All of our residents work in partnerships of three to four; each resident taking on a panel of patients for whom she will provide primary care throughout residency, but also helping to cover their partnership’s patients when the resident PCP is not in clinic. Preceptors mentor residents both in small groups and individually, teaching an evidence-based approach to acute and chronic care. Each clinic site also employs an interdisciplinary team approach to best meet the needs of the differing populations.
Emphasis is placed on communication, professionalism, and a systems-based approach to caring for a population of patients. Quality improvement is the focus of an annual project across the program; and residents may serve as leaders in local change efforts in each clinic.
Duke Outpatient Clinic
The predecessor of the Duke Outpatient Clinic (DOC) was established shortly after Duke University Hospital (DUH) opened in 1930, as a medicine outpatient clinic to serve the public, regardless of ability to pay. Today the DOC has continued that safety-net tradition since moving to its current location in north Durham in 1997. Conducting 20,000 visits for 5,000 adult internal medicine patients each year, the patient population is majority-minority (nearly two-thirds African American), female, lower-income, including more than half covered by Medicare or Medicaid and 10% uninsured.
An interdisciplinary team-based and patient-centered approach to care is emphasized, supported by several resources in the clinic, including: two clinical social workers, a clinical pharmacist, two ambulatory case managers, two advanced practice providers, a chaplain, financial care counselors, along with many other committed staff. A range of specialty care is also available on-site, including Endocrinology, Cardiology, Dermatology, Physical Therapy and Smoking Cessation.
Residents develop their own primary care patient panels and share clinical messages within practice partnerships based on availability. The faculty of the Division of General Internal Medicine, the Ambulatory Chief Resident and other Medicine faculty staff the clinic and precept residents.
The DOC is also continually trying to innovate. The diverse patients at the DOC are generally medically complex with a high rate of psychiatric and social drivers, which prompted the development of the HomeBASE Plus program, launched in 2013, providing intensive team-based case management for our highest utilizing patients. More recently, beginning in 2019, a weekly Big Pool complex care team meeting has allowed any patient to be discussed with high needs. These approaches have been effective at shifting care from the ED and hospital back to the clinic. The DOC is also collaborating with the Duke Population Health Management Office (PHMO) on shared care for high-needs patients.
Duke Primary Care at Pickett Road
The Pickett Road clinic is part of the Duke Primary Care network of clinics. Patients at this site are more likely to have commercial insurance and work as professionals in the community. Patients at Pickett Road clinic range from young university students to elderly patients.
Pickett Road is staffed by 9 attending physicians (8 who teach in the resident clinic), one nurse practitioner, a population health nurse, and 24 residents. As Medical Director, Dr. Sharon Rubin has led the clinic to outstanding performance among Duke Primary Care practices in multiple domains of care including cancer screening and cardiovascular care. Residency Site Director Dr. Jeffrey Clough leads the ambulatory attendings in teaching Primary Care Medicine. In addition to supervising the resident continuity clinic many attendings teach medical, physician assistant, and nurse practitioner students. Pickett Road has an on-site lab and nurse managed anti-coagulation clinic.
Residents play an integral role at Pickett Road. Residents have their own panels and take an active role in caring for their patients, as well as providing acute visits for attendings’ patients. Feedback and observed practice are also emphasized. One of the best parts of the resident clinic is the camaraderie between the residents and the staff. Residents also work together, taking care of and covering each other’s patients, just like a mini private practice, when a resident is out of clinic or on vacation.
VA PRIME Clinic
PRIME Clinic harnesses the VA’s comprehensive resources to serve veterans of all genders, many of whom would otherwise be medically underserved. Located about 3 miles from Duke University Hospital on Hillandale Road, PRIME is a resident-staffed clinic that integrates care into a patient-centered medical home model with same-day access to mental health services. Residents are organized into care teams with a supervising attending physician supported by ancillary staff, including a dedicated RN, LPN, medical support assistant, clinical pharmacist, social worker, and phlebotomists.
The VA infrastructure empowers residents to provide cutting-edge evidence-based medicine without the overwhelming fiscal barriers common in community practice. As part of their ambulatory care experience, residents in PRIME will spend one or two weeks working in more executive roles: assisting in quality initiative projects, participating in executive and administrative meetings with Durham VA leadership, and assisting Prime Clinic staff in triage. Trainees have the opportunity to develop longitudinal and meaningful relationships with their patients, and the PRIME Clinic is frequently reviewed as one of the most memorable experiences throughout residency. This is a unique opportunity to serve our nation’s heroes in one of the most rewarding missions in healthcare.