Established in 1989, the Weill Cornell Medicine Primary Care Program is characterized by its clinical rigor and opportunities for academic exploration. It is a targeted 36-month residency that provides a focused outpatient medicine curriculum in addition to intensive inpatient training. Primary Care Residents rotate through the same inpatient clinical rotations as Categorical Residents – including General Medicine, Subspecialty Medicine, and Intensive Care rotations – but have additional dedicated time devoted to primary care medicine, including spending a full six months of each the PGY2 year and the PGY3 year training in the ambulatory setting.
This enriched ambulatory time is devoted to direct patient care in the resident's continuity clinics, ambulatory selectives with an expanded didactic curriculum and subspecialty clinic exposures, and regular evidence-based medicine journal clubs, all of which teach residents in the Primary Care Track how to care for adult patients across the spectrum of internal medicine.
Primary Care residents also are introduced to the role of the academic general internist through a mentored longitudinal scholarly project, a unique senior resident leadership/teaching role as Ambulatory Chief Resident, and funded attendance at the annual Society for General Internal Medicine meetings.
Why Primary Care?
Increasing the number of primary care trainees and practitioners has become a national priority and represents a critical contribution to addressing the current health care crisis on many fronts, including access, value, and quality of care. Primary care physicians are generalists trained in the entire breadth of internal medicine, both chronic and acute. They build longitudinal patient relationships, offer comprehensive patient-centered care, and improve access to care and health outcomes for their patients. They are leaders in clinical medicine, academic medical education, community outreach, and patient advocacy. We are proud to contribute to this valuable tradition and to train the primary care leaders of tomorrow. Join us!
What Distinguishes our Primary Care Track?
While the Weill Cornell Primary Care track is fully integrated into the larger Categorical Residency Program, it has special characteristics that set it apart. Note, it has a separate match through its unique NRMP program number.
The program offers diverse clinical practice opportunities including:
- Six-month expanded ambulatory exposure in the PGY2 and PGY3 year
- Comprehensive outpatient subspecialty curriculum
- Second continuity-clinic experience during PGY2 and PGY3 year
- Urban, rural, and international experiences
In addition, it offers a range of academic exposures including:
- Longitudinal structured scholarly project
- Wide range of one-on-one mentorships
- Funded travel to academic general medicine conferences
- Senior leadership and teaching experience as an Ambulatory Chief Resident
Above all, the program affords a great degree of personalization and flexibility which allows residents and program leadership to work together to tailor a training experience specific to the individual's needs and interests. Residents both develop excellence in an area of clinical practice but also explore areas of interest within the scope of academic general internal medicine, including clinical research, medical education, medical ethics, public health, and health policy. Graduates of the program are well poised for careers as general internists, clinician-educators, clinician-investigators and patient advocates.
Primary Care Program Schedule Overview
Primary Care residents rotate through most of the same inpatient clinical rotations as Categorical residents, but have additional dedicated time devoted to outpatient primary care internal medicine during the PGY2 and PGY3 years. The breakdown is approximately as follows, represented in two-week intervals:
Highlights of the Primary Care Program
Three Outpatient Practice Sites
Faculty and residents practice side-by-side at three fully integrated outpatient practice sites, providing comprehensive care to a truly diverse patient population. Both residents and faculty see a broad payer-mix, including privately insured, Medicare, and Medicaid patients in approximately equal proportions. The patient population is multi-cultural and multi-lingual, reflecting the international flavor of New York City's population. Residents serve as true primary care physicians for all aspects of a patient's care and become proficient in the essential components of ambulatory medicine including chronic care, urgent care, telephone medicine, prevention and screening, and patient education.
- WCIMA Helmsley Medical Tower is the hospital-based faculty/resident practice of Weill Cornell Internal Medicine Associates. There are approximately 30 attending physicians and 95 residents in practice at this site. It is the educational hub of the ambulatory rotation where didactics and morning report are hosted. The patient population is socioeconomically, culturally, and linguistically diverse, hailing from the entire NYPH catchment area, including Queens, Harlem, Bronx and Brooklyn, in addition to our local neighborhood. Patients at this practice are characterized by complex medical illness and a high index of co-morbidity.
- WCIMA Wright Center is a small faculty/resident practice located just seven blocks north of main campus. There are three attending physicians and 16 residents in practice at this site. The small size allows for a more intimate interdisciplinary work environment. The practice tends to have the patient diversity found at the HT4 site, but also has a larger share of patients from our Upper East Side community.
- Long Island City Health Center is a Federally Qualified Health Center that is located in the northwest section of Queens, approximately 15 minutes from main campus. There are three attendings and 16 residents in practice at this site. It is a multidisciplinary practice that offers internal medicine, pediatrics and obstetric/gynecology services to a diverse patient population, including a large urban immigrant population and an important number of uninsured patients. Residents participate in a community health curriculum at this site based in the nearby public housing projects.
Second Continuity Clinic
In the second half of residency, Primary Care residents participate in a second weekly continuity clinic outside of their main practice site. The second continuity experience allows residents to build a longitudinal relationship with a patient panel, honing specific clinical skills in a focused area of primary care. Sites vary widely and have included HIV medicine, Endocrine, Gynecology, Renal, Rehabilitation Medicine, Adolescent Medicine, Weight Management, Psychiatry, Genetics, Rheumatology, Neurology Memory Clinic, Home Visits, Rapid Hospital Discharge clinic, and work with the NYC Department of Health.
