SCHEDULING
The longitudinal chief's clinics will occur over the last year, as a weekly half day clinic or biweekly full day clinic. Sometimes there will be circumstances where there should be no clinic scheduled that week (e.g. resident vacation). The goal is a minimum of 36 clinics over the year. Each half day clinic will start with 1 new (2hr), and 1 follow-up (30-60 min) per clinic. This may be increased over time according to comfort level of the resident and staff. At the outset, there needs to be a clear policy in place for notification for rescheduling/cancelled clinics - e.g. who contacts resident; unanticipated absence (e.g. supervising faculty sees patients if resident is sick and patients cannot be rescheduled), policy for when supervisor is covering another service e.g. GRU. There also needs to be a clear plan in place regarding triage of referrals, and mechanism to followup investigations in a timely manner. Additional clinical support (e.g. nursing) will depend on availability at the individual sites. It is the responsibility of the resident and supervisor to schedule a volume of patients that is appropriate to the level of support available.
EXPECTATIONS FOR RESIDENTS
Residents will abide by the CPSO policy on postgraduate education: http://www.cpso.on.ca/policies/policies/default.aspx?ID=1846
The resident will do the proper documentation and billing per OHIP rules. The supervisor should ensure that the resident is taught this at the start of the rotation.
The resident will keep booking staff and supervisor fully informed about conflicting responsibilities or need for schedule changes, at the earliest possible convenience.
EXPECTATIONS FOR FACULTY
The supervisor must be on site and prepared to intervene as necessary during the clinic. They must follow the PGME policy on supervision and graded responsibility, and abide by the CPSO policy on postgraduate education. All new consults must be reviewed and seen. Follow-ups should be seen until the supervisor has an adequate sense of the resident's abilities. The supervisor may then use his/her judgment in deciding whether follow-ups need to be seen prior to leaving the clinic, reviewed verbally prior to leaving the clinic, or reviewed verbally at the end of the clinic after the patient has gone home (graded responsibility).
Supervisors should allow and facilitate graduated responsibility of the resident over the course of the year. The experience should not be a duplication of the ambulatory experience offered to PGY1-4 residents. There must be an educational dialogue every clinic, and teaching to facilitate attainment of rotation specific objectives, with a special focus on preparing the resident for independent practice.
Chief residents are not expected to supervise junior learners during this rotation, as there are other rotations in the program (GRU, Inpatient consults) where this is required and evaluated. If a patient has findings of particular learning value however, residents are encouraged to involve other housestaff if appropriate.
EVALUATION
Formal evaluation and feedback will occur every 6 months. Informal evaluation and feedback should occur every 3 months. At least 1 (preferably 2) clinical exam STACERs must be completed over the course of the year.