General Information
Current trends in medicine point toward shorter and fewer hospitalizations for patients and greater emphasis on outpatient care and care management services. The goal of the Clinic Block Rotation is to give first year residents early exposure to their continuity clinic's services, functions and personnel. This will help R1s build a strong foundation for a successful three-year outpatient continuity clinic experience.
The R1 clinic block will be scheduled during blocks 2-4 of the academic year and will usually consist of:
a) Six to eight half days of clinic each week
b) One to two half days of care coordination and clinic specific activities per week
c) Thursday afternoon half days in small group workshops for R1s and R2s related to the continuity clinic experience (NOTE: Some residents will be blocked out of other rotations in order to attend these workshops.)
d) Tuesday afternoons will be protected for meetings, balint, and didactics
e) One half-day of shadowing an attending or senior resident, see below for additional details
R1s will see 3 patients per half day for the first two weeks during clinic block. They may then may increase up to 4 patients per half day. R1s should be seeing 5 patients per half day by the end of R1 year.
This rotation is vacationable
Orientation and Supervision
The Clinic Block Rotation will be introduced briefly during R1 Orientation by the faculty chair. At the beginning of each R1's Clinic Block the resident will meet with their clinic chief resident, a faculty preceptor or their advisor at their continuity clinic for a more detailed orientation of the block activities. During the clinic block, first year residents will schedule time with staff members and learn about their jobs and responsibilities. Either the clinic chief resident or the preceptor of the day will act as a day-to-day point person if any questions or problems arise during the block.
First year residents will precept all of their patients with the preceptor before the patient leaves the clinic. All patients need to be seen for the first 6 months of residency, ending January 1.
Clinic hours:
Swedish Family Medicine First Hill - 9:00AM to 5:00PM M-F
Downtown Family Medicine - 9:00AM to 5:00PM M-F, 8:30am start on Tuesday
Swedish Family Medicine Ballard - 9:00AM to 5:00PM M-F, 8:30am start on Tuesday
*Clinic specific activities occur at the residents' continuity clinic site unless they are scheduled to shadow one of the faculty or senior residents at another site.
**During the Clinic Block there will be up to eight total half days devoted to the activities listed below. It will be up to the resident to make sure that these activities are completed.
1) Getting to know the clinic staff, clinic systems and learning laboratory skills
2) Care coordination with a focus on preventive care and chronic disease management as well as routine telephone, email and mail follow up with panel patients
3) Faculty shadowing - Once per block, residents should schedule to shadow a faculty member. This should replace a care coordination day. If unable to schedule with a faculty provider, a senior resident at any of the three clinic sites. If the R1 desires to shadow a specific faculty or senior resident, they should notify the clinic chief and admin scheduler. Schedules allowing, these requests will be accommodated. Focus should be on personal goals of improving clinic flow and efficiency, use of EHR, working with support staff, use of referral resources, etc.
Rotation Goals:
Gain competency in the diagnosis & treatment of common outpatient acute & chronic illness.Gain competency in the provision of health care maintenance including immunizations and screenings.Learn to effectively counsel patients.Understand when to appropriately refer patients to specialty care.Develop proper use of the electronic medical record, including timely completion of documentation, orders, and inbox management.
Rotation Objectives:
Patient Care Gathers essential information about the patient (history, exam, diagnostic testing, psychosocial context)Accurately documents a clinical encounter on a patient with a chronic condition, and generates a problem list Recognizes role of clinical protocols and guidelines in acute situations Consistently recognizes common situations that require urgent or emergent medical care Generates appropriate differential diagnoses Develops appropriate diagnostic and therapeutic management plans Demonstrates awareness of recommendations for health maintenance and screening guidelines developed by various organizations Incorporates disease prevention and health promotion into practice Identifies procedures that family physicians perform
Medical Knowledge Demonstrates the capacity to improve medical knowledge through targeted study Demonstrates capacity to assess and act on personal learning needs Demonstrates the capacity to correctly interpret basic clinical tests and images Begins to integrate social and behavioral sciences with biomedical knowledge in patient care
Systems Based Practice Understands that health care resources and costs impact patients and the health care system Understands that effective team-based care plays a role in patient safety Recognizes social context and environment, and how a community’s public policy decisions affect individual and community health Understands that quality patient care requires coordination and teamwork, and participates as a respectful and effective team member
Practice-based Learning & Improvement Acknowledges gaps in personal knowledge and expertise and frequently asks for feedback Uses feedback to improve learning and performance
Professionalism Demonstrates honesty, integrity, and respect to patients and team members Documents and reports clinical and administrative information truthfully Consistently recognizes limits of knowledge and asks for assistance Consistently demonstrates compassion, respect, and empathy Demonstrates awareness of the importance of maintenance of emotional, physical, and mental health Accepts constructive feedback
Communication Creates a non-judgmental, safe environment to actively engage patients and families to share information and their perspectives Identifies physical, cultural, psychological, and social barriers to communication Uses the medical interview to establish rapport and facilitate patient-centered information exchange Organizes information to be shared with patients and families Ensures that clinical and administrative documentation is timely, complete, and accurate Maintains key patient specific databases, such as problem lists, medications, health maintenance, chronic disease registries
Reviewed and Updated: June, 2018, John Stevens
Effective: 6/25/2018-6/24/2019