Faculty Chair:

Leandrita Ortega, MD

Contacts:

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Required Experiences:

Gerald Champion Regional Medical Center Clinics

Optional Experience:

Other local practices in an elective rotation format.

A focused “clinic rotation” elective is available.

 

Weekly Schedule PGY 2:

Two to three half-day clinics per week

Weekly Schedule PGY 3:

Three to four half-day clinics per week

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Requirements:

AOA

Continuity of Care Training

Continuity of care must be taught as a core value of osteopathic family medicine.

• Each resident is expected to maintain continuity of care for his/her patients when such patients require hospitalization or consultation with other health care providers. The resident must maintain participation in the decisions involving the health of the patient.
• For those patients unable to visit the continuity of care site, training opportunities must be provided for the resident to gain experience in home care and care in long-term care facilities.
• No rotation, discipline or other duties are to interfere with the intent or implementation of the continuity of care experience portion of the residency.

The major focus of the training program must be on providing comprehensive primary care for patients in the ambulatory continuity of care setting including the following:

• The continuity of care training requirement must be fulfilled by only osteopathic family medicine.
• For a given resident the continuity of care experience may be at no more than two sites. Each site must meet all facility requirements and all continuity educational requirements as outlined in these standards.
• If the residency program elects to use two sites, the resident may be assigned to both sites simultaneously or each site for at least twelve consecutive months during OGME-2 and OGME-3. During OGME-1, the continuity experience must be at a single site.
• The patient population of the continuity of care site must include a variety of patients in terms of age, gender, and ethnicity.
• Each resident must be assigned a designated panel of patients.
  • The resident must be responsible, under supervision, for the health care needs of their assigned panel of patients.
  • The resident must be clearly identified as the health care provider for the panel.
  • As the skill and proficiency of the resident improves, an increasing daily patient load is expected.
• The three year continuity of care site experience must include at least 1,650 patient visits, with a minimum of 150 occurring in the OGME-1 year.
• Residents must see patients in the continuity of care site for a minimum of forty weeks per year.

The ambulatory care experience must train residents to be both productive and efficient in a primary care setting. At a minimum this must include:

• Appropriate utilization of osteopathic principles and manipulative treatment.
• Diagnose and manage medical and surgical conditions.
• Perform office procedures.
• Incorporate preventive measures.
• Provide patient education.
• Provide counseling.
• Coordinate care.
• Manage consultations.
• Maintain medical records.

ACGME

Each resident must be assigned to a primary FMP site. (Outcome)

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. (Detail)

One hundred sixty-five of the FMP site patient encounters must be with patients younger than 10 years of age. (Detail)

One hundred sixty-five of the FMP site patient encounters must be with patients 60 years of age or older. (Detail)

Residents’ patient encounters should include telephone visits, e-visits, group visits, and patient-peer education sessions. (Detail)

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Description of Rotation or Educational Experience:

The FMC experience is the basis of the education provided in family medicine residency. It is here where you will obtain the skills needed to provide patient centered medical care. All residents are assigned a panel of patients that they will be responsible for caring for. Continuity is an essential component of this care. This is also the place you will obtain the patient care skills, and medical knowlege to treat 85-90% of all medcial problems you will encounter in your patients. Preventative care and continous improvement through practice based learning and improvemt skills will be a focus of this education.

Expectations:

Residents:

Residents are expected to arrive to continuity clinics on time and to dress and act in a professional manner. They are expected to follow up on their patients’ labs/studies and monitor their EMR for phone notes daily. It is expected that the residents will be respectful of the office space and personnel. The resident is responsible for maintaining a procedure log as well as completing assigned readings.

Faculty:

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.

Call:

There is no call specific to this experience.

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Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

Objectives

The resident demonstrates the ability to:

• Obtain and report developmentally, age and presentation/setting appropriate history (R1)
• Perform and report developmentally, age and presentation/setting appropriate physical examination (R1)
• Generate an appropriate differential diagnosis (R1)
• Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment (R1)
• Develop and carry out patient management plans (R1)
• Document patient care in appropriate record system and maintain essential components of the patient’s record of care (R1)
• Counsel and educate patients and their families in a clear, respectful and culturally conscious manner (R1)
• Use information technology to support patient care decisions and patient education (R1)
• Perform appropriate procedures, with attention to consent, technique, patient comfort and follow-up (R3)
  • Skin biopsy/excision
  • I&D
  • Toenail procedures
  • Cryotherapy-skin
  • Pap
  • IUD insertion/removal
  • Endometrial biopsy
  • Trigger Point injection
  • Joint aspiration/injection
• Provide health care aimed at preventing health problems or maintaining health (R2)
• Collaborate with health care professionals, including those from other disciplines, to provide patient-focused care (R2)

