Ambulatory Block
Schedule and Orientation
1. Goals and Objectives
The main goal of the program is to teach residents the comprehensive and continuous care of a panel of patients in the ambulatory setting, focusing on the management of acute and chronic illnesses in a diverse patient population. Residents will learn to deliver high quality, updated, evidence-based medicine. Residents will learn to make rational, cost-effective, and patient centered clinical decisions for their patients. The care of the “whole patient” is emphasized, paying special attention to helping residents develop strong patient advocacy attitude and skills, and cultural awareness. Principles of health promotion and disease prevention and screening are also major components of the curriculum.
· Residents will be able to demonstrate the ability to provide compassionate, efficacious, and efficient, patient care to patients in the ambulatory setting
· Residents will demonstrate the ability to care for ambulatory patients with a broad range of acute and chronic medical conditions, and learn to become their patients care coordinator and advocate.
· Residents will demonstrate willingness to continuously improve and self assess their ambulatory knowledge base and clinical practice process.
· Residents will review the principles of epidemiology, pathophysiology, therapeutics, and prevention in the management a diverse set of illnesses. Residents will demonstrate the ability to retrieve and critically review and apply relevant medical literature to the care of their patients.
· Residents will demonstrate an understanding of individual and group quality improvement initiatives.
· Residents will be able to appropriately access the services of the multi-disciplinary team members for the care of their patients (including social workers, nurses, medical assistants, patient representatives, home visit nurses, physical therapist, nutritionist, interpreters, and others…). Residents will participate in home visits and clinic disease management committees.
· Residents will learn the practice of evidence based medicine enabling the them to make rational clinical decisions, individualized to the needs of their patients
· Residents will understand the approach to, and care of the “whole patient”. Residents will demonstrate at all times, ethical, humanistic, respectful, empathetic, culturally competent, and professional demeanors in all their interactions with patients, staff, and peers.
· Residents will learn indication/contraindication and techniques of office based procedures.
· Residents will be able to communicate effectively and efficiently on written medical records
· Residents will be familiar with the workings of an office practice, including important practice concepts of scheduling/billing/compliance/telephone medical triage.
This syllabus is also available on the medicineclinic.org website. Look in Orientation, under Ambulatory Block.
In order to standardize the residents’ exposure to the essential aspects of ambulatory medicine, each OPD blocks have been assigned specific subspecialty clinics and didactic conferences.
|
OPD Block |
Didactics |
Sub/Specialty Experience |
|
Jr. OPD 1* Residents |
Clinical Epidemiology II, OPD Wed MR, Friday Division of GM Conference, Hazelden Training (not every block), Chart Review, Berrie lectures, Monday Psychiatry intake |
Neurology, lipid, endocrine, rehab NB DM ctr, AIM DM cln, Derm, Rheum Chronic kidney Dz (CDK), home visits, cardiology, osteop (JF), rehab |
|
Jr. OPD 2 * Residents |
Harkness Report¥, Chart Review, Friday Division of GM Conference , Monday Psych intake |
Ortho, Pain Center, Osteop(ES), asthma Hematology, Oncology, thyroid, liver clinics |
|
Sr. OPD 1* |
OPD Wed MR, Division of GM Conference, AIM QI team activity, chart review, DM QA rounds, Monday Psych intake |
Derm Clinic/Rounds, Chest, allergy, ENT, GI, liver transplant, sleep clinic/lab, cardiology, Preop, AIM DM management, Renal/Lupus, Inpt Diabetes Service |
|
Sr. OPD 2* # Teaching Sr. |
Clinical Epi III, Harkness Report¥, Division of GM Conference, Sr PIC (PIC), TS Didactics, Monday Psych rounds, DM Rounds |
Ophthalmology, GU, AIM DM management clinic, NIFs lab, Rheum |
¥A schedule for resident presentation at Harkness is generated by the chiefs’ office and posted in the VC 205 conf. room
Evening clinics Evening clinics are scheduled for the Interns and Junior OPD 1 residents, it starts at 5pm and end by 7pm. Residents scheduled to work on walkin Thursday afternoons will not have evening pts.
