The ambulatory clinical experience and patient contact for the primary care residents are largely provided in the Primary Care, and SRO/Homeless and clinic sessions at the O'Toole outpatient building. The clinic functions through a team concept with nursing, social work, and medical disciplines interacting to formulate and implement a plan of care.

Continuity of care is stressed and patients are assigned to one resident physician for three years of that resident's training. Primary care strategies of preventive medicine, patient education, and health maintenance are stressed and team conferences are employed to review and discuss the care of patients. The commitment of primary care residents to continuity of care is such that it extends to the inpatient setting where another team of residents may be caring for their patients.

As the primary physician for these patients, it is the resident's responsibility to communicate with the inpatient team, providing inpatient colleagues with information and insight, which facilitate patient care. However, the inpatient team maintains day-to-day management responsibility throughout the patient's hospital stay.

The SRO/Homeless Program is an extensive and rapidly growing community outreach project. While the fundamental thrust of the work in this area is community service and the care of patients, the potential for study and education is considerable. Participation of primary care residents in the SRO/Homeless Program adds a dimension to the service provided. Experience with patients at the hotels and shelters complements the more traditional setting of the SRO/Homeless clinic, thus providing practical experience in the methods of community medicine.

Additional outreach experience is provided for the residents through the Chelsea-Village program and Immigrant Health Program. These programs serve as alternatives to institutional care for homebound chronically ill and elderly individuals in the Greenwich Village, Chelsea and Chinatown communities. Resident physicians participate in these programs as members of a team of healthcare providers, making home visits and otherwise designing strategies for maintaining the patient's health and independence.

Special electives that enhance the education of the residents are incorporated into the primary care ambulatory training. Some of these electives may include dermatology, ophthalmology, otolaryngology, rehabilitation, gynecology, adolescent medicine, geriatrics, endocrinology, and international health.