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 |
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 |
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 |
¥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.
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.
·
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.
·
·
·
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.
· 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.
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
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,
(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 |
|
Ludwin |
|
25-Aug |
wed |
Wang, Jing |
Halazun |
10-Sep |
fri |
Chan, Gallant |
|
|
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 |
|
|
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.