Faculty Co-Chairs:

Joanna Rachelson MD

Danielle Fitzsimmons-Pattison MD

Contacts:

1. Danielle Fitzsimmons-Pattison
2. Joanna Rachelson
3. Brenda Cuellar

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ACGME Program Requirements   (see IV.C.)  

ACGME Program Requirements

• IV. C.4. Each resident must be assigned to a primary FMP site. (Core)
  • Residents must be scheduled to see patients in the FMP site for a minimum of 40 weeks during each year of the program. (Detail)
    • Residents’ other assignments must not interrupt continuity for more than eight weeks at any given time or in any one year. (Detail)
    • The periods between interruptions in continuity must be at least four weeks in length. (Detail)
  • Experiences in the FMP must include acute care, chronic care, and wellness care for patients of all ages. (Core)
  • Residents must be primarily responsible for a panel of continuity patients, integrating each patient’s care across all settings, including the home, long-term care facilities, the FMP site, specialty care facilities, and inpatient care facilities. (Core)
    • Long-term care experiences must occur over a minimum of 24 months. (Detail)
  • Residents should participate in and assume progressive leadership of appropriate care teams to coordinate and optimize care for a panel of continuity patients. (Detail)
  • Residents must provide care for a minimum of 1650 in-person patient encounters in the FMP site. (Core)
    • The majority of these visits must occur in the resident’s primary FMP site. (Core)
    • One hundred sixty-five of the FMP site patient encounters must be with patients younger than 10 years of age. (Core)
    • One hundred sixty-five of the FMP site patient encounters must be with patients 60 years of age or older. (Core)
• IV.  C.9. Residents must have at least 200 hours (or two months) or 250 patient encounters dedicated to the care of children and adolescents in an ambulatory setting. (Core)
  • This care must include well-child care, acute care, and chronic care. (Detail)

• IV.C.21.  Residents must receive training to perform clinical procedures required for their future practices in ambulatory and hospital environments. (Core)
  • a)  The program director and family medicine faculty should develop a list of procedural competencies required for completion by all residents in the program prior to graduation. (Core)
  • a).     (1) This list must be based on the anticipated practice needs of all family medicine residents. (Core) IV.C.21.a).(2) In creating this list, the faculty should consider the current practices of program graduates, national data regarding procedural care in family medicine, and the needs of the community to be served. (Core)

 Required Experiences: 

Continuity Clinic at MMC or LCDF

Optional experience:

Other local practices in elective rotation format.

A focused “clinic rotation” elective is available.

Asylum shelter call

Weekly Schedule PGY 1:

One to two half-day continuity clinics per week

Weekly Schedule PGY 2:

Two to three half-day continuity clinics per week

Weekly Schedule PGY 3:

Three to four half-day continuity clinics per week

General information.

The continuity clinic experience allows growth of medical knowledge. Residents will gain skills needed to provide patient centered medical care. Preventative care and continuous improvement through practice based learning and improvement skills will be a focus of this education.

 

Expectations for Residents and Faculty (if beyond those outlined in resident manual):

Residents are expected to arrive to continuity clinics briefs on time . Failure to attend without notice will result in a written warning.

They are expected to follow up on their patients’ labs/studies and monitor their EMR for phone notes daily.  Notes will be completed within 72 hours of the patient being seen.  The resident is responsible for maintaining a procedure log as well as completing assigned readings.

PGY1 Residents

PGY1 residents will precept all patients with faculty.

Attending will see all patients for the first 6 months of the year.

PGY2/PGY3  Residents

Senior residents who have been cleared must precept any patients who are medicare patients, OB patients, HIV patients or receiving transgender care patients.

FM Attending/Preceptor

Family medicine faculty will provide precepting of all patient care and procedures performed in resident continuity clinics. The faculty are expected to allow the resident to participate in active patient care and procedures when appropriate. The faculty will treat the residents in a respectful manner and should also provide time and allowance for explanation and teaching of patient conditions and their treatments.

The PharmD

When available  PharmD faculty will provide medication consultations and collaborate with residents to ensure appropriate, effective, and safe use of medication therapy. Referrals can be made for medication management but residents are expect to continue with collaboration and learn from the PharmD

The Psychologist/ Prescribing psychologist

When available  will provide behavioral health consultations and collaborate with the FM residents in providing instruction and  direct patient behavioral health care. Her/his/their primary role is that of a consultant/teacher.  When a patient is referred to the psychologist for a consultation, the resident responsible for that patient’s care is expected to participate with the psychologist in the assessment and recommendation formulation. Will also be available for behavioral observations of resident engaging in clinical care.