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Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

Objectives

The resident:

• Demonstrates an investigatory and analytic thinking approach to clinical situations (R1)
• Knows and applies basic and clinical knowledge in specified areas/diagnoses (R3)
  • Routine child health exam
  • Routine gyn care
  • Routine physical exam
  • Hypertension
  • Diabetes
  • Hyperlipidemia
  • CAD/CP
  • Dermatitis
  • Skin lesions
  • Abdominal pain
  • UTI
  • BPH/urinary retention
  • Hepatitis
  • N/V/D; dehydration
  • COPD/asthma
  • Acute upper resp sx
  • GERD
  • Hypo/hyperthyroidism
  • Depression
  • Anxiety/panic
  • Arthritis: RA, DJD
  • Back pain
  • Headache
  • STDs/vaginitis
  • Prenatal care
  • Postnatal care
  • Contraceptive management
  • Menstrual disorders
  • Menopause

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Practice Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to:

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement
• Locate, appraise and assimilate evidence from scientific studies related to their patients’ health problems
• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners

Objectives

The resident:

• Recognizes his/her own strengths and limitations (R1)
• Asks questions as an engaged, critical learner (R1)
• Uses information technology to manage information, access on-line medical information, and support their own education (R1)
• Facilitates the learning of students and other health care professionals (R2)
• Participates in QI process using AAFP Metric system
• Participates in Journal Club

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System Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Coordinate patient care within the health care system relevant to their clinical specialty
• Incorporate considerations of cost awareness and risk-benefit analysis in patient care
• Advocate for quality patient care and optimal patient care systems
• Participate in identifying systems errors and in implementing potential systems solutions

Objectives

The resident:

• Practices cost-effective health care and resource allocation that does not compromise quality of care (R3)
• Advocates for quality patient care and assist patients in dealing with system complexities to minimize discomfort or confusion (R3)
• Recognizes that the patient is part of a greater system and provides care in a manner that supports continuity (R3)
• Knows how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance (R3)

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Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others
• Responsiveness to patient needs that supersedes self-interest
• Respect for patient privacy and autonomy
• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation

Objectives

The resident:

• Accepts responsibility for patient care (R1)
• Never misrepresents patient care information (R1)
• Consistently performs in a punctual, reliable and collegial manner (R1)
• Demonstrates dress, hygiene and manner of speech that consistently reflect appropriate standards (R1)
• Demonstrates a responsiveness to the needs of patients and society that supercedes self-interest (R1)
• Demonstrates a commitment to excellence and on-going professional development (R1)
• Demonstrates a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, patient privacy, informed consent, and business practices (R1)
• Demonstrates sensitivity and responsiveness towards patients’, colleagues’ and team members’ gender, age, culture, disabilities, ethnicity and sexual orientation (R1)

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Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with patients and families across a broad range of socioeconomic and cultural backgrounds
• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member of leader of a health care team or other professional group
• Maintain comprehensive, timely, and legible medical records

Objectives

The resident:

• Makes organized and effective oral presentations (R1)
• Creates and sustains a therapeutic and ethically sound relationship with patients and families (R2)
• Elicits and provides information using effective listening, nonverbal, explanatory, questioning, and writing skills (R1)
• Communicates with the patient, family and members of the healthcare team in a timely, developmentally and culturally appropriate manner (R1)
• Uses information technology to effectively communicate with all components of the health care team (R1)
• Works effectively and respectfully with others as a member or leader of a health care team or other professional group (R1)

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Teaching Methods

Residents will provide medical care to patients under the direct supervision of the attending physician. They will be supervised on all procedures performed. They will participate in weekly conferences. Residents will be assigned specific reading topics to be completed by the end of their month on the service.

Assessment Method (residents)

Direct observation with a ongoing global assessment based on the REDI system. All procedures will be recorded on New Innovations and independence for each procedure assessed using the REDI system. Evaluation from each of the community preceptors to be completed at the end of the rotation. Review of documentation by family medicine preceptors as part of continuity clinic supervision.

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.

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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

UpToDate: UpToDate, Inc.: http://utdol.com