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• W2077884674 abstract "The majority of medical school graduates have little training in primary care or experience with a continuity setting. This contributes to a sense of frustration and lack of preparedness when internal medicine interns start their continuity clinic experience. At Providence Portland Medical Center, residents practice in a combined resident-faculty patient-centered medical home as part of a multidisciplinary team.The program offers a 2-week full-time clinic-block rotation for interns. This intense outpatient exposure enhances the continuity clinic experience, as interns learn about clinic resources, time management and efficiency, and management of ambulatory conditions. However, the timing of this rotation is sequential for the 12 interns. Some interns do not rotate until December, nearly 6 months into their own continuity clinic experience.Our innovation is an intensive 2-week block rotation in the first month of internship entitled, “Introduction to Outpatient Medicine and the Patient-Centered Medical Home (IOM).” Six interns started in IOM for the weeks 1 and 2 of their internship experience and 6 started in the inpatient setting, and the groups switched for weeks 3 and 4. To create time for this intensive outpatient exposure, we removed all interns from elective rotations in July. Concurrent innovations in the inpatient setting allowed the inpatient units to function with fewer interns during July, enabling the program to place half into the IOM rotation.Input gathered from the faculty preceptors and residents generated the curricular content. Our main goal was to maximize the needed skills to thrive in the outpatient environment. Having the interns in clinic as a group allowed for a variety of teaching methodologies, from 1∶1 mentoring to small group workshops and didactics. Integrated direct patient care allowed interns to immediately apply what they had learned. Curricular topics covered are listed in the table. Time was spent on personal introductions to the multidisciplinary team, which includes a care manager/social worker, clinical pharmacist, dietician/diabetic educator, physical therapist, behavioral specialists, community health care worker, medical assistants, and patient relations representatives. This enabled interns to understand team roles, and how best to utilize the resources of the medical home.We also carved out time to extensively work on the use of the electronic health record, focusing on workflow and efficiency. One area is a smooth transition of complicated patients from the outgoing postgraduate year (PGY)–3s to the new PGY-1s. The outgoing residents chose their 10 most complicated patients on their panel and wrote a transition summary. The new PGY-1s were given time to review these charts in detail, and work with faculty on chart extraction skills. We had heard feedback about the difficulty of these patient transitions. One recurrent theme was that there was insufficient time for a thorough chart review. The intervention, which gives the intern more time to gather information before meeting their new patients, enabled them to be better prepared for the initial visit. Finally, the PGY-1s had a graduated experience in direct patient care, starting with 1 patient in a half-day and advancing to 3 patients. This practical experience enabled them to use their newly learned skills right away.The main outcome was that the interns increased their comfort level in the continuity clinic experience much earlier than in previous years, and displayed a higher level of functioning. An informal survey of the interns after the rotation showed all interns considered the rotation a positive experience. An interesting outcome of the rotation was that interns knew the workflows and the medical home concepts much better than senior residents. The precepting faculty and the clinic team felt the interns were integrated into the care team much more smoothly and rapidly when compared to previous years. Due to the overwhelmingly positive feedback, we plan to incorporate this rotation for the upcoming academic year. The main adjustment will be to improve the integration of the patient care into the lecture days to avoid the potential for “educational overload” from multiple content sessions." @default.
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• W2077884674 date "2014-06-01" @default.
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• W2077884674 title "Introduction to Outpatient Medicine and the Patient-Centered Medical Home Rotation: Teaching Interns to Thrive in Clinic" @default.
• W2077884674 doi "https://doi.org/10.4300/jgme-d-14-00107.1" @default.
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