R1 Clinic Month Rotation 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.

Laboratory Skills (clinic and individual activity – first year)

During their Clinic Month, each resident will work with the staff at their continuity clinic in order to develop competency in performing and interpreting the following:

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 the 45^th St. and/or 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.

Clinic Systems (individual activity – first year)

Residents need to develop a clear understanding of their clinics’ organizational systems. During their Clinic Month they will spend time getting to know their clinic staff and their jobs and responsibilities including:

• Medical Director 

• Clinic Manager - becoming familiar with general management of a medical clinic, patient flow, etc.

• Front Desk Staff – Telephone Receptionists, Receptionists, Schedulers, etc.

• Back Office Staff – Billing, QCP, etc. (a coding workshop will be done as a small group activity at SFM)

• Triage Staff – Triage Assistants, Triage Nurses, etc.

• Nursing Staff

• Social Work Staff

• OB Coordinator (or Clinic Chief) - learning how OB patients are assigned, etc.

• Referral Staff (or Clinic Chief) – learning how to fill out forms, how to find specialists and other community resources, etc. (working with interpreters and cross cultural issues will be done as a small group activity at SFM)

• Insurance Screeners - becoming familiar with the various insurance plans their clinics accept, how to find covered services, formularies, etc.

• Financial Screeners - learning how they determining eligibility for sliding scale care, enrolling patients in BCHP, BHP of Washington, CHIP, First Steps, Medicare, Medicaid and SSI and accessing community resources for uninsured and underinsured and low income patients.

 Medical Records (clinic and individual activity – first year)

Accurate documentation of all patient encounters and information is critical to good patient care. During their Clinic Month residents will become familiar with their clinics’:

• Medical charts – chart layout including problem and medication lists, flow sheets, lab results, consults, etc.

• Flow sheets for chronic problems as well as health care maintenance.

• Paper medical record system – finding charts, returning charts, filing charts, etc.

• OB chart system – finding charts, returning charts, filing charts

• Dictation and use of templates

• Triage forms - how to fill them out completely and accurately

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 (future resources)

• Palm Pilot use including logging procedures

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 Friday 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 Friday 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 months when there is the most space available.