FHC Intern Orientation

Introduction to Farrell Health Center Rotation

PGY 1 -  FHC 1

Rotation Goals: To establish Farrell Health Center as the medical home for residents and provide skills to successfully care for patients in the ambulatory setting.

Objectives:

•  Gain an understanding of the teams and workflows at the Farrell Health Center

• Understand various roles: PFA, MA, RN, NP, SW, nutrition, podiatry at our clinic

• Begin to develop skills in assessing and managing patients in the ambulatory setting

• Begin to develop your continuity panel and develop skills in care coordination

• Learn about our partnerships with student run free clinics

•  Learn about resources available to patients including services offered within Farrell, within NYP, and in the community

Professionalism

1. Resident must attend all patient care and teaching sessions.

2. Resident must be on time for all patient care and teaching sessions.

3. Resident must participate and prepare for all patient care and teaching sessions.

Systems-Based Practice

1. Residents will demonstrate an understanding of office policies and procedures in the FHC.

2. Residents will understand the roles and responsibilities of members of their team.

3. Residents will develop a medication prescribing framework and effective prescribing skills.

4. Residents will understand the role of the ancillary team in the FHC.

Medical Knowledge

1. Residents should demonstrate basic medical decision-making capabilities

2. Residents should be able to correctly select and subsequently interpret basic clinical tests

3. Residents should begin to integrate social and behavioral considerations with biomedical knowledge in patient care

•   Participation in all activities listed on the weekly schedule.

•  Review your schedule and rotation guide prior to starting so that you are familiar with your schedule and rotation expectations. Direct questions to Dr. Garcia if any. 

•  Notify chiefs and rotation liaison if you will not be present for any expected activities.

• Take time to thoroughly pre-read on scheduled patients prior to your first patient care session.

•  Discuss any rotation feedback/suggested changes with the rotation liaison. 

Other useful information: 

QI and Comm Med:  corresponding zoom meeting links as applicable and further information and learning goals for QI and community medicine activities are on the residency site on their respective pages. For any recurring Friday morning zoom meetings, the zoom room should be the same going forward. 

Didactics: find this zoom meeting link on the residency website. This zoom will be the same for Thursday afternoon lectures going forward. When on any outpatient rotation, attendance at didactics is expected.

IDT: Interdisciplinary team meetings occur monthly within your assigned Farrell teams. IDT will always fall on a Wednesday morning and should occur via zoom. The goal at these meetings is to discuss identified cases and their management strategies while ensuring dialogue and coordination between care providers, care coordinators, social work, community health workers. All residents should be receiving emails (as part of their assigned Farrell provider team) from meeting coordinator Cynthia Martinez-Feliz containing the lists of patients to be discussed and the zoom link with password. You are not asked to attend other clinic team's IDT meetings, only your own.  When on outpatient rotation, attendance at IDT meeting is expected.

Shadowing attendings/residents:  This is an opportunity for you to learn FHC physician best practices. Use this time to pick up skills in efficiency (starting notes, working on notes, placing orders, communicating with staff, and precepting).

Shadowing Nursing: These sessions will give you the opportunity to see how non-physician team members participate in patient care and which situations (apart from vaccines alone) call for RN involvement, counseling 

Session with Social Work: This is an opportunity to learn how best to collaborate with social work and social work assistants, what situations call for social work referral or consultation; situations in which social work mental health needs to be activated vs. social work as it relates to connection to resources (community resources, food stamp assistance, etc) 

Patient Care: In addition to shadowing, you will have your first direct patient care sessions during FHC orientation. This is an opportunity to put the above skills to good use and start building your patient panel.

Professionalism lecture: With Dr. Rosenthal, who is also our biopsychosocial rounds facilitator, to discuss professionalism in residency.  

Admin time: Use admin time as you need; recommended use is to pre-read for future patient care sessions, finish notes, or do other clinical readings. This time is also available for other important external things that may need to get done before the year gets busier 

ABFM Modules: Please be aware that if you would like, you can use admin time to complete an ABFM Self-Assessment activity. Overall, these self-study modules are helpful for clinical care, studying for our in-service training exam, and ultimately studying for and registering for the boards.  ABFM modules are not a strict requirement for this specific rotation, as there will be time built into later FHC rotations for this as well.  If you would like to get an ABFM module out of the way now, we recommend: Preventive Care

 https://portfolio.theabfm.org/ → click “access self-assessment activities”

1)   General EMR 

(These items are applicable throughout, including orientation sessions, Epic sessions, clinical shadowing, and direct patient care sessions) 

ACCESS: 

• Log in to Epic

• Ensure able to log in under FRL FAMILY MEDICINE

• Ensure able to log in under ALN IP FAMILY MEDICINE

• Ensure the Family medicine list is accessible

• FOLLOW Dr. Berenyi’s Farrell order sets.

