Quincy Family Practice Program
Residents Manual
Curriculum
Section 1: INTRODUCTION
The SIU Quincy Residency Training Program curriculum is designed to prepare the resident to pursue any of the available opportunities in the discipline of Family Medicine. The curriculum includes required block experiences, didactics, self-study, and procedural training. Additionally, areas of the curriculum are taught in a longitudinal fashion. Elective experiences allow the senior resident to focus on individual learning needs or interests to best prepare for future practice and lifelong learning.
Curriculum learning goals, objectives, specific rotation mechanics and resource lists are available at www.quincyfp.org/qfpcurricula.htm
Section 2: GENERAL IN-PATIENT ROTATION DUTIES
Quincy Family Practice residents receive in-patient experience in a variety of rotations. Most rotations are done on a one-on-one preceptorship basis with attending physicians. In depth information about each of these rotations can be obtained at www.quincfp.org/qfpcurricula.htm. Valuable information concerning these rotations can also be obtained from residents who have previously completed the rotation. It is crucial that you review and discuss the rotation information with your attending. Each curriculum has a QFPC faculty assignment. Feel free to discuss any aspect of this curriculum with him/her. Complete procedure logger at www.newinnov.com.
Section 3: CARE OF CHILDREN (PEDIATRIC) CURRICULUM
The resident will work in the pediatric department and learn from all available attending physicians. Specific comments regarding specific experiences follow. Pediatric Early Bird Rounds are telecast from Children’s Hospital in St. Louis every Friday at 8:00 a.m. The residents on in-patient and out-patient pediatrics are highly encouraged to attend these sessions.
In-Patient Pediatrics
Each resident will complete two blocks of pediatric in-patient service. The resident should be very aggressive about establishing and maintaining a presence on the pediatric floor and level two nursery. The resident should introduce themselves to the pediatric and family medicine attendings, as well as to the head nurse and staff nurses. A sign should be placed in the nurses station on 6th floor and in the nursery with the resident’s beeper number.
Each day, the resident should make rounds before the attending physicians. They should make sure that all notes and H&P’s are complete on the charts. You should discuss each of your patients with the appropriate attending physician every day. You should have a definite plan in mind for the patient prior to the time you talk to the attending physician. Attending physicians appreciate it when the resident presents these plans. If the attending pediatrician has not arrived on the floor by 9:00 a.m., you should page the attending and discuss your plan for the day. You should let the attendings know that you are very interested in performing procedures as needed. Major therapeutic changes should also be discussed with attending physicians.
Be sure to see all admission on a timely basis. If a pediatric patient is admitted while you are in the Family Practice Center clinic, please see the patient promptly after the clinic. If the patient is acutely ill and needs prompt attention and you are in the family practice clinic, make arrangements for your patients to be cared for in clinic and go to the pediatric ward. This will maximize your educational opportunity with acutely ill patients and give you more opportunity to perform procedures.
You will also be responsible for Level 2 nursery. Make sure the resident on obstetrics knows that you are the resident for level 2 babies. It is important to be at the delivery of a potentially sick newborn since much of the stabilization happens within the first hour. Make sure the nursery nurses and labor and delivery nurses also know that you are on sick nursery.
In the afternoons when you do not have Family Practice Center Clinic, if there are not pressing hospital issues, you may attend clinic with the private physicians, just check with the attending first.
Lastly, you will be responsible for three case studies due at the end of the month. Theses will be assigned by the faculty responsible for pediatrics and an email with the assignment will be sent to you in the the first week of the block.
See the Care of Children rotation mechanics at www.quincyfp.org for more specifics on this rotation.
Out-Patient Pediatrics
During the outpatient pediatric rotations, you will spend time with the attending pediatrician. You may spend one week with a nurse practitioner learning the essentials of the well child visit. The desires and philosophies of each of the attending pediatricians are slightly different, and you will have to learn these the first day you are with the pediatrician. This part of the rotation involves performing clinical activities that are done by the attending pediatrician. This includes being with the attending pediatrician at all times during his/her clinic hours, admitting, and following his/her patients in the hospital, (if no resident is assigned to in-patient pediatrics) and evaluating and treating his/her emergency room patients.
During your first Outpatient Pediatrics month, you will spend one afternoon at the health department. Here you will learn about immunizations as well as the WIC (Women, Infants and Children) program and how it helps to care for patients. Questions are always welcomed and appreciated.
