Journal of General Internal Medicine

, Volume 23, Issue 7, pp 921–926 | Cite as

The Ambulatory Long-Block: An Accreditation Council for Graduate Medical Education (ACGME) Educational Innovations Project (EIP)

  • Eric J. WarmEmail author
  • Daniel P. Schauer
  • Tiffiny Diers
  • Bradley R. Mathis
  • Yvette Neirouz
  • James R. Boex
  • Gregory W. Rouan
Innovations in Education



Historical bias toward service-oriented inpatient graduate medical education experiences has hindered both resident education and care of patients in the ambulatory setting.


Describe and evaluate a residency redesign intended to improve the ambulatory experience for residents and patients.


Categorical Internal Medicine resident ambulatory practice at the University of Cincinnati Academic Health Center.

Program Description

We created a year-long continuous ambulatory group-practice experience separated from traditional inpatient responsibilities called the long block as an Accreditation Council for Graduate Medical Education Educational Innovations Project. The practice adopted the Chronic Care Model and residents received extensive instruction in quality improvement and interprofessional teams.

Program Evaluation

The long block was associated with significant increases in resident and patient satisfaction as well as improvement in multiple quality process and outcome measures. Continuity and no-show rates also improved.


An ambulatory long block can be associated with improvements in resident and patient satisfaction, quality measures, and no-show rates. Future research should be done to determine effects of the long block on education and patient care in the long term, and elucidate which aspects of the long block most contribute to improvement.


ambulatory education clinic residency training chronic care model 



The authors have no acknowledgements to report.

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Eric J. Warm
    • 1
    Email author
  • Daniel P. Schauer
    • 2
  • Tiffiny Diers
    • 1
  • Bradley R. Mathis
    • 1
  • Yvette Neirouz
    • 1
  • James R. Boex
    • 3
  • Gregory W. Rouan
    • 1
  1. 1.Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Department of Internal Medicine, Institute for the Study of HealthUniversity of Cincinnati College of MedicineCincinnatiUSA
  3. 3.Department of Public Health SciencesUniversity of Cincinnati College of MedicineCincinnatiUSA

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