Ambulatory Block

Schedule and Orientation

 
August 23rd, 2010 OPD Block 3
PGY II and III Residents

 

 

 

 

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.

 

Rotation specific objectives:

·         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

Neurology, lipid, endocrine,

NB DM ctr, AIM DM cln, Derm, home visits,

Jr. OPD 2 *

Residents

Blume Rounds¥, Chart Review,  Friday Division of GM Conference , Monday 8AM Psych intake

Pain Center,  Osteoporosis,   asthma, rheum

Hematology, Oncology, thyroid

Sr. OPD 1*

OPD Wed MR, Division of GM Conference, AIM QI team activity, chart review, DM QA rounds, Monday Psych intake

Derm Rounds, Chest,  ENT, GI, cardiology, Preop, AIM DM management, Inpt Diabetes Service

Sr. OPD 2* #

Teaching Sr.

Clinical Epi III, Blume Rounds¥, Division of GM Conference, Sr PIC (PIC),  TS Didactics, Monday Psych rounds, DM Rounds

Ophthalmology,  AIM DM management clinic, NIFs lab, Rehab

*Residents should attend Milstein MR on days not expected at 8am OPD conferences.

¥A schedule for resident presentation at Harkness is generated by the chiefs’ office and posted monthly in the VC 205 conf. room

Evening clinics Evening clinics are scheduled for Junior OPD 1 residents, it starts at 5pm and end by 7pm.  Residents scheduled to work on walkin (W*) Thursday afternoons will not have even. clinic.

 

Subspecialty and Specialty Experiences (see schedule legend explanations, next page)

Residents will be scheduled to attend 2-4 subspecialty clinics per week.  It is a precious opportunity to broaden your ambulatory knowledge outside of primary care. Over the course of 3 yrs, we will provide a standardize exposure for all residents to over 30 specialty and subspecialty experience on and off campus. To enhance your own learning, please review the specialty specific FCIM curricular guide (on clinic website, look under orientation, ambulatory block, and “Specialty and Sub-specialty experience”) to help you develop some concrete learning goals during the sessions.

 

Walk In Clinic (Walk-in)–Room 214 Please be in clinic promptly at 9am or 1pm

Urgently ill AIM patients, who are unable to be seen by regular MDs, will be seen here.  Residents will learn to provide thoughtfully focused and efficient evaluations of urgent ambulatory complaints.  Given the busy clinic, here you have to focus learning triage and quick management skills and decision making than providing comprehensive care.  Although the 2 AM walk-in residents do not need to “clear out” the arrival box before noon conference, they should work quickly and see enough cases in the morning so the PM 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 regular care. Please always double check the last clinic appt date as well as the PMD’s last note content to ensure accuracy of meds and f/u. If there is no quick f/u appt for a pt who needs quick post walk-in follow up, consider using another clinic MD/NP for an interim SCHEDULED follow up visit for coverage.

To ensure communication of the urgent visits, consider sending your notes as SHM in Eclipsys to the PCP.

 

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.  Cases will be presented to the PIC at the end of the session

 

 

 

 

 

The Didactics- All conference located in VC 205 unless otherwise stated.

·         Clinical Epidemiology II and III lecture series with Dr. Palmas will meet in VC 205. It starts at 2pm on Friday.

·         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 rounds 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.  On the weekdays when you are not scheduled for OPD MR, all residents should attend Milstein MR.

·         Division of General Medicine Conference 8:00am Friday mornings in the Atchley-Loeb conference room on PH 8East.   This conference is on summer break and will resume in Sep.

·         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 c.enter, residents will hear lectures, interact with patients, and attend AA meetings.  We will email you with registration packet 3 weeks before attending.  Hazelden is only offered 4 times a year.

·         Monday AM Psychiatry Intake rounds 8am VC2 –case discussions learning with Dr. Mark Petrini, our new AIM teaching psychiatrist. (all OPD residents should attend, except Junior OPD night residents)

 

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. 

 

Senior Teaching Senior- PIC, Physical Diagnosis, Teaching Senior Rounds (OPD 2 PGY III):

In the teaching senior curriculum on OPD 2, resdents will be given time to prepare and teaching afternoon Chief Conferences for the inpatient night residents. Residents will also co-precept interns with clinic attendings. In addition this month, residents will have the opportunity to participate in 2nd year med student teaching in the Physical Diagnosis with Dr. Gowda. For precepting, please read the “Shaping the Teaching Conversation” article on the Teaching Senior webpage on the medicineclinic.org website.