Social Worker:

When available  will provide collaborate with the FM residents in providing instruction,  direct patient behavioral health care and assist with social needs.  Her/his/their primary role is that of a consultant/teacher.  When a patient is referred to the social worker for a consultation, the resident responsible for that patient’s care is expected to participate with  the assessment and recommendations.

Goals: 

By the end of the residency residents will develop the knowledge and skills to appropriately evaluate and treat ambulatory patients of all ages and life stages. This will include the evaluation and treatment of the patients’ biomedical, behavioral, and social needs.  They will develop skills in working with interprofessional teams.

 

Deliverables (if applicable): Anything a resident needs to produce during the experience

1. Residents will care for a panel of patients and maintain appropriate documentation as well as addressing any  care needs that arise.

There will be an educational opportunity at the beginning of each clinic session that residents will be expected to participate in. (ie. Daily Board review question, and or learning topics).

1. At the end of clinic resident will check out with attending and run the list of their patients briefly.  The resident will identify one learning topic they either researched during clinic or wish to learn more on in the future.

OBJECTIVES: Throughout and at completion of residency residents will be expected to:	EDUCATIONAL STRATEGIES/ACTIVITIES Including direct instruction,role modeling bedside teaching	ASSESSMENT:
Counsel and educate patients and their families in a clear, respectful manner including utilizing cultural humility.(PC, ICS, SM)	Direct interaction during presentations including discussions of appropriate assessments, differential and plans.	Faculty observation, verbal feedback, written feedback based on documentation and procedure competency checklist.  BH observation Review and feedback on written notes
Makes informed decision about diagnostic and therapeutic interventions based on patient information and preferences, utilizing most current scientific evidence and clinical judgment (PC, MK, PBLI)	Using information technology to support patient care decisions and patient education	Faculty observation, verbal feedback, written feedback based on documentation and procedure competency checklist.
Utilizes interdisciplinary teams and own knowledge to  provide preventative health maintenance at various life stages.(PC, IPCS)	Interaction with interprofessional teams including but not limited to pharmacy, behavioral health and social work.	Faculty observation, verbal feedback, and global assessment form. BH observation
Perform appropriate ambulatory procedures, with attention to consent, technique, patient comfort and follow-up (PC,MK)	Performs common procedures under direct faculty supervision	Faculty observation, verbal feedback, procedure competency checklist, and global assessment form.
Residents must demonstrate continuous improvement in patient care based on constant self-evaluation and lifelong learning as well as collaborate in teaching of other medical learners.  (IPCS,SBP, PR)	Verbal and written interactions with faculty, work with students, and collaborate with Interprofessional team on patient care in clinic	Faculty observation, verbal feedback, and global assessment form.
Quality improvement methods, and implement changes with the goal of practice improvement (PC, PBLI)	QI research projects	Presentation of QI projects and ongoing PDSA cycles.
Advocates for quality cost effective patient care and assist patients in dealing with system complexities to minimize discomfort or confusion including partnering with health care managers and providers in coordination of care.   (SBP, PC, IPCS,SM)	Care of a diverse patient panel. Working with faculty and Interprofessional team.	Faculty observation, verbal feedback, and global assessment form.
Continuously develop professionalism and adherence to ethical principles as demonstrated by acceptance of responsibility for care and accurate documentation. Residents are expected to demonstrate  compassion integrity and respect for other.(PR,PC, SBP, IPCS, SM)	Presentations, or written notes and behavioral observations	Faculty observation, verbal feedback, written feedback based on documentation and procedure competency checklist
Residents will be able to evaluate social and environmental factors affecting patients’ care and utilize strategies such as MI, lifestyle medicine,and other treatment modalities  to address these concerns.(SBP,PC, MK, SM)	Oral written presentation and bh observations.	Faculty observation, verbal feedback, written feedback based on documentation and procedure competency checklist

 

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed. An Attending will be available the entire time the resident is on the rotation. An Attending will be available at all times during continuity clinic visits.

Educational Resources

Readings:

Outpatient Diagnosis of Acute Chest Pain in Adults

Web Resources:

American Academy of Family Physicians: http://www.aafp.org

Society of Teachers of Family Medicine: http://www.stfm.org

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