Walk In Clinic (Walk-in)–Room 214 Please be in clinic promptly at start of clinic
Urgently ill AIM patients, who are unable to be seen by regular PCPs, will be seen in the Walk-in clinic. Residents will learn to provide thoughtfully focused and efficient evaluation of urgent ambulatory complaints. Residents may be scheduled for walk-in (W) clinics 1-2 times/week during OPD block.
Although the morning walk-in residents do not need to “clean up” the arrival box before noon conference, they should try to work quickly and see enough cases in the morning so the afternoon residents do not get overwhelmed. Residents should also be on the look out for pts who are using walk-in excessively for complaints or refills, and help them get back into care advancement. If there is no quick f/u appt for a pt who needs quick post walk-in follow up, consider using another clinic MD/Firm NP for interim “scheduled” follow up visit for coverage.
To ensure communication of the urgent visits, please always write electronic notes on walk-in, and provide copies of these notes back to the PMDs (this can be done by printing up an extra copy of the note and giving the notes to the VC 205 staff to place in the PMD’s mailboxes).
Pre-Op Clinic (Preop) Room AIM 240, Monday and Friday AM
Review your pre-procedure evaluation knowledge by reading the guidelines listed under Calculators section in www.medicineclinic.org. Again the style of practice in this clinic is usually quite focused and concise, and often for the majority of patients who are either well, or referred for very low risk procedures (like cataracts), the approach is quite straight forward and the H&P itself is the main elements for the “preop” eval.
Diabetes Management Clinic –Evelyn Thompson RN VC 2-220 (small conf. room)
Residents assigned to this clinic will work alongside Ms. Evelyn Thompson, our DM RN to advance care of uncontrolled DM pts followed in our clinic. A multidisciplinary Diabetes Rounds will occur biweekly, designated residents will be contacted to attend by Dr. Deb Jones/Alex Montero.
The Didactics- All conference located in VC 205 unless otherwise stated.
· Harkness Report a.k.a.”Blume Rounds” follows noon conference M-Fri Senior and Junior OPD 2 residents are scheduled to attend. Clinic for OPD 2 residents start at 2pm instead of 1pm. Residents scheduled for oncology, osteoporosis, neurology, are excused from Blume rounds. Residents are also excused when they attend Hazelden Training. A schedule for resident presentation at Harkness is generated by the chiefs’ office and posted monthly in the VC 205 conf. room.
· Junior and Senior OPD1 residents are expected at the Wednesday AM Outpatient Morning Report in room VC-205 at 8AM. Conference topics will be emailed to you. When not scheduled for OPD MR, all residents should attend Milstein MR.
· Division of General Medicine Conference takes place 8:00am Friday mornings in the Atchley-Loeb conference room on PH 8East. Topics will be emailed to you, breakfast will be served.
· Naomi Berrie Diabetes Center NBDC consists of both didactic and clinical teaching and is coordinated by Dr. Robin Goland at the NBD Center, at the Russ Berrie Building- at 1150 St. Nicholas Avenue, 2nd Floor 2nd Fl Classroom (Tuck Library) at 10AM Tuesday (the 1st day). Refer to more info below in subspecialty experiences. PLEASE SHOW UP ON-TIME!
· Hazelden Physician Addiction Medicine Training Center (Junior residents) At this downtown center, residents will hear lectures, interact with patients, and attend AA meetings. Training dates this year will be on 9/16/2008, 10/30/2008, 12/11/08, 3/5/09, 5/21/09. We will email you with registration packet 3 weeks before attending.
· Monday AM Psychiatry Intake rounds 8am VC2 –case discussions with Dr. Mark Petrini
Other OPD Activities
The Observed History and Physical (PGY I and II residents)
In the first 2 years of training, all residents will perform one complete history and physical exam on a new patient in the presence of an attending physician. For most residents this is completed during R1 year. Please speak to Dr. Mackey or Dr. Chang if you have not completed this.