Ambulatory Chief Resident
All Primary Care residents serve as Ambulatory Chief Resident (ACR) during two-three months of their senior year, an experience unique to our program which provides a wonderful opportunity to act as a clinical educator in the practice. ACRs assume a leadership role and refine their teaching skills by taking responsibility for presenting morning report two days per week for all WCIMA residents. Additional responsibilities include supervised precepting of house staff, pap clinic supervision, assisting with administration for the Primary Care Program, and an important role as the liaison between residents and faculty at the WCIMA practice site. This valuable opportunity mirrors the responsibilities of junior academic faculty and teaches trainees about managing an outpatient practice, clinical administration, teaching and leadership skills.
Research Methods Course
All primary care residents participate in a structured research course as preparation for their required scholarly project. Both didactic lectures and small group mentoring sessions to discuss residents' projects in detail are specifically designed to direct the efforts towards a published end-product. Primary care residents during PGY2 and PGY3 have additional protected time dedicated to independent work on their project. They present regular updates to their peers and to the Primary Care core faculty for feedback, support, and mentorship. Whether it is a resident's first foray into scholarly work or they already have advanced research skills gained through an M.P.H. or other degree, the Primary Care research curriculum is designed to be flexible enough to meet each individual trainee's needs and help them reach the next level of scholarly achievement.
Our residents have produced some impressive work, most presenting their abstracts at national conferences and some going on to careers as clinician-investigators. Recent projects have ranged from a systematic review of social media in resident education, to an exploration of the impact of the Affordable Care Act on access to primary care in Queens, to a practitioner's guide to prescribing pre-exposure prophylaxis for HIV, to an evaluation of outcomes in an obesity management clinic, to a qualitative exploration of what drives physician social engagement, to an assessment of post-hospitalization mortality in Tanzania. Below please see selected examples of recent resident publications:
Madeline Sterling, 2016 graduate
Patterns of Scheduled Follow-up Appointments Following Hospitalization for Heart Failure: Insights from an Urban Medical Center in the United States, Journal of Clinical Interventions in Aging 2016. (In press)
Paul Lu, 2016 graduate
Adam Schwartz, 2015 graduate
Celine Goetz, 2014 graduate
Ashwin Vasan, Asst Prof Population and Family Health, Mailman School of Public Health
Integrated care as a means to improve primary care delivery for adults and adolescents in the developing world: a critical analysis of Integrated Management of Adolescent and Adult Illness (IMAI), BMC Med 2014.
Kira Ryskina, 2013 graduate
Leon Igel, 2013 graduate
Anne Garment, 2011 graduate
Jackie Yuen, 2011 graduate
Subspecialty Elective Curriculum
The Primary Care Subspecialty Curriculum is organized around clinical themes including dermatology, cardiopulmonary medicine, musculoskeletal medicine, women's health, endocrinology and psychiatry. A combination of rotations in specialty clinics, syllabus readings, and case-based conferences serve to concentrate the learning experience around management of common outpatient and subspecialty conditions. At the residents' initiation, time can also be set aside for individual specialty electives of the residents' choice.
Evidence-Based Medicine Journal Club
Once weekly during ambulatory blocks, Primary Care residents and faculty meet together and discuss evidence-based "answers" to clinically relevant questions formulated during the previous week of practice. Two residents are chosen to identify a focused clinical question, demonstrate their literature search strategy, and summarize the relevant article(s). By keeping these searches focused and succinct, residents develop the skills necessary to incorporate evidence-based searches into their standard practice, including formulating an answerable clinical question, searching the appropriate databases, appraising the literature critically, and applying the results to patient care.
Ambulatory Morning Curriculum
An extensive ambulatory curriculum morning lecture series is delivered to ensure all residents graduate with a solid foundation in general medicine. Topics include hypertension, diabetes, musculoskeletal complaints, asthma, COPD, thyroid disease, cardiac testing, GERD, mental health, pain management, women's health, travel medicine, age-specific screening, sexual health and LGBT health, to name just a few. In addition to the ambulatory lectures, time is dedicated two mornings per week to Morning Report presentation of outpatient cases, led by the Ambulatory Chief Resident. Generalist faculty attend to enhance the discussions.
During the PGY2 year, our Primary Care residents participate in two to four week clinical electives at Cayuga Medical Center in Ithaca, New York. Opportunities include hospital medicine, rural health, consultative medicine, and Gannett Health Services – the student health practice offering experiences in adolescent medicine, women's health and behavioral medicine. The experience provides an introduction to real-life primary care embedded in a smaller community, and offers a fascinating juxtaposition to care in urban Manhattan. The Ithaca-based clinician-educators are wonderful primary care role models, and residents have found that the area is a beautiful region to explore during the fall and spring. More information is available here.
Primary Care PGY3 residents are offered the same opportunities to participate in global health electives as Categorical residents, including structured rotations at sites in Tanzania, Haiti and Brazil. In addition, the Primary Care track offers PGY2 residents valuable flexibility to structure some of their elective time for international clinical and/or research electives.
Society of General Internal Medicine
Each PGY2 and PGY3 Primary Care residents is funded to attend the national meeting of the Society of General Internal Medicine (SGIM) each spring, with submission of an abstract or clinical vignette to the conference. The SGIM conference is an incredible meeting of leaders in academic general medicine, and represents a great opportunity for residents to learn about the national agenda of general internal medicine. Residents are encouraged to get involved in the wide range of activities offered through the society, and to use the meeting time to develop ideas for their own projects, explore career options, make contacts, and learn about primary care internal medicine. Primary Care PGY1s are funded to attend the regional SGIM meeting.
Primary Care residents and faculty enjoy good eating and casual socializing as often as possible! The Ambulatory Chief Resident organizes a group get-together about once every two months to foster camaraderie amongst the Primary Care classes and between residents and faculty. Other, more formal gatherings include the Intern Welcome Party, Alumni Networking and Career Night, and the Senior Graduation Party.