OUTPATIENT G1 ROTATION

Contact: Lisa Callies

Continuity Clinic:  Wednesday PM

Educational Goals and Objectives:

The goal of the first year outpatient experience is to provide experience and exposure to geriatric care, subacute rehab care, breast screening and health, chemical dependency, ENT, and general outpatient care (at the Medicine Clinic and COC).


 

Educational objectives

Assessment method

Patient Care

1) Learn the basics regarding medical care provided in Nursing Homes and subacute care settings with a focus on the special needs of the elderly and subacute rehab

2) Learn breast exam, diagnosis and counseling of patients at the Breast Center
3) Learn about and participate in end-of-life care and advanced disease management with the palliative care service

4) Learn about common and more obscure ENT problems with Dr. Michael Tedford

5) Work on interview skills with discussion of taped interviews

6) Use reading time for assigned readings

7) Learn the basics regarding Chemical Dependency diagnosis and treatment including effects of physician impairment

8) Develop ongoing skills in general outpatient Internal Medicine in the Medicine Clinic and COC

9) See below for specifics of some of the rotation components

1) Global faculty assessment

2) Direct faculty observation

Medical Knowledge

1) Understand the variable presentations of medical problems in the geriatric population and the unique care needs of subacute rehab patients

2) Understand the different types of breast cancer and the different treatment approaches and options.

3) Understand pain and other symptom management options and techniques.

4) Understand the basic evaluation and treatment of adult ENT disorders

5) Understand the risks of physician drug and alcohol abuse

6) Understand how to recognize the signs of impairment of physicians and know the requirements in reporting such impairment

Global faculty assessment

Practice-Based Learning and Improvement

1) Demonstrate insight into knowledge deficiencies and limitations

2) Use information technology to answer clinical questions

Global faculty assessment

Interpersonal and Communication Skills

1) Refine the skills necessary to present patients and topics informally and formally to another physician or group

Global faculty assessment

Professionalism

1) Arrive to clinic on time and finish charting when applicable before leaving clinic

Global faculty assessment

Systems-Based Practice

1) Understand systems unique to each of the outpatient settings including follow up care, communication, and community resources

Global faculty assessment

 

Goals and Objectives for Outpatient Continuity Clinic:

The goal of Medicine Clinic is to provide an opportunity for the resident physician to manage a group of patients with a wide range of medical problems over their three years of training.

Objectives:

Learn to manage acute and chronic medical conditions including diabetes, hypertension, pulmonary problems, heart disease, lipid disorders, GI disorders, outpatient gynecologic problems, dermatologic conditions and depression/anxiety.
Learn appropriate health maintenance measures and apply to patients.
Learn to communicate with and educate and support a group of patients over time.
Learn time management and appropriate charting and billing in the outpatient setting.

 This rotation is designed to give you a variety of experiences, most of which focus on the outpatient, non-acute care areas of adult health care. During this rotation you will miss the Tuesday and Thursday conferences. Call Lisa Callies and any clinic if you are sick or must be gone. You are expected to wear your beeper at all times. Get the Outpatient reading and videos from Lisa Callies’ office and see her prior to starting the rotation.
1. Reading Time: Use Wednesday mornings and Monday afternoons to read the assigned material. You are expected to be in the hospital when doing it. Assigned readings include Tuesdays with Morrie, Kitchen Table Wisdom; I'll Quit Tomorrow, and selected journal review articles.
2. Geriatrics and transitional care: You will work with Dr.
Laurel Laden on Tuesday mornings at St. Mary’s Transitional Care Unit which is at 1925 Norfolk Ave in St. Paul. Dr. Laden’s contact information is available through Anne Klinkhammer or Lisa Callies.
3. Chemical Dependency: On Wednesday mornings following Grand Rounds, you will meet with either Dr. Miller or Dr. Heltemes according to the schedule in Lisa's office and their contact information is available there also. These tutorials will cover chemical dependency topics such as alcoholism; alcohol induced medical illnesses, drug abuse, alcohol and drug abuse in the physician and subsequent impairment issues. There are assigned readings for this experience.
4. Medicine Clinic: Every Wednesday afternoon you will have your regular continuity clinic. There are some readings about interviewing, as well as our Basic Physical Exam document, which you will use throughout your residency. A three week minimum notice, given to Anne is required if you are planning on taking vacation time. If you are doing an elective instead of G1 outpatient, you still will have Continuity Clinic
5. Breast Clinic: Thursday mornings you will be with Dr. Margit Bretzke on the fourth floor in the Piper Building, 612-863-3150, evaluating breast problems. This will include exam, diagnosis, counseling, and follow up of patients. You are to attend one or more breast conferences, which occur every Monday at noon, 6th floor Piper Bldg. Also, make arrangements to spend one Thursday afternoon in that clinic watching procedures with the radiologists.
6. ENT Clinic: Occurs every Thursday afternoon from 1-5 PM at Dr. Michael Tedford’s office in Edina, 7400 France Ave, Suite 107. Please call Dr. Tedford @ 952-832-5252 before the start of the rotation.
7. Interview Tutorial: You will be witnessed conducting one interview of a patient encounter during your time in Medicine Clinic in the first year. These will be reviewed with you during open time. Choose patients with end-of-life or other challenging situations. Emphasis will be on empathy, comfort, and subtle skills rather than gathering data. Please watch the videos "On The Edge of Being" and "Notes From the Edge", "Dr. Peter", "One Story, Two Voices", and "The Doctor."
8. ANGMA COC: Tuesday PM, and all day Friday will be with the ANGMA COC physicians. The clinic is at the NE corner of highways 169 and 494 in Edina, 952-914-8100. There are some materials on health care delivery in the readings, which are pertinent to this experience.
The address is 8100 W. 78th St, Edina. Reach the clinic from the hospital as follows:
1. Go north on 10th ave on the east side of the hospital and go one block to 26th St. Take 26th St. west (one way) to Portland. Turn left (south) on Portland and go to 31st street. Turn right and 31st St. and go a few blocks and enter 35W South. After 35W S merges with the Crosstown (62), stay to the right and continue west on 62 until you come to highway 169 south. Take this south for a few miles to Valley View Road. After the exit ramp, turn left and cross the highway and then turn right onto the Frontage Road. In a short while this will take you to the clinic. Park anywhere in the surface lot. The clinic is the first clinic on the first floor (Suite 100).

10. Palliative Care consults: Contact Dr. Richards at the beginning of the rotation. Learning about End-of-life care is an important aspect of this rotation so priority should be given to working with Dr. Richards during all open times. After each consult, we will catalogue your observations. You will also be working with Katie Herman, Chaplain and Kirsten McSteen, CNS.

 

 

 

AM

PM

Monday

Palliative Care (Dr. Richards)

Reading time

Tuesday

Transitional care rounds

 (Dr Laurel Laden)

ANGMA COC

Wednesday

Grand Rounds
Chemical dependency
(see schedule)

And  reading time

Medicine clinic

 Thursday

Breast clinic

ENT Clinic    (Dr. Tedford)

Friday

ANGMA COC

ANGMA COC