FP (R1)

Curriculum Description – The Family Medicine outpatient experience is an introduction to common clinical experiences which include the wide range of clinical encounters – including, but not limited to preventive medicine, pediatric, adult and elderly care. The Family Medicine Outpatient clinic is the primary site for residents to attain experience and practice clinical application of their medical knowledge as a primary care provider for a broad range of medical issues.

Curriculum Goals:

The ACGME has outlined six core competencies for all residents in training. The primary goal of the Family Medicine outpatient clinic experience is for residents to develop the following 6 competencies in the context of daily practice and performance in a busy primary care clinic setting.

1. Patient care that is compassionate, appropriate, and effective for the treatment of health

programs and the promotion of health.

2. Medical Knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patience care.

3. Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care.

4. Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals.

5. Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds.

6. Systems-based practice, as manifested by actions that 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.

Rotations

PGY-1 Family Medicine Outpatient clinic- – 1 month during PGY-1 year in the Family Medicine Center.

PGY-3- Family Medicine Outpatient clinic - 1 month spent during PGY-3 to increase efficiency and practice leadership roles by working with team as well as mentoring junior residents and staff members with common clinic operations or clinical cases.

Other Learning Activities

Didactics – A longitudinal curriculum of lectures

Family Medicine Center – Daily learning with precepted cases.

Meeting with coders at beginning and end of rotation.

Familiarity with current guidelines for routine wellness exams.

AAFP board review

PGY-3: completion of required MOC Modules

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ACGME Program Requirements:

www.acgme.org – from the Family Medicine RRC requirements

Administrative Information:

Last review: Nov 2018

Family Medicine Outpatient Coordinator: Dr. Moses Cheng

Length of rotation: 1 month

Number of months to be completed: PGY1 – 1 month; PGY3-1 month

Maximal time away allowed from rotation: 1 week

Number of half days in FM clinic: PGY1 - 6 and PGY3 – 8 (may add procedure clinics if open)

Preferred clinic times: M, T, F AM/PM

A.M. Report attendance required: Yes

Thursday afternoon conference attendance required: Yes

FM called required: Yes

Responsible for hospitalized FM panel patients: Yes; a supplementary note must be completed

Responsible for OB panel patients: Yes

Selected Rotation Specific Objectives by ACGME Competency Category:

The following is a listing of selected knowledge, skills and attitudes (K.S.A.s) that residents are expected to gain competency in during their rotation in Family Medicine outpatient clinic. It is understood that not all the K.S.A.s will be attained on a single rotation, but they will be developed and attained throughout the 3 years of residency; specific K.S.A.s that are not developed on the Family Medicine outpatient clinic rotation will be developed during the other rotational experiences, or longitudinally in didactic presentations and team meetings.

The rotation specific objectives will be reviewed with each resident prior to the beginning of the rotation in order to clarify which objectives the resident is trying to attain. The resident have ready access to either a print or online version of the curriculum, and use it as a reference point for areas to focus on during the rotation. At the end of the rotation, the rotation specific objectives will be reviewed with their advisor, and those attained will be checked. This review will be kept in the resident’s file, in order to document the resident’s progress.

Rotation-Specific Objectives for Family Medicine Outpatient Rotation

Patient Care:

Gather essential and accurate information about their patients:

PGY-1

__­_­Demonstrate competence in thorough and accurate documentation of all patient encounters, including (but not limited to) EFMP applications, DMV placard forms, Overseas Screening, and separation/retirement/school physicals, well woman exams, well infant exams, acute appointments.

___Demonstrate competence in generating appropriate and timely consultation requests.

___Complete mandatory HIPAA training.

PGY-3 Must demonstrate competence to independently:

___Acquire relevant and accurate history from patients and families in an efficient and concise manner.

___Diagnose, manage, integrate, and coordinate care of patients of all ages.

___Use multiple information sources to develop a patient care plan based on current medical evidence.

___Treat medical conditions commonly managed by family physicians and provide preventive care.

___Recognize and provide initial management of emergency medical problems; and, use of pharmacotherapy.

___Perform medical, diagnostic, and surgical procedures commonly performed in the practice of family medicine.

___Mentor students, residents (through supervision), and other team members.

Medical Knowledge

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.

The resident should gain understanding of pathophysiology, presentation, initial evaluation, outpatient management and appropriate follow-up of patients who have the following included (but not limited to) conditions:

PGY-1 and PGY-3

___Preventive annual exams, periodic screening exams (infant, child, adult, elderly), familiarity with USPTF guidelines, routine prenatal care, Management of chronic diseases such as diabetes, hypertension, hyperlipidemia, pain syndromes.

___Display knowledge of office standard operating procedures (SOP’s).

PGY-3

___Understand the indications for common diagnostic studies including lab, imaging, and cardiopulmonary studies and use of other advanced studies.

Practice-Based Learning and Improvement

Use information technology and on-line medical information to support education:

PGY-1 and PGY-3

___Gain familiarity and be proficient with electronic medical record

___Utilize hospital’s evidence-based medicine resources (Up To Date; FPIN; Ovid; Medical Letter; Prescribers Letter; Other resources on Clinical Portal) to obtain current information on patient management.

___Demonstrate in ability to perform evaluation and management of common conditions.

___Demonstrate appropriateness in ordering consults, lab and radiology studies, and medications.

Analyze practice experience and perform practice-based improvements:

PGY-1 and PGY-3

___ Demonstrate good time management skills to increase efficiency in patient care.

___ Utilize hospital coding experts to analyze personal and departmental patterns.

___ Improve HEDIS measures for panel patients.

___Identify areas in own practice or local system that can be changed to improve the processes and outcomes of care.

Interpersonal and Communication Skills

Work effectively with others as a member or leader of a health care team or other professional group

PGY-1 and PGY-3

___ Communicate effectively with physicians, other health professionals, and health related agencies.

___ Demonstrate competence in working with clinic care team members.

___ Interactions with other physicians and health care professionals will be collaborative with the patients’ interests held foremost.

___ 360° Evaluations will be completed during each academic year for all residents and interns.

Provide information using effective nonverbal, explanatory, questioning and writing skills

PGY-1 and PGY-3

___ Demonstrate skills for complete, concise and relevant patient presentations to staff attendings and consultants.

___ Complete notes on all patients in a timely manner.   

Professionalism

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

PGY-1 and PGY-3

___ Residents will be on-time to all work-related events, will complete all administrative work within hospital/departmental policies and will present themselves with and appropriate/professional appearance/demeanor at all times.

___Demonstrate compassion, integrity, and respect for others.

___Demonstrate sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in age, gender, culture, race, religion, disabilities, and sexual orientation.

Systems-Based Practice

Demonstrate an awareness of and responsiveness to the larger context and system of health care.

PGY-1 and PGY-3

___ Residents will gain an understanding of the larger context of outpatient care within the existing military and civilian healthcare organizations within the region.  This will be accomplished via discussions with faculty, direct consultation with medical services at other centers and facilitation of transfers of care when appropriate to other centers.

­­­___ Incorporate considerations of cost awareness and risk-benefit analysis in patient and/or population-based care as appropriate by utilizing and applying EBM principles and utilizing EBM databases.

___ Chain of Command in military health care facilities.

___ Demonstrate proficiency utilizing AHLTA (electronic medical record).

Specific Expectations of Residents:

PGY-1 and PGY-3

1. Record all procedures in New Innovations in a timely manner and assign a supervising physician.

2. Complete rotational evaluation on New Innovations within 2 weeks of completion of rotation.

3. Complete curriculum review within 2 weeks of completing the rotation with resident advisor; denote on the curriculum areas where competency was attained.

4. Required attendance at:

a.  Morning report;

b. Academic conferences.

5. Routine call responsibilities.

6. Coverage on OB panel patients and deliveries.

7. Family Medicine Clinic as scheduled.

Evaluation: 

Resident Evaluation:

Daily evaluation

The Family Medicine Rotation Coordinator should provide oral feedback to the residents on progress and performance. Attendings will also provide feedback on the quality of written communication by critically reviewing resident chart entries.

Mid-rotation feedback:

With Family Medicine Rotation Coordinator at completion of week 2. Resident must ensure time is scheduled with staff.  Written feedback required if resident is failing at mid-rotation evaluation or at any other time.

Final Evaluation

The Family Medicine Rotation Coordinator should be sent an evaluation by the resident via New Innovations.  Evaluations should be completed within two weeks after rotation.

Methods of Evaluation:

Portfolio:

The following items will be entered in the residents training record by the GME coordinator:

-Procedures documented in New Innovations

-Resident New Innovation evaluation

-Rotation specific objectives completed (see check- list)

Staff Evaluation: (the staff is evaluated by the resident)

-Residents evaluate staff using the annual New Innovations staff evaluation

Rotation Evaluation: (the rotation is evaluated)

-Resident assesses quality of the rotation by completing the New Innovations standard rotation evaluation form. Evaluations should be completed within two weeks after rotation.

Recommend reading list:

It is expected that residents will read, at a minimum, Up To Date articles on the conditions of the patients they are following. In addition, they should complete all readings regarding routine wellness physicals which are available online as well as in hard copy in the Family Medicine Binders provided at the beginning of the rotation.

References:

1. Program Requirements for Graduate Medical Education in Family Medicine; approved: September 2013; effective: July 2014.