Senior PIC (PIC PGY III):
As part of the Teaching Senior (OPD2) curriculum, under close observation by the PICs, residents will learn to hear intern evaluations, help come up with diagnostic and therapeutic plans, and learn basic concepts in ambulatory medical education. Please preview the “One Minute Preceptor” article on the Teaching Senior webpage on the medicineclinic.org website.
· QI/chart review-Using chart review tools, residents will use this opportunity to examine their own charting habits as it relates to quality of care and communication of care. It is also an opportunity to take a more systematic look at some process and outcome measures in the care of your patients with common chronic illnesses. Please page and meet Dr. Chang (80664) for a brief orientation when scheduled. Please after completing the DM work sheet xerox a copy for me and keep a copy for your self in your own binder in your firm.
· Team QI- an independent team activity for the OPD 1 seniors. Residents will work with Dr. Chang at the beginning of the block to identify a system based problem in clinic. Using the 4 weeks of the block, residents will work as a team to collect information on the composition of the problem, and proposed (and possibly even test) new solutions to the problem. For example, residents this past year have worked on projects of outpatient critical lab alerts, improving discharge process, medication reconciliation, telephone messaging, translator triaging, etc….
The Sub-Specialty and Specialty Experiences (schedule legend in parenthesis)
Residents are assigned to a variety of subspecialty sites to broaden their learning experience. At many, special arrangements have been made to provide this invaluable learning experience for you. You are expected to attend all of these assigned sessions. Each clinic or private office is informed by writing each month of your expected presence. We will do our best to notify you if a subspecialty clinic has been cancelled, however, given the sheer number of clinics involved, we ask that the residents call some irregularly scheduled clinics to ascertain the occurrence of the session prior to going there. These clinics include lipids, osteoporosis, and orthopedic private office sessions. Read below to check the location and timing of the clinic before attending.
Please review the FCME defined specialty competencies before attending the clinics. See explanation in curricular guide and medicineclinic.org website. Please feel free to contact Dr. Chang if you are interested in arranging a more extended experience at any of these sites during your OPD or elective blocks.
(Allergy) & Immunology: adult allergy VC-3 Thu PM Dr. Slankard. Fellow K Donohue
(Asthma): Harkness 9th fl rm936 305-0631, report to Dr. Miller or Dimango Tue and Thu pm
Cardiology (Cards) Clinic: AIM East, David Sherman - Monday and Friday PM, Tuesday AM
(Chest): VC 10th Fl, Monday PM, report to clinic attending.
(CKD): Chronic Kidney Disease -Dr. Leonard Stern -Tue PM is at Irving Pavilion 2nd fl, x5-0559 Tuesday Joanne Vernocchi is Dr. Stern’s assistant for more info
Diabetes Management Clinic (Diabetes): Residents assigned to this clinic will work alongside Ms. Evelyn Thompson, our DM RN to advance care of uncontrolled DM pts followed in our clinic. Please meet Ms. Thompson at VC 220 conference room. Individual residents will also be asked to join our Thursday 8AM Diabetes Multidisciplinary Management Rounds. (for Inpt Diabetes see below)
Dermatology (Derm): Clinic-Atchley 12th Fl., Dr. Engler 50705
Derm Rounds (Derm Rds) - Monday 8 AM, page 1799 in advance to check location for meeting with Dr. Grossman and team. Dr. Grossman enjoys working with the medical residents, and rounds are quite fun.
(Endocrine): Tuesday PM AIM East, Dr. Wardlaw, please report to attending in charge.
(ENT): VC 10th Fl. Report to attending in charge x 56100
Gastroenterology clinic (GI): AIM East, Thursday afternoon, Dr. Garcia-Carasquillo
(GU) Urology: Allen Pavilion, Room 3FE Rm.155, Dr. Goluboff 932-4309
Hematology (Heme): Tue PM, Fri AM Atchley Pav. “Garden” basement x5-1983. Dr. Diuguid/Flamm
(Home Visits) with the Home Bound Elderly Program: Tue afternoon 1pm when scheduled, please page Dr. Deb Jones b 81939 that morning to confirm meeting place.
