PGY2: FHC1 and FHC2 Rotations

Goals:  

1. Effectively provide comprehensive primary care to patients at Farrell Family Health Center. 

2. Become familiar with a few resources across NYP ACN available to our patients. 

3. Take ownership and accountability for all patients you provide care for at Farrell Health Center (from the time they are on your schedule, until all post clinic tasks are completed for each patient).

4. Practice efficiency and effective time management skills with increasing patient case load: during patient care sessions, inbox management, EPIC navigation, etc. Discuss tips/tricks with preceptors. 

5. Use practice based learning skills to advance your knowledge and skills across the six ACGME competencies. 

Objectives:

Patient Care

1. Promote age-appropriate preventative health care for all patients taking into consideration patient preferences.

2. Identify and address barriers to receiving comprehensive healthcare. 

3. Recognize urgent and emergent conditions that need escalation of care. 

4. Develop a system for management of chronic diseases (keeping track of health care maintenance needs for each of these chronic conditions (e.g. eye, foot exams for DMII; monitoring for secondary hyperparathyroidism in pts with CKD; surveillance for HCC in patients with liver cirrhosis, etc), recognize indications for referral to specialists (e.g. nephrology for CKD)

Practice-Based Learning

1.  Utilize point of care evidence based medicine resources to incorporate answers to clinical questions into medical decision making

2. Incorporate and include references in your notes to demonstrate effective use of evidence based medicine skills which should support your medical decision making. 

3. Reflect on feedback focusing on identifying gaps between expectations and your performance- offer strategies to bridge this gap and improve your overall patient care skills. 

Professionalism

1. Attends and is on time to all patient care and didactic sessions.

2. Takes full accountability and responsibility for timely task completion.

3. Participates and prepares for all patient care and didactic sessions.

4. Checks in with preceptor prior to the start of each session and debriefs at end of sessions including asking for feedback.

Systems-Based Practice

1. Become familiar with  error reporting systems (keep safes, chain of escalation of concerns with system level issues that impact your patients' care)

2. Use local resources effectively to meet the needs of a patient population and community.

3. Recognize complex aspects of health care and how they are inter-related: documentation, EMR, billing/coding, resources available for patients, insurance coverage, prior authorizations, etc.

Interpersonal Skills and Communication 

1. Communicate learning goals to preceptors

2. Demonstarte respect and value for all healthcare team members. 

3. Effectively huddle with your Farrell healthcare team to optimize patient care. 

4. Explore and begin to use more advanced communication skills with patients including motivational interviewing, shared decision making, prioritized agenda setting, brief counseling. 

Rotation Activities Responsiblities 

1. Review website page thoroughly to prepare for rotation and take note of all assigned activities 

2. Multiple faculty, community organizations have graciously volunteered to work with our residents. Please practice best professionalism practices: communicate specifics regarding when/where to meet if this is not clear; notify responsible parties if any expected issues with assigned activities, tardiness, out sick, etc. and work to reschedule the activitiy if possible.

3. Complete post-activity evaluation form. This is how rotation supervisor will know you have completed the activity. 

Patient Care Responsibilities

1. Arrive on time/early for patient care sessions (communicate if running late) --> Huddle with MA/RN team 

1. Check in with preceptor (either via chat or in person) so they know you have arrived and are ready for patient care 

2. Come to precepting having reviewed all charts with agenda outlined, with personal learning goals, and questions for preceptors

3. Precept after every patient

4. Goal to have at least 2 total direct observations which can be done over your 2 FHC blocks (FHC1, FHC2).  You can get the most out of the experience by reviewing and requesting preceptors to use this Direct Observation Form to help focus coaching/feedback and evaluations on aspects of patient care you are working on for yourself. 

5. Ask for feedback 

6. Notes should be submitted within 24 hours of clinical session

7. Inbox should be checked daily results notes should be submitted based on our policy.

• Review NYP ACN community organizations to learn about the resources available to our patients: https://www.nyp.org/acn/community-programs. Please reach out to Dr. Desai to coordinate any indepth experiences to learn more about any of these programs (optional). 

