Faculty Chair:

John Andazola, MD

Contacts:

John Andazola, MD

Required Experiences:

Longitudinal procedural training required in Family Medicine

Optional Experience:

Anesthesiology

Interventional Radiology

Schedule:

Longitudinal

Requirements:

AOA

Procedural Medicine

The program must have defined mechanisms to train residents to competency in the following

procedures (minimum number):

• Joint injections. (6)
• Biopsy of dermal lesions. (6)
• Excision of subcutaneous lesions. (6)
• Incision and drainage of abscess. (6)
• Cryosurgery of skin. (6)
• Curettage of skin lesion. (3)
• Laceration repair. (6)
• Endometrial biopsy. (3)
• Office microscopy.
  • Wet Mount (1)
• Splinting. (6)
• EKG interpretation. (6)
• Office spirometry. (3)
• Toenail removal. (3)
• Defibrillation. (ACLS/CPR)
• Removal of cerumen from ear canal. (3)
• Endotraceal intubation. (6)

ACGME

Residents must be able to competently perform all medical, diagnostic, and surgical procedures considered essential for the area of practice. Residents: (Outcome)

• must appropriately use and perform diagnostic and therapeutic procedures. (Outcome)

Other Required Procedures

• Pap Smear (1)
• IUD Insertion (6)
• Circumcision (6)
• NST/CST Interpretation (6)

Description of Rotation or Educational Experience:

Introduction and Overview:

Family physicians perform a wide array of inpatient and outpatient procedures based on their training, expertise and health care needs of the community. Although the philosophy of “see one, do one, teach one” is deeply ingrained in medical training, there is no definite knowledge about how residents develop competency in performing procedures. Training of residents in a core list of common procedures with specific emphasis on development of competency will ensure the development of family physicians that are capable of delivering comprehensive care as envisioned in the medical home concept. This will in turn increase patient safety, continuity of care and satisfaction. Furthermore it will enable the family physicians to enjoy substantial financial rewards.

Purpose:

Procedural training is integrated in a longitudinal manner during the three years of residency concurrent with other rotations and curricula. A core list of procedures is identified based on national surveys, current practice patterns of family physicians in the community and faculty consensus and the training is instituted under the direct supervision of faculty. In addition to direct supervision procedural training include didactic presentations on indications, contra- indications, risks and benefits, informed consent, appropriate coding and billing, management of aftercare and complications. The residents are encouraged to acquire further skills in additional procedures based on their future practice requirements. The residents are required to document the procedures on New-Innovations and the level of performance and competency are evaluated by the supervising physicians. Compilation and documentation of the procedure log will enable the residents to acquire certifications and hospital privileges upon completion of their training.

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Expectations:

Residents

The resident is responsible for maintaining a procedure log of all procedures performed. Upon completion of the minimum number of procedures required (see list above). The resident should ask the supervising faculty member to be evaluated for competency. If the resident meets a minimum score of 80% or greater on the check off list and the supervising faculty member’s assessment is “Competent” then the resident will have achieved a level of “Competent”. After a resident is felt to be competent to perform a certain procedure no further check list evaluations need to be completed.

Faculty

Family medicine faculty will provide precepting of procedures as seen in resident continuity clinics. The faculty and preceptors are expected to allow the resident to participate in active patient care and procedures when appropriate. The preceptors should also provide time and allowance for explanation and teaching of common procedures including their indications, complications, and alternatives. The faculty member must complete a check list evaluation at the completion of each procedure until resident has been assigned a level of “Competent”. A minimum score of 80% is required to assign a level of “Competent”.

Call

There is no call specific to this educational experience.

Osteopathic Philosophy, Principals and Manipulative Treatment

• The Integration of Osteopathic Principles into the daily practice of family medicine.
• The appropriate application of OMM to patient management.

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 the health of infants, children and adolescents. This should include gathering patient and family information, synthesis, and partnering with patients and families for quality patient care.

Competencies

Residents are expected to:

• conduct a patient encounter that recognizes the primacy of patient needs and treats the patient as an appropriately equal health care partner making sure that they understand their health issues;
• document the patient care encounter in the medical record in a concise and legible manner following a problem-oriented format and using the SOAP notation;
• provide the patient with information in a format that will optimize patient understanding;
• communicate follow-up results to each patient in a timely manner;
• arrange for follow-up of the current problem that fits the guidelines of current standards of care and attends to the special needs of the patient, family or caregiver;
• demonstrate adherence to patient confidentiality standards.

