title: The Ambulatory Diagnostic and Treatment Center: A Unique Model for Educating Medical Trainees and Providing Expedited Care.
abstract: In this article, the authors reexamine the Ambulatory Diagnostic and Treatment Center (ADTC) model, which uniquely combines the education of trainees with the care of referred patients at one Veterans Affairs medical center. As an ambulatory clinic with an inpatient mind-set, the ADTC uses a series of closely spaced outpatient appointments that are longer than typical ambulatory visits, offering a VIP-level of evaluation with the patient-centered goal of expedited diagnosis and treatment. Faculty triage patients by weighing factors such as urgency, educational value, complexity, and instability of diseases in conjunction with the resources, availability, and appropriateness of other services within the medical center.The ADTC's unique focus on the education of trainees in comparison with other clinical rotations is evident in the ratio of learning to patient care. This intensive training environment expects postgraduate year 2 and 3 internal medicine residents and fourth-year medical students to read, reflect, and review literature daily. This mix of education and care delivery is ripe for reexploration in light of recent calls for curriculum reform amidst headlines exposing delays in veterans' access to care.A low-volume, high-intensity clinic like the ADTC can augment the clinical services provided by a busy primary care and subspecialty workforce without losing its emphasis on education. Other academic health centers can learn from this model and adapt its structure in settings where accountable care organizations and education meet.
authors.affiliation: R.A. Serrao is assistant professor of medicine, Section of General Internal Medicine and of Infectious Diseases, Medical Service, Veterans Affairs Boston Healthcare System, and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. J.D. Orlander is professor of medicine, Section of General Internal Medicine, Medical Service, Veterans Affairs Boston Healthcare System, and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Serrao
authors.forename: Jay D
authors.initials: JD
authors.lastname: Orlander
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D001900:Boston; D002983:Clinical Competence; D003266:Continuity of Patient Care; D004503:Education, Medical, Graduate / Q000379:methods*; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D017145:Models, Educational; D017146:Models, Organizational; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D011787:Quality of Health Care; D012017:Referral and Consultation