continuity clinics either at Dartmouth Hitchcock Medical Center or at a well established community-based practice.

Two additional longitudinal clinical experiences are available for PCT residents. During PGY-2 and 3, residents have the option to participate in specialty longitudinal clinics. In addition, all residents participate in a clinical experience at the Good Neighbor Clinic, a local "free clinic" for medically underserved patients that is staffed by Dartmouth Hitchcock Medical Center faculty.

Community-based block rotations

Dick's House at Dartmouth College

In each of the 3 years, PCT residents practice for 2 months in community-based practices in rural or urban sites, under the supervision of experienced community-based internal medicine faculty. These rotations provide outstanding clinical and medical practice organization experience. Opportunities to travel outside the region or participate in international health care during a community-based rotation are available.

During these rotations, residents participate in all aspects of medical practice including experiences in outpatient, inpatient, emergency room, extended care facilities, and other health care settings. An extensive computer network connects regional practices enhancing learning on community rotations. During these rotations, residents usually continue their longitudinal clinic 1 half day per week.

  • Emergency department: PCT residents develop competence in the emergency room setting during block rotations at Dartmouth Hitchcock Medical Center, Inpatient rotations at the VA, and during their community health rotations.
  • Inpatient experience: PCT residents spend 5-6 months each year on inpatient rotations (7 during PGY-1). These rotations include general medicine ward (VA and Dartmouth Hitchcock Medical Center), intensive care unit, inpatient cardiology, and hematology-oncology ward rotations. Because intensive care training is often critical for rural practice, Primary Care residents spend a total of 2 months training in ICU rotations and 2 months in CCU rotations over the 3 year training period. PCT residents gain additional inpatient experience through inpatient activity during community based rotations. 1 inpatient general medicine consultation rotation is scheduled during the senior year.
  • Research electives: As in the Categorical Track, PCT residents are encouraged to use 1 or more elective months to accomplish their required research project. Residents have easy access to faculty willing to engage in planning and implementing projects or in incorporating residents in their own research. Planning for the research projects is coordinated by the Department of Medicine Resident Research Coordinator.