Ambulatory clerkships provide the opportunity for students to assume initial responsibility for the evaluation of patients in the ambulatory setting. Supervision will be provided by faculty preceptors in the academic setting as well as community private practices. Students expand upon competencies they developed during the third year as they team with residents and/or preceptors to provide preventive health services as well as acute and chronic illness management. The faster pace of ambulatory care provides an environment that strengthens patient and family communication skills, rapport development, and oral presentations. The use of evidence to inform treatment and counseling of patients and their caregivers are additional competencies that are highlighted in the outpatient setting. This rotation is designed to provide individualized teaching in the management of outpatient medical problems for students interested in combined internal medicine and pediatrics practice experience. The student will spend the majority of their outpatient clinical experience in a community combined internal medicine and pediatrics practice. There may also be opportunities for other experiences such as sports medicine and transitions of care clinics. The student will gain experience in the ambulatory setting including preventative medical services, assessment of growth and development in children and adolescents, diagnosis and treatment management of common adult and pediatric ambulatory problems, psychosocial issues affecting patient compliance, and the importance of multidisciplinary care. There may also be opportunities for performing or observing procedures such as EKG, Pap, microscopic examination of wet mounts, throat cultures, and injections. Other activities include Internal Medicine grand rounds and block conference and Pediatrics grand rounds and block conference.At the conclusion of the experience, the student will give a short presentation to the practice site of a topic of interest.