Objectives

The resident will:

• Demonstrate competency (C) on a minimum of 80% of checklist items.
• Obtain informed consent from the patient prior to the procedure.
• Document the medical necessity for a procedure in the medical record.
• Communicate with the patient and the family about complications, post procedure care and results of laboratory or pathology and document in the medical record.
• Institute the process of time out prior to the procedure for proper identification of the patient, site and type of procedure to be done.

Medical Knowledge

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 lifelong learning.

Competencies

Residents are expected to:

• demonstrate an understanding of pertinent pathophysiology in making management decisions using literature and evidence based medicine to support your decisions;
• prioritize the probable and potential diagnoses ensuring that attention is given to the most likely, most serious and most readily treatable options;

Objectives

The resident will:

• Attend at least 75% of Wednesday afternoon didactics and procedure workshops.
• Review the AAFP online course/ Text book of primary care procedures for each of the core procedures.
• Maintain active certification in NRP, PALS, BLS and ACLS during the 3 years of the residency training.
• Achieve competency in core procedures as determined by the supervising physician.

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 lifelong learning.

Competencies

Residents are expected to:

• use the medical literature that is applicable to their patient’s care;
• perform an online medical information search;
• Participate in practice review (e.g., chart review, practice profiles, practice-based quality improvement activities.

Objectives

The resident will:

• Review his/her individual procedure log and performance quarterly with his/her advisor.
• Participate in peer review of charts and quality improvement projects during Wednesday afternoon didactics

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.

Competencies

Residents are expected to:

• complete the tasks of the patient care session so that all necessary duties (including telephone messages, charting, administrative tasks, patient care) are accomplished in a timely, organized, and professional manner.
• demonstrate involvement in the continuing care of their patients in the office, hospital and the patient’s home;
• make referrals and prescribe therapies focusing on the best possible patient care outcomes
• bill patients appropriately for services rendered, referring those who need financial assistance to appropriate business office personnel and community resources.
• participate in activities facilitating their choice of practice setting and their ability of implementing their career plans;
• accurately code for services rendered, maintaining compliance with federal and state agencies

Objectives

The resident will:

• Record a procedure note for all inpatient and outpatient procedures documenting the medical necessity/indication, informed consent, type of procedure and complications and the name of the faculty assisting with the procedure.
• Bill appropriately for each procedure performed.
• Utilize appropriate ICD9 and CPT coding as demonstrated by chart audits to be discussed during quarterly review with the resident’s faculty advisor.
• Document all procedures including patient’s age, gender, patient identifier, medical necessity and complications on the New-Innovations for evaluation by faculty.

Professionalism

Goal

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

Competencies

Residents are expected to:

• demonstrate the application of ethical and moral principles as they pertain to end of life issues, patient confidentiality, billing practices, and marketing of these practices.
• demonstrate respect, compassion, and integrity in all doctor-patient encounters and in interactions with staff and other members of the healthcare team.
• recognize special needs, cultural, age, and gender issues and adapt care to accommodate the differences.
• engage in continuing medical education activities that are influenced by interest, deficiency, and need.
• engage in activities that will foster personal and professional growth as a physician.
• utilize current, available technologies in the care of patients.

Objectives

The resident will:

• Seek out appropriate procedures during all rotations while maintaining a focus on patient needs and the needs of the rotations assigned.
• Participate in the patient care in a rural family medicine practice and hospital during the second year and attend all procedures including operating room, emergency room, inpatient and outpatient.
• Identify his/her procedural training needs based on his/her planned post graduate practice and obtain competency in these procedures. The resident can utilize the consultants and their elective time for accomplishment of this goal.

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.

Competencies

Residents are expected to:

• develop a trusting, professional relationship that allows them to inquire into and discuss sensitive issues that may impact on the execution of the negotiated management plan;
• collaborate with other professionals on the health care team, fostering mutual respect and facilitating the effective handling of patient care issues.

Objectives

The resident will:

• Communicate with the supervising physician regarding medical necessity for the procedure, complications and follow up results.
• Record all procedures on new innovations.
• Communicate with the patient and the family about complications, post procedure care and results of laboratory or pathology and document in the medical record.
• Document the medical necessity for a procedure in the medical record.

Teaching Methods

Clinical Teaching

Didactic conferences

Workshops

Assessment Method (Residents)

Procedure Evaluation Tool Check Off List

Formative Feedback (IEP quarterly meetings with advisors)

Global Assessment Tool through New Innovations

360 evaluations

Assessment Method (Program Evaluation)

Formative Feedback from Residents in the rotation

Global Assessment Tool through New Innovations

Evaluation at the end of the rotation by the preceptor

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed.

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Educational Resources:

Readings:

 

Videos:

 

Wet Prep

Web Resources: