Ambulatory Chief Residents
Tyra Thorstad, MD
Ambulatory Chief Resident, University of Washington
UW/Roosevelt General Internal Medicine Clinic
AMION Clinic CodesAmion Clinic Codes
Harborview Adult Medicine Clinic
The Adult Medicine Clinic at Harborview Medical Center provides care to a diverse patient population, including Seattle's poor and medically indigent, as well as many non-English speaking immigrant populations. Patients have a broad array of common and occasionally complicated medical conditions that often co-exist with psychiatric illness or substance abuse. Residents will frequently co-manage their patients with our clinic psychiatrist and chemical dependency counselors and are well supported by our social workers. Residents repeatedly cite the high degree of autonomy as one of the strengths of this site.
Harborview International Medicine Clinic
The International Medicine Clinic at Harborview Medical Center is a small clinic that provides primary care to poor, medically indigent, non-English-speaking refugee and immigrant populations in King County. Patients typically originate from Southeast Asia or East Africa, and many have complex chronic medical conditions, co-existing with cultural adjustment issues, social problems, depression, anxiety, and post-traumatic stress disorder. Residents learn how to care for culturally diverse populations, work with interpreters, and serve as patient advocates. They gain an awareness of the epidemiology of disease in other parts of the world and different health systems and practices. Weekly pre-clinic conferences are tailored to the clinic's unique population. Residents interested in this clinic should have willingness to work with interpreters, a strong commitment to the underserved, and an interest in addressing global health disparities. Also, because of the inherent challenges of building and maintaining a patient panel in this vulnerable population, we require a three-year commitment during residency.
There are principally three features that set Pacific Medical Centers practice of over 125 providers apart from the other training sites in this system: the mix of patients, experienced mentoring attendings and an efficient clinic infrastructure. With a strong mission of providing specialty care to patients from the community clinics, a managed care program for retired military members and a large commercially insured base of patients, PMC can offer you a wide and interesting range of patients to work with.
Residents are paired with attending preceptors who are always available to help evaluate patients and make treatments decisions. This co-management structure allows residents to develop ambulatory clinical skills and independence while working alongside an experienced physician. Residents praise the PacMed clinic experience for preparing them for real world challenges. We work as a team with superb support staff (nurses and medical assistants) and access to top-quality laboratory, radiology, cardiovascular testing is unmatched.
Pioneer Square Clinic
The Pioneer Square Clinic is a satellite clinic of Harborview Medical Center located in the heart of Pioneer Square. Patients are typically under privileged, underserved, men and women who comprise part of Seattle's indigent population. They are often homeless or living in low-income housing. Many have mental health or substance abuse issues or both. Residents will learn to provide health care to homeless clients as well as solid skills in primary care. While extremely rewarding, it can be challenging developing a continuity panel in this environment due to the socio-economic status of the patients. For residents interested in homeless healthcare or medical needs of underserved populations, this would be an ideal continuity clinic.
UW Roosevelt General Internal Medicine Clinic
UW General Internal Medicine is a community of health care providers offering outstanding care to a diverse patient population and a commitment to resident education. Patient care visits are the core educational activity, supported by enthusiastic and knowledgeable attendings. Clinic precepting is aimed at assisting the residents in giving good care while maintaining the primacy of the resident-patient relationship. To facilitate residents' learning about ambulatory medicine, we have an evidence-based 3-year curriculum, which is presented via case-based interactive pre-clinic conferences. These conferences are led by residents using teaching material prepared by the attendings. Education is also fostered through weekly chart reviews, patient videotape reviews, and regular meetings with mentor attendings. The Roosevelt Clinic continually strives to provide a supportive and nurturing environment for residents while offering top quality ambulatory education preparing residents for practice.
UW Belltown Clinic
The Belltown clinic is one of the seven UW Medicine Neighborhood clinics, which are busy multi-specialty urban primary care clinics throughout King county. The UW Medicine Neighborhood clinics have a strong continuous quality improvement program and are the "front line" for many patients entering the UW Medicine Healthcare System. Internal Medicine residents are based at the Belltown facilities and precepted by experienced, enthusiastic attendings who all hold clinical faculty appointments with the University of Washington. We have a fully integrated electronic medical record (EPIC) and computer access in all exam rooms with access to all of the UW and other resources. Lab and radiology services are onsite. To facilitate residents' learning there are didactic conferences weekly on a variety of primary care topics. Residents are able to deliver primary care for a diverse population of patients, which include the working professional and the urban underserved. This clinic provides excellent opportunities for those residents with interests in primary care and preventive medicine.
VA Puget Sound Health Care System
The VA continuity clinic offers residents the opportunity to see veterans with a broad array of diseases including diabetes mellitus, hypertension, chronic obstructive pulmonary disease, coronary artery disease, chronic renal insufficiency and dyslipidemias. Residents will become comfortable caring for patients with multiple diseases and co-morbid conditions as well as in preventive health measures. The VA clinic features a fully computerized chart with the ability to view radiology imaging, EKGs and clinical pictures, and with links to a variety of on-line references. Each clinic session, residents attend a pre-clinic conference that is based on a comprehensive three year curriculum encompassing the common medical issues encountered in primary care. In order to gain experience caring for a diverse patient population, residents with VA clinic provide primary care and maintain a panel of patients in both the VA Women's Clinic and the VA Primary Care Clinic.