Continuity Clinic

Educational Goals and Objectives

Overview:

All residents will be assigned by Baton Rouge General Internal Medicine Residency Program to participate in a one (1) half-day a week rotation in the office practice of a Board Certified internist. The residents will see a broad variety of pathologies during this part of this rotation. The resident is expected to have their own panel of patients and the same resident must be based at the same location for the duration of their three years of residency training. During this rotation the number of working hours recommended by the ACGME is respected.

Principle Teaching/Learning Activities:

Patient Care: The residents are asked to obtain histories in new patients and interval histories in follow up outpatients. The residents are also asked to perform a detailed physical examination. The resident will present these findings and an initial assessment and plan to the attending for discussion. At this time, feedback will be given regarding the resident's performance in obtaining the history and physical exam, as well as regarding the proposed management plan.

Teaching Conferences: The residents are expected to participate in all academic activities as schedules permit: medical grand rounds, journal club, regular Friday afternoon conferences, and morbidity and mortality conferences during this rotation.

The principal educational goals are indicated with regard to the six ACGME competencies in the tables below.

Patient Care
Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

1. Interview patients more skillfully, focusing on the critical parts of the history of patients.
2. Obtain a detailed social, epidemiological and family history that is pertinent.
3. Review previous laboratory and pharmacologic data.
4. Skillfully examine patients, focusing on important findings that are relevant.
5. Understand the most common laboratory studies and procedures and interpret the results of these tests.
6. Define and prioritize patient's medical problems.
7. Generate reasonable differential diagnosis.
8. Develop evidence based management strategies.

Medical Knowledge
Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents are expected to:

1. Expand applicable knowledge base of the basic and clinical sciences related to their patient's chief complaint.
2. Review the pathophysiology, clinical manifestations, diagnosis, treatment and prognosis of common disorders.
3. Access and critically evaluate information.
4. Apply knowledge to decision making.

Practice-Based Learning and Improvement
Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to:

1. Identify gaps in knowledge and skills.
2. Develop and implement strategies to fill gaps to improve their delivery of patient care and expand their medical knowledge.
3. Learn from previous experiences, errors and practice measures.
4. Use information technology.
5. Locate, appraise and assimilate evidence from scientific studies related to their patients' health problems.

Interpersonal and Communication Skills
Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates. Residents are expected to:

1. Communicate effectively with patients and families.
2. Communicate effectively with physicians.
3. Communicate effectively with non-physician healthcare workers.
4. Provide clear, accurate and concise patient presentations.
5. Maintain complete, legible and timely records.

Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:

1. Demonstrate respect, compassion and integrity.
2. Demonstrate sensitivity and tolerance to patient and colleagues' diversity.
3. Demonstrate altruistic behavior.
4. Refrain from arrogance or abuse of power.
5. Adhere to respect of privacy, confidentiality and informed consent.

Systems-Based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to:

1. Understand and use multidisciplinary resources to deliver optimal health.
2. Collaborate with other members of the healthcare team.
3. Use evidence-based, cost-conscious strategies.

PGY 1:
Emphasis on screening/preventive medicine.
Identifying conditions/illness and evaluation need for hospital admission vs. treating in ambulatory setting.

PGY 2:
Understand appropriate billing and insurance issues.
Utilize resources available for cost-effective appropriate patient care in ambulatory setting.

PGY 3:
More autonomy in management.
Understanding the concept of private practice.

Recommended Resources:
All residents are expected to read about their patients. Attendings in consult services often distribute pertinent articles to the team. Baton Rouge General Medical Center has full online access to MD Consult and there is a medical library with medical textbooks and journals at Baton Rouge General. Residents can access these resources 24 hours a day. Reading of current literature relevant to each patient is also expected. The series entitled "Medical Knowledge Self Assessment Program" is also a program resource.

Evaluation Methods:
The resident is given feedback on his/her case presentations, record keeping, medical decision-making and other clinical skills on a daily basis. Each attending physician evaluates the resident twice a year on their continuity clinic experience and they are encouraged to give direct feedback during the weekly clinics. The Program Director and advisor review all evaluations as they come in to the Program Office. The resident has two educational development conferences (EDC) per year with their advisor. Evaluations from other healthcare workers (nurses, social workers and ancillary staff) are also obtained and discussed with the residents during their educational development conferences.

Baton Rouge Clinic
7373 Perkins Road
Baton Rouge, LA 70808

Hospital Medicine Group
3600 Florida Boulevard
Baton Rouge, LA 70806

Medical Associates of Baton Rouge
3401 North Boulevard, Suite 200
Baton Rouge, LA 70806

Internal Medicine Pediatric Group
11424 Sullivan Road
Baton Rouge, LA 70818

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