• Complete this form after completing CHALK activity: ACN Community Programs Education Reflections 

• Review NYP ACN community organizations to learn about the resources available to our patients: https://www.nyp.org/acn/community-programs

• Complete this form and send to Dr. Desai after completing your site visits/experiences: ACN Community Programs Education Reflections 

• Note: if unable to coordinate/demonstrate proof of completion, you will need to make up time with extra an FHC session during elective time.

Didactic prep time

• This is embedded into the schedule as protected time rather than additional clinical time.

• MANDATORY: send draft of slides to lecture hosts for feedback and support to prep for session. 

• consider ways to engage learners outside of lecturing (games, videos, podcasts, true/false, board questions, small groups, cases) 

• consider ways to go beyond passing on information: what skill do you want participants to leave with? (be able to diagnose, treat, interpret studies, communication skill)

• include teaching points surrounding social determinants, social justice/injustice  and how the play a role into the topic you are presenting 

1. Reach out to Dr. Chacko the week prior to the session and include learning goals for your coaching session. 

2. Session will consist of her directly observing you for some patients and you directly observing her for some patients. You will discuss the learning goals prior to start of session and choose what aspects of the visit you want your direct obs to focus on (e.g. counseling/communication skills, history taking, agenda setting, etc) 

3. Learning goals examples: office and/or EPIC efficiency/EPIC optimization, effective huddling, agenda setting, complex care management, practice based learning and incorporating point of care evidence based medicine tools during patient care, problem based charting, effective chart reviews, billing/coding, communication skills, systems based practice (prioritzing patient safety, appropriate use of keepsafes and other risk management strategies)

4. Decide with Dr. Chacko which patients she will take lead on and which you will take lead on for your combined session together. 

How to access Reach Out and Read Training: Job Aide  

• You will receive an email reminder for IDT teams

• Review the IDT list and come to meeting prepared to discuss needs of patients that can benefit from interprofessional team members

• You can add any patients you see fit for resources available 

• see CMAS/QI page for details

Expectations: 

• Reach out to Drs. Desai and Pilipenko prior to session to coordinate details

• The session is telemedicine (you can be offsite and log on for sessions remotely) 

• Review tally and pre-read about patients: reason for referral, any relevant labs/studies, and relevant information

• Present summary of cases at pre-clinic review meeting with Drs. Desai and Pilipenko (15 mins prior to first patient on zoom): 

Join Zoom Meeting: https://columbiacuimc.zoom.us/my/zoomwithkd 

• you are encouraged to refer patients to IMCC during time you will be rotating so we can provide consultation for your continuity patient (IMCC Is booked far out but we can try to accommodate your patient if we have some notice; call them if we have no shows etc)

• Scribe notes during visit unless you are leading a visit (can discuss with Drs. Desai and Pilipenko if interested in leading session) 

  • You may use .kdimcc for note template

  • include references at end of your note to support the interventions we use for each patient (to become familiar with evidence based available for integrative therapies and to support our team's medical decision making)

• Dr. Nalgonda sees patients at FHC and you will be working with her when indicated on Orange Schedule

• Please come prepared to sessions having pre-read/pre-charted for patients

• Ask for feedback

• If NH visit assigned, this will be indicated on Orange Schedule

• Preceptors will submit medhub evaluations after precepting sessions and you will be evaluated on the 6 ACGME competencies

• Ask for feedback and request it at a time you are in a space to receive it and specify how you'd like it: medhub, directly right after clinic session, email at a later time, set up a meeting during admin time, etc. 

• Ask for feedback on a specific skill: e.g. I'd like some feedback on the resources I am using to look up clinical questions

• Ask for direct observations with specific learning goals in mind: e.g. Would you be able to observe me do agenda setting?

• Submit end of rotation evaluation 

• Informal feedback is also invited and should be discussed with rotation liaison 

• Complete reflection form for Community Program Education