Section 4: ADULT MEDICINE AND SURGICAL ROTATIONS
For these rotations, the resident is assigned to work with an attending physician from the community. The relationship is on a preceptorship basis, that is, there is one-to-one teaching between the attending and the resident. Thus, you will be working with an attending physician and his/her own patients. The resident is expected to make rounds with the attending, do H&P’s, procedures, discharge summaries, and in some cases go to the attending’s office. Each resident will clarify this with the attending physician on the first day of the rotation. Residents should make every effort to see the attending physicians’ patients prior to the time rounds are made. If the resident has done most of the details of work rounds and written a progress note, there is more time for teaching to occur. The resident is also responsible for the attending’s patients during evening hours. On occasion, the resident will be called in to see an admission for the attending physician or to return to the hospital to see a patient who has taken a turn for the worse. Residents should be encouraged to understand the psychosocial aspects of medicine on each rotation and to communicate with patients and families extensively.
Section 5: FAMILY PRACTICE IN-PATIENT SERVICE
The family practice inpatient service is generally covered by three residents (at a minimum two residents and a Family Practice attending physician). The philosophy of the family practice in-patient service is to teach all of the elements of family practice as they apply to hospitalized patients. Usually, family practice in-patient service encompasses patients in every department in the hospital.
Residents are responsible for responding to all consultations from medical and surgical units, and for the teaching and supervision of medical students and pre-medical students on the service. Generally, senior residents will be responsible for medical consultations on the psychiatric unit. Senior residents are also responsible for working up some of the general admissions to the family practice in-patient service. The senior resident should concentrate on caring for those patients who are more critically ill (i.e. those in the ICU) or supervise junior residents caring for these patients. The junior resident, in general, is responsible for other general admission to the family practice service including those of attending physicians, those of other first year residents, and those patients with no doctor who have been assigned to the family practice service by emergency room physicians.
Family practice in-patient service rounds with the attending physicians will begin at 9:30 a.m. each morning. These rounds may be attended by the PharmD. Prior to 9:30 a.m. the Family Practice Service residents will have seen all of the family practice in-patients, have written notes, and made plans for the day’s activities. The attending will go over these plans and make necessary changes and also utilize this time as the major teaching portion of the in-patient services.
The residents on the service should do a detailed history and physical on all patients admitted, even if another resident has admitted the patient the previous night. The resident on the service is responsible for knowing all of the details of the patient’s admission and previous medical history. The resident should consider himself/herself the patient’s primary physician.
Resident physicians are responsible for informing faculty physicians about the admission and progress of the faculty’s patients. If the faculty member is not the attending physician on service for the week, the residents on the family practice service should notify the faculty physician at the time of admission and also notify them at the time of discharge. It is very important that faculty physicians are kept up-to-date on their patients. Any significant management changes should be communicated to the faculty physician.
Residents on the service receive two weekends off during the four-week block. The family practice service must be covered by one of these residents at all times. The only exception to the policy occurs when the residents have their annual retreats.
When the resident on the obstetric service is unavailable, the residents on the family practice service may be responsible for obstetric patients of Quincy Family practice program faculty, and on rare occasion the Pittsfield and Lewis County obstetric patients. The senior resident should have first responsibility for this duty, and the junior resident assume responsibility if the senior resident is unavailable.
Section 6: PROCEDURES
The performance of medical procedures is often needed to provide comprehensive patient care. Prior to performing any procedure (both in in-patient and out-patient) the resident must inform the supervising attending. The resident should be well aware of the indication, technique, possible complications, expected outcomes and alternatives. Excellent resources are available at www.medconsult.com. Procedures for Primary Care Physicians, Pfenninger, and Ferri Manual. Informed consent is mandatory. The resident must have five of the following in-patient procedures supervised—thoracentesis, paracentesis, central lines, lumbar punctures, and chest tube placements.
Before the resident can do the procedure without direct supervision. The resident should never perform a procedure that they are not experienced with or are uncomfortable with out direct supervision.
Documentation of all procedures is critical for future privileging. The resident should keep a copy of all procedures dictations. An office-based list will be provided to each resident. All procedures are to be recorded on the procedure logger www.newinnov.com.
Section 7: OBSTETRICS
The basic two block obstetric rotations emphasize learning the principles of family-centered maternity care. The learning objectives, reading list and specific articles and monographs to be studied during the two months are available at www.quincyfp.org at the Labor and Delivery Nursing Station and at the Quincy Family Practice Library.
The following rules and suggestions will help maximize learning on the obstetric rotation:
- The resident should be very aggressive about establishing and maintaining a presence on the maternity floor and the labor and delivery unit. On the first day of the rotation, the resident should make an effort to introduce themselves to the attending physicians who deliver babies to the head nurse and to the staff nurses. The resident should let each of these people know their desire to follow women through their labor and delivery. A sign prominently displayed should be posted in labor and delivery with the resident’s beeper number. The resident should spend most of his/her time in the labor and delivery area. Most of the required reading should be done in the private rooms in the labor and delivery area or nurses desk, rather than in the library or in the Quincy Family Practice Center. The resident should clearly post their clinical days, and other days they will be unable to cover the labor and delivery unit. Another resident should be designated for emergencies during these hours.