Inpatient Diabetes (Inpt DM): *new* Tuesday all day with Dr. Susana Ebner 5-4633, meet team at 9am at 5GN Room 407 x 342-0158. Spend day with diabetologist and diabetes educators. (a 2 week-1month elective is also available for interested residents)
(Lipid) Clinic: Harkness 956 tel #57666 (Mon am-Ginsberg 7-12pm, Thu am-Goldberg). Clinics are not regularly scheduled, and may be cancelled if the schedule is not full please call a few days in advance to verify time.
(Liver): AIM East, Wed AM Dr. Garcia/Dove bp 81542
Liver Transplant (Liver Txp): Wed PM, PH 14 Transpl .Ctr., Attendance will be checked by Dr. Brown.
Lupus Clinic (Lupus): Monday AM AIM East, now combined with Renal. Dr. Wiesendanger, please read “must read” Rheum articles from “ambulatory reading list” on website.
Naomi Berrie Diabetes Center (NBDC): Director Dr. Goland (contact Mr. Steven Bennet 851- 5494). The 1st day of training is focused on didactics, meet 10am Tue in the Tuck Library, 2nd Fl NBDM bldg (elevator in the back). This day is then followed by 2 separate activities spread over the rest of the OPD block. The first is an individualized session, occuring each Wed afternoon where one resident is rotated to spend time in the Berrie Center clinical unit, shadowing patient care with either Dr. Caspar the Diabetic Ophthalmologist, or with one of the Diabetes specialist. The second activity occurs as a group session on one Friday afternoon, where the group will observe an insulin pump teaching class. Refer to your OPD block schedule for dates of assignments.
Neurology (Neuro): VC 10th Fl, Dr. Peter Kim , bp 88056 Thursday PM
Non-invasive Flow Study (NIFS) : Wed and Thu AM, lab is in Milstein 2nd floor 2-031. Dr. Salameh and Crimmins. Learn how to read and do carotid/renal/leg dopplers and NIFS. Show up at 9:30am
Oncology (Onc): Monday 1PM Atchley Pav.“Garden” Basement -Report to Dr. Flamm x 43044
Wed 1 PM Breast clinic Atchley 10th fl (Dr. Hershman)
Ophthalmology (Ophtho): Flanzer Eye Center 635 W. 165th St., Please be in clinic on-time at 1pm. Report to the ophtho chief resident. (DO NOT attend Harkness Report the day of clinic)
Orthopedic Clinic These are private offices, and occasionally the attendings may be away. Please call the
Offices to verify the timing of the office hours before attending.
Hand /Sports (Hand)- Dr. Rossenwasser Monday AM Atchley 2nd fl. X58036
Shouder/Sports (Sports) Dr. Levine Wednesdy all day, Atchley 245 X50762
(Osteop)orosis Clinic (Dr. Jessica Fleischer and Dr. Ethel Siris):
· Osteop JF- (OPD 1 Jr) Monday afternoon, Harkness 9th Fl, Dr. Jessica Fleischer x 52529
· Osteop ES- (OPD 2 Jr) Wed afternoon Harkness 9th Fl., Dr. Siris, X 52529 Please show up on time, by request of Dr. Siris. Do not attend Blume Rounds on that day. Clinic starts at 12:30pm. Clinic may be cancelled when Dr. Siris is away, please call to verify session existence, timing, and location before attending.
(Pain) Management: PH 5, Rm 500 Dr. Weinberger, PLEASE BE ON TIME, 9am and 1pm 57114
Rehab Clinic: Monday PM, VC3 Director Dr. Kevin Sperber X52274. Introduce yourself to the attending of the day.
(Renal): AIM East, Monday AM, report to attending of the day. Also combined with lupus now.
(Rheum)atology/Arthritis: AIM East, Tue AM Wednesday PM, Report to Dr. Dwyer/Nickerson/Blume
please read “must read” rheum articles from “ambulatory reading list” on website.
