Clinic Overview

General Information

In the R1 and again in the R2 year, each resident will spend one four week block doing five half days of clinic at their outpatient continuity clinic. The other five half days will be spent in individual and small group activities and case conference discussions related to the continuity clinic experience.  During the R3 year, each resident will spend a number of two to three week blocks working seven half days of clinic in their continuity clinics. They will be seeing up to three to four patients per hour and will have one to two half days scheduled administrative time for patient follow-up, consultation, reading, research, and preparation for teaching R2’s and R1’s during didactics and case conferences.

Orientation and Supervision

The Clinic Month Rotation will be introduced briefly during the R1 Orientation at each continuity clinic site. At the beginning of each R1’s Clinic Month the resident will meet with the Clinic Chief or a faculty preceptor at their continuity clinic site for a more detailed orientation of the block activities. This orientation will include familiarizing the resident with the clinic staff with whom they will meet to accomplish the goals of the block. Either the Clinic Chief or the preceptor of the day will act as a day-to-day point person if any questions or problems arise. The resident’s advisor will be responsible for reviewing the block activities with the resident at their quarterly review using the Clinic Month Checklist.

Content Areas

Behavioral Sciences (clinic and individual activity – all three years)

Behavioral Science skills are an integral part of successful family practice and are taught throughout the three years of residency. During their Clinic blocks, each resident will have the opportunity to have one of the behavioral science faculty shadow them during at least one of their patient encounters, or videotape a patient encounter, and review the visit or videotape with the behavioral science faculty. This review session will address basic interviewing techniques and styles of interaction including both verbal and non-verbal communication with patients. Also addressed will be issues related to managing difficulty patients, making mental illness diagnoses, making mental health referrals and accessing other resources including co-counseling visits with the behavioral science faculty.

Each resident will also develop competency in:

• Phlebotomy

• Subcutaneous and IM administration of medications

• PPD testing

• IM immunizations

In addition, each resident will develop competency in obtaining samples and completing paper work for lab requisitions (and for obtaining the subsequent lab results) including STAT labs, order in advance and standing orders for:

• PAP and other pathology tests

• Cultures

• Urine tests

• Blood tests

Pharmacy (individual activity – first year)

During their Clinic Month, each resident will spend time at DFM Clinic’s on-site pharmacies. They will learn about the role of the on-site pharmacies, formularies for various health insurance plans including Medicaid, and procedures for procuring medications for under and uninsured patients.

Computers (clinic and individual activity – all three years)

Computers play an increasingly important role in medical data management. During the Clinic blocks residents will learn to master:

• Internet resources including doing literature searches via the University of Washington links and Swedish intranet links

• Computerized medical records (except at DFM)

Patient Education (clinic and small group activity – all three years)

Patient education is an essential part of every patient encounter and includes such issues as teaching patients how to care for themselves while ill, how to take their medications, and how to prevent illness and injury. During their Clinic blocks residents will become familiar with and be able to access and utilize written patient information, including patient handouts in the exam rooms, in clinic files, in residency developed computer folders and on the Internet.

R2 Specific Activities (clinic and individual activities)

During their R2 Clinic Month residents will build on the skills above as well as additional procedural skills. There will also be a greater emphasis during the R2 year on the community context of care. These skills and activities will include:

• X-ray techniques

• OB ultrasound

• NST’s

• Home visits

• Nursing home care

• Public health nursing

• Maternity support services

• Shelter care

• 45^th St. Youth Clinic

Clinic Month Schedules

The Clinic Months for R1’s and R2’s will be scheduled during the first seven blocks of each academic year. Three or four residents will be scheduled during the same block and will all meet together for Thursday Workshops and Monday Case Conferences.  The Clinic blocks for R3’s will be scheduled throughout the year.  R3’s do not have Thursday Workshops but do participate in Monday Case Conferences on a volunteer basis and act as teachers and consultants at these conferences.

(R3) – A third year resident may be scheduled in clinic in blocks of two to three weeks depending on their schedule as FP Service Chief and specialty rotations where they are paired with another third year resident.

(R2, R1) – At the satellite clinics, first and second year residents will be scheduled in their continuity clinics during the first six months when there is the most space available.

R2 Clinic Month (back to top)  

*Clinic – R2’s will see 6 to 7 patients per half day. Each clinic will need to be creative in scheduling the extra clinics for R2’s by scheduling R3’s on rotations where they are in clinic fewer days.

**Case conferences – see schedule

***Clinic Specific Activities Times below are approximate. It will be up to the resident to make sure that these activities are checked off and signed by the person involved in teaching. 

R3 Clinic Blocks (back to top)

*Clinic – R3’s will see 8 – 10 patients per half day. Each clinic will need to be creative in scheduling the extra clinics for R3’s by pairing the R3 on their continuity clinic rotation with a fellow R3 who is away, doing VA, FP Service, CCU or a focused specialty rotation.

**Administrative time includes: Charting, patient follow-up, consulting, reading, chart reviews for chronic disease management, preparing presentations for didactics or case conferences, research for R3 talks, etc.

Goals (back to top)

Current trends point toward shorter and fewer hospitalizations for patients and greater emphasis on outpatient care and case management services. The goal of the Clinic Month Rotation is to increase residents’ exposure to their continuity clinics’ services, functions and personnel. This will help R1’s and R2’s develop a comfortable platform of knowledge to assure a successful three-year outpatient continuity clinic experience and will help R3’s prepare for future practice in ambulatory care.