- When called for the laboring woman, the resident should make an initial assessment, contact the attending physician to report the findings and plan, and continue to care for the woman throughout labor. The resident should spend time in the room, giving the woman emotional support, answering questions, and learning breathing techniques.
- A good relationship with the obstetric nurses is essential to a successful experience. Listen to the nurse’s suggestions and ask for their help. They are experts in vaginal examinations, cervical assessment, placement of scalp electrodes, and fetal monitor pattern interpretation. They very much want to teach you.
- Emphasize the importance of family-centered maternity care – the role of coaches, the importance of ambulation, the use of intravenous medications and other technologies only when needed, the importance of comfort and choice for the woman, etc.
- Please care for the family unit following delivery. Each day, examine the baby and report progress to the mother. Discuss the case with the baby’s doctor, and express your willingness to be involved in any special care (circumcision). Make rounds on every post-partum woman you deliver.
- Notify the resident covering sick nursery whenever a physician is called to attend to a suspected or identified sick newborn.
Section 8: OFF-SITE ROTATIONS
The American Board of Family Practice will allow no more than two off-site rotations in the second year and two off-site rotations in the third year. The two months cannot occur back to back. This does not guarantee that the Quincy Family Practice Program will allow a resident to have that many off—site rotations. An off-site rotation must be for an educational experience that is not obtainable at the Quincy family practice Program and off-site rotations must fit into the overall educational and clinical needs of the program. The program always reserves the right to schedule continuity clinics on two two-day periods while a resident is doing the rotation at East St. Louis or other locations not far from Quincy. The Director of Resident Affairs and/or the Program Director will carefully examine requests for off-site rotations. Away rotations cannot be scheduled for the last two weeks of June or first two weeks in July.
Section 9: LONGITUDINAL EDUCATIONAL EXPERIENCES IN THE COMMUNITy
In addition to hospital experience and experience in the Family Practice Center, there are community activities in which residents participate. These longitudinal activities include nursing home visits, Family Planning, Recovery Resources, visits to homebound patients, and pre-participation sports physicals.
- Nursing Home Visits
During the second and third year of the residency program, residents are assigned nursing home patients. These nursing home patients may reside at any of the five nursing homes. Each resident, under faculty supervision, is responsible for the care of approximately 10-15 nursing home patients. Nursing home patients should be discussed with faculty. Routine nursing home visits are required every two months or more frequently if acute problems arise. When a patient is admitted or readmitted to the nursing home, monthly visits are required for the first 90 days. Occasionally, other residents who have patients in that nursing home may be responsible for these monthly visits if a patient’s assigned resident is not available. Routine 2-month visits are then started. At the nursing home, the resident is to write a progress note. Bring a copy to Lois Schlueter in the Billing Office if not done by the faculty supervisor. It is mandatory that this copy be brought to the Family Practice Center so that the proper records can be kept in our charts, and so that proper billing can be done. Each nursing home has a designated area for progress notes and that institution’s policy should be followed.
- Family Planning
Family Planning of Quincy provides contraceptive counseling for women of limited finances. This clinic provides extensive experience with pelvic examinations and public health. The first time a resident works there, they need to be “checked off” by an attending physician or resident physician who has previously seen Family Planning patients. Each male resident will be required to perform no less than 12 clinics while female residents staff 6.
- Recovery Resources
Required educational experience and community service occurs at Recovery Resources for second year residents. This facility is a treatment house for patients with substance abuse problems. Family practice residents are assigned on a block basis to visit Recovery Resources one-half day morning per week (Fridays usually). Residents are expected to perform brief admission physicals, renew prescription orders, and care for minor ailments. Further educational experience in substance abuse will also occur at Recovery Resources.
- Home-Bound Patient Visits
Second and third year resident will be assigned patients for home visits. The resident will usually be assigned less than five such patients. The resident should make the appropriate visit, consulting the attending physician prior to and after the visit. The resident should dictate a note for the chart and fill out a card so that appropriate charges can be made. The resident is encouraged to notify faculty beforehand so they can jointly make these visits. The resident is encouraged to identify patients from their own practice who may be better cared for by home visits. Residents will be required to do a minimum of two home visits.
- Pre-Participation Sports Physicals
As part of the required sports medicine curriculum, all residents will participate in pre-participation physical examinations. At present, we perform these physical examinations for the YMCA and for five or six schools here in Quincy. This activity is coordinated by an attending that will notify you when your presence is required. Residents will be required to perform no less than two sessions per year. These will be assigned. Residents will be responsible to find a back-up resident if unable to attend.
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