Sleep Disorder (slp lab/cln): Dr. R Basner 304-7166 Sleep Clinic now located at 154 Haven Ave Room 406 (173rd St and Haven). Readings of study starts at 7:30 am, but you can join in on the read at 8am
(Thyroid): Friday PM, Atchley Basement “Garden” level x 50983, Dr. McConnell combined surgery/endocrine clinic in Atchley Pavilion
AIM Housestaff Practice On-Call Schedule
The objective of resident telephone coverage is to provide physician availability to our patients (preventing unnecessary and expediting necessary ER visits), and to provide hands-on experience and training for residents in “telephone medicine”. AIM residents’ patients who call the clinic after office hours with urgent complaints will first speak to our answering service. The service then will page the first on-call resident to HCI’s MD access line 517-1111/1114//1101. The second call resident will only be paged, if the first call resident fails to answer his/her beeper after 30 minutes. On-call residents do not cover phone calls for AIM attendings, fellows, NPs, or non-AIM physicians.
The Resident acct # is 391 (after dialing the access number, you will be prompted to provide your mail box number, please do not give these numbers out to patients). A Webcis Telephone Note should be completed for all calls. Please make sure to always enclose a copy of this note to the PMD’s mail boxes. You should also email or page the PMDs for more urgent messages. If you have any questions regarding how to respond to the phone call, please contact for the overnight AIM Attending-On-Call at the same number (accct 390) for more guidance.
On your assigned date, please make sure your beeper is kept with you, and NOT signed out for the night. If preferred, you can notify the answering service to call you on your cell or home phone instead. Please also inform the answering service supervisors, in advance of any switches. Swaps of phone call coverage must be communicated to the Answering Services. ("Attn HCI Supervisor"- email coverage@hlink.com or call 517-1111 re: acct 391)
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|
|
1st call |
2nd call |
|
|
1st call |
2nd call |
|
26-Sep |
Fri |
Cluzet |
Paulin |
13-Oct |
Mon |
Hisert |
Paulin |
|
27-Sep |
Sat |
Quagliarello |
Cluzet |
14-Oct |
Tue |
Balzora |
Hisert |
|
28-Sep |
Sun |
Carty |
Quagliarello |
15-Oct |
Wed |
Ramnauth |
Balzora |
|
29-Sep |
Mon |
Sears |
Carty |
16-Oct |
Thu |
Lee, M |
Ramnauth |
|
30-Sep |
Tue |
Singer |
Sears |
17-Oct |
Fri |
Peacock |
Lee, M |
|
1-Oct |
Wed |
Powell |
Singer |
18-Oct |
Sat |
Aldaia |
Peacock |
|
2-Oct |
Thu |
Pistenmaa-Aaron |
Powell |
19-Oct |
Sun |
Hisert |
Aldaia |
|
3-Oct |
Fri |
Peacock |
Pistenmaa-Aaron |
20-Oct |
Mon |
Lim, E |
Hisert |
|
4-Oct |
Sat |
Lee, M |
Peacock |
21-Oct |
Tue |
Cluzet |
Lim, E |
|
5-Oct |
Sun |
Lim, Emerson |
Lee, M |
22-Oct |
Wed |
Carty |
Cluzet |
|
6-Oct |
Mon |
Sears |
Lim, Emerson |
23-Oct |
Thu |
Lamothe |
Carty |
|
7-Oct |
Tue |
Singer |
Sears |
24-Oct |
Fri |
Kumar, S |
Lamothe |
|
8-Oct |
Wed |
Powell |
Singer |
25-Oct |
Sat |
Ramnauth |
Kumar, S |
|
9-Oct |
Thu |
Pistenmaa-Aaron |
Powell |
26-Oct |
Sun |
Balzora |
Ramnauth |
|
10-Oct |
Fri |
Kumar, S |
Pistenmaa-Aaron |
27-Oct |
Mon |
Aldaia |
Balzora |
|
11-Oct |
Sat |
Lamothe |
Kumar, S |
28-Oct |
Tue |
Paulin |
Aldaia |
|
12-Oct |
Sun |
Paulin |
Lamothe |
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*week day phone coverage start at 5pm and ends 9am the next day; weekend shift start at 8am, and ends 8am the next day.