Our Residency Program offers an extensive and well-structured ambulatory experience. Its main component is the Continuity Clinic, which takes place in the Nesset Health Center, situated within the hospital campus.

In 1976, concurrently with the start of our program, Drs. Donald P. Rubino and Rush Priest, two respected general internists from the community, brought the nucleus of their practice to the Nesset Center for the express purpose of sharing their practice with Residents. The concept of creating a shared Faculty/Resident practice for teaching purposes was an unusual innovation at the time, and predated by at least a decade similar developments in other teaching institutions. Since then the Internal Medicine practice at the Nesset Health Center has grown to over 25,000 visits per year. Its main goal is to provide excellent patient care within a longitudinal experience for Internal Medicine Residents. During their three years of training, Residents build their own clinical practices and are identified as their patients' primary care givers.

Seven full-time General Internists chosen because of their skills and dedication to teaching are the Faculty. There is close collaboration between Residents and Faculty in the provision of care, which results in a lively exchange of ideas and transmission of knowledge. PGY I Residents receive special instruction and preparation for the practice of Ambulatory Medicine through our Mentoring Program, where three Residents work closely with an experienced Faculty member throughout the year. In the PGY II and III years the ratio of Residents to Faculty is 4:1. Each PGY I Resident spends one session per week at the Nesset Health Center, whereas PGY II and III spend two sessions per week.

The patients who receive their care at the Nesset Health Center are as diverse as the community where we are located. We enjoy an ideal mix of ages, genders, ethnic backgrounds, and even insurance status, which closely mimics the patterns seen in today's practice of office medicine. The Faculty also makes a special effort to ensure that all Residents become proficient and knowledgeable about the requirements of Managed Care practice, honing their skills and developing efficient and cost-conscious habits of clinical practice. As a consequence of their thorough preparation, it is not surprising that our Residents often contact us shortly after completion of their training, to let us know how prepared and comfortable they felt going into practice. Perhaps the best testimonial of the preparation our Residents receive is the large number of Residents who are recruited by established medical practices.

Supplementing the longitudinal ambulatory care experience at the Nesset Health Center is the exposure to office practice while on subspecialty elective rotations. Whereas the bulk of learning on these rotations takes place in the hospital, all Residents are exposed to significant office experience by working alongside experienced specialists while rotating through electives such as Gastroenterology, Endocrinology, Oncology and Rheumatology.

This era of managed care has made it necessary to broaden the skills and experience of Internists beyond those traditionally associated with Internal Medicine. In recognition of these demands, we have developed the rotation in non-traditional Internal Medicine specialties. This is a specific one-month office-based rotation during which all Residents develop knowledge and obtain procedural skills in Dermatology, ENT, Gynecology and Women's Health, Ophthalmology, Orthopedics, Podiatry and Sports Medicine.

The final component of our Ambulatory experience is a unique emphasis on providing health care to the medically underserved. This occurs through two different types of programs, both of which are voluntary but very popular.

Community Health is a volunteer-based free clinic serving the indigent and uninsured on Chicago's near northwest side. Our residents and one of our faculty members staff the clinic three nights per month on a voluntary basis. We feel that this experience will instill the values of service and volunteerism in our Residents. This experience also provides our Residents with an exposure to a more diverse patient population as well as health problems more unique to an urban setting. The Residents also learn teamwork and cost-conscious use of limited resources. The experience at Community Health has been a wonderful addition to our Ambulatory experience as it offers a completely different view of the healthcare needs of our population and results in a highly satisfying and fulfilling personal experience.

The second opportunity emphasizing care of the medically underserved is our international medicine experience. For the last 13 years, each February, Residents from the Internal Medicine Residency program have been part of a medical team that travels to rural Guatemala to bring medical care to the poor and underserved in that country. The Residents are supervised on these trips by Department of Medicine faculty members. Over the past several years, in addition to the above opportunity, the program has also assisted numerous Residents in participation in other international medicine opportunities. Residents have traveled to Latin America, Africa, China and India on these medical missions. The Residency program supports these voluntary efforts by crediting them as an elective rotation and offering financial assistance as well. Through these international experiences, the Residents learn teamwork, self-reliance and the personal and professional satisfaction that comes from helping those in need. It also broadens their cultural horizons and gives them a glimpse of healthcare in other parts of the world. The program believes these experiences can be fundamental in the development of the kind of physician we want to train at Lutheran General Hospital.