 

Quality Improvement/Clinic Chart Review  (Chart) http://www.medicineclinic.org/charting.html

·   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 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. OPD 1 Juniors scheduled for the formal chart review session, please page and meet Dr. Chang (80664) in VC 205. 

 

·   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

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.   

 

(Asthma): now moved to PH 8 Center- tel 5-0631, report to Dr. Miller or Dimango Wed/ 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.

 

Diabetes Management Clinic (AIM DM):  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. 

 

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 welcomes medical residents to participate in discussions on rounds.

 

(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

 

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 or email Dr. Margrit Wiesendanger before the session to confirm meeting place.

 

Inpatient Diabetes (Inpt DM):   with Dr. Susana Ebner 5-4633, meet team at 9am at 5GN Room 407 x 342-0158. Spend the morning 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., Dr. Brown helps checks attendance.

 

Lupus Clinic (Rheum): Monday AM AIM East, please read   “must read” Rheum articles from “ambulatory reading list” on website.

 

Naomi Berrie Diabetes Center (NBDC): Director Dr. Goland and Golden (contact Ms. Camacho 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, occurring 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. Starts 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)

    (OncCnf 5garden)Oncology Conference: Tue 8am-9am, residents are welcomed to join the conf.

             

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 Clinic: Dr. Weinberger 9am and 1pm x5-7114, The clinic sees patients both in Herbert Irving Pavilion-Garden, and PH Room 5th floor Room 500. Please call ahead to find out where they will be that day.

 

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 Rheum 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 PH8 Room 859. The phone #s are 212-304-7166 and 212-305-7591 for the lab itself. Dr. Basner said to be there from 7:30 to 9:00, which is  when he reads the studies.  There is clinic after the reading.

 

(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 objectives of telephone coverage are to provide after-hours phone consultation to our patients (preventing unnecessary and expediting necessary ER visits), and to provide hands-on experience for residents in “telephone medicine”.  AIM patients who call the clinic after office hours with urgent complaints will first speak to our answering service.  The service will first page the first on-call resident to The HCI’s Physician Access Line 212- 517-1111 or 1114. The Resident acct # is 391 (you will be prompted to provide this acct # to the operator).   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, NPs, or ACN clinic residents, so if you come across misdirected calls, make sure to redirect them to the main AIM acct #390.

 

A Webcis or Eclipsys Telephone Note should be completed for all calls.  You can use SHM to FORWARD a copy to the PMD so they are aware.. If you have any questions regarding how to respond to a particular pt call, ask HCI to page the AIM Attending-on-call that day (or me) to provide 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 517-1114  re: acct 391)

 

 

 

1st call

2nd call

 

 

1st call

2nd call

23-Aug

mon

Fox

Wahab

8-Sep

wed

Ludwin

Shen

24-Aug

tue

Halazun

Fox

9-Sep

thu

Richmond, L

Ludwin

25-Aug

wed

Wang, Jing

Halazun

10-Sep

fri

Chan, Gallant

Richmond, L

26-Aug

thu

Camacho

Wang, Jing

11-Sep

sat

Narula

Chan, G

27-Aug

fri

Leaf

Camacho

12-Sep

sun

Leaf

Narula

28-Aug

sat

Shen

Leaf

13-Sep

mon

Scherer

Leaf

29-Aug

sun

Wahab

Shen

14-Sep

tue

Wahab

Scherer

30-Aug

mon

Fox

Wahab

15-Sep

wed

Richmond, Lisa

Wahab

31-Aug

tue

Halazun

Fox

16-Sep

thu

Leaf

Richmond, L

1-Sep

wed

Wang, Jing

Halazun

17-Sep

Fri

Ludwin

Leaf

2-Sep

thu

Narula

Wang, Jing

18-Sep

sat

Camacho

Ludwin

3-Sep

fri

Scherer

Narula

19-Sep

sun

Scherer

Camacho

4-Sep

sat

Metcalf

Scherer

20-Sep

mon

Shen

Scherer

5-Sep

sun

Chan, G

Metcalf

21-Sep

tue

Narula

Shen

6-Sep

mon

Ludwin

Chan, Gallant

22-Sep

wed

Camacho

Narula

7-Sep

tue

Shen

Ludwin

23-Sep

thu

Wahab

Camacho

*week day phone coverage start at 5pm and ends 9am the  next day; Saturday/Sunday/Holiday shift start at 8am, and ends 8am the next day.

* Please do not give the HCI physician access number out to patients, this is a MD only line.