• Customize the toolbar and tabs

•  Add visit speed buttons for billing

Inbasket: 

• Review contents: different categories only appear as messages come in

• Results notes

• How to send an Epic message to individuals and pools

• Review rules (checking inbasket, labs daily)

•  How to mark as done

Patient:

• Find a patient (chart)

• Find a visit (using encounters tab)

• Find a patient from schedule view

• Start a documentation encounter 

Documentation:

• Visit data, snapshot, other tabs

• Pre-charting vs “start the visit”

• Chart review tabs

•  Entry 

• Note Templates 

• Dot phrases

• Ensure logged in under preceptor for cosigning notes/bills/visits

• Accept to save note and sign encounter when note/bill is complete

• SmartTexts/SmartPhrases

Orders tab

• Preference lists

• Facility list

•  Updating preference lists

Plan tab

• Associating diagnoses

• Appropriate use of copy forward - assessment/plan section

•  Problem-based charting

Wrap up tab

•  Follow up interval, dispo/CC note tab

•  Billing codes and customizing this section

• How to see routing history

Personalization

•  Tab organization

•   Preference (order) sets

•  Dot phrases (both for notes and also management prompts), ensure HCM, advance   

• directive, etc phrases are included

• Visit note shortcut buttons if desired

 Applying skills within a session

• Messaging PFAs, MAs

•  using color dots

• rooming/vitals à visit in progress à orders, wrap-up notes à precepting, MA and/or RN labs vaccines etc à check out

• No show notes / no show procedure

• How to route notes, labs, encounters

• How to write letters, send patient communications

2) EPIC within patient care session: 

TABS:

• Review most commonly used tabs (chart review, notes, wrap up, plan, problem list, iNYP)

• How to assign yourself as PMD

• Review media tab for documents

iNYP:

• Where to find old records from Allscripts and historical labs/studies

MEDICATIONS TAB:

• Medication list

• How to cancel or discontinue meds

• How to add meds patient is on NOT prescribed by you

• How to Rx meds (reorder vs new med)

• How to print a med list for a patient 

• How to Rx DME

ORDERS:

·         Locate order input bar (bottom left)

·         Review preference sets and subcategories (labs, peds age-specific, studies, referrals, POC tests)

·         How to place an order for today’s visit

·         Placing future orders for labs/studies

·         How to check if appointments made/studies scheduled (Chart review)

·         How to order a CT lung screen (only paper order)

FLOWSHEETS:

·         Location within Epic

·         How to add new vitals within a visit

SHORTCUTS:

·         F2, ctrl+space

MISC:

·         Vaccinations tab

·         How to find and do Forms (school forms, M11Qs, etc)

·         Growth Chart Tab

3)    FHC Intro

• Washington Heights community, Spanish language, increasing Arabic language, insurances accepted primarily Medicaid Medicare

• Expectations re: pre-precepting, precepting one case at a time, chart completion 24h, interpreter services at all time unless explicitly excused on the basis of formal language proficiency score

• Expectations re: managing labs, patient calls/inquiries, forms

• When to recall patients

• Problem list - keep as updated as possible

• Medication list - keep as updated as possible, reconcile / mark as reviewed

• Current status of video/telephone visits, development of these processes in the context of the pandemic, largely phasing back to all in person care 

• Expectations / procedure when calling out sick from Farrell, rescheduling patients

• Clinic flow in a typical session; divisions by team; fewer patients per session initially with gradual ramp-up

• Various types of visit slots (new patient, established patient, adult/peds/prenatal/special session; provider slots, overbooks

• Encourage collaboration with PFAs and MAs via secure chat, closed-loop communication

4)    Shadowing Sessions with Nursing

• color dots and and flags

• Attention to various team member roles in session, discussion when team members are being involved in session what is it for?

5)    Shadowing Sessions with Resident or Attending

Active shadowing as much as possible; can try scribing notes in MD/DO sessions only if time allows

TEAM MEMBER ROLES:

Attention to various team member roles in session, discussion when team members are being involved in session what is it for?

          o   RNs: vaccination/medication administration, vaccination review/query, counseling (esp. within prenatal visits), WIC forms, assistance with contacting patients with abnormal results if MD cannot reach

          o   MAs: vision/hearing, blood draw, populate some of the school forms, etc

          o   Referrals to other team members, ex: podiatry, SW, nutrition, consultants

          o   Communication with team members within session; including calling, haiku messaging, appropriate use of color dots and flags

Bright futures for Well Child Visits:  https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_POCKETGUIDE.pdf 

1.  CHHMP: https://www.vagelos.columbia.edu/education/student-resources/office-student-affairs/vp-s-club/clubs-and-organizations/student-run-clinics/columbia-harlem-health-and-medical-partnership-chhmp

○      Address: 521 W 126th St, New York, NY 10027

2. Q Clinic:https://www.ps.columbia.edu/education/academic-programs/md-program/md-student-resources/office-student-affairs/p-s-club/clubs-27

○      Address: 446 West 36th Street, New York, NY, New York, NY 10018

1. Residents are expected to complete rotation evaluations on Medhub which are anonymous and will be reviewed every 6 months. 

2. Please also be aware that you can communicate with Dr. Garcia directly about the rotation -- we welcome all feedback.

3. You will also receive direct/medhub feedback from preceptors during and after patient care sessions.