Resident Expectations
Urgent absence:
You must page the Chief immediately so that coverage can be arranged.
Vacation:
Assign your Epic Inbasket to another member of your team (i.e.Blue Team 1) while you
are gone. Communicate with them so they know to look in your Inbasket. Make sure you
have granted them access.
Patient care:
• UIM: Care for scheduled patients, hospital discharge follow ups and ER or
Urgent Care patients – pitch in and be a team.
• Affiliated Specialties: Your attendance is required and expected. See patients,
ask questions, make sure you are meeting your Learning Objectives for that
specialty (See Learning Objectives sheet)
• Clinic schedule: 8am – 12 noon and 1pm – 5pm; Patient schedules change
frequently – do not leave prior to the end of a clinic session. You will spend 10
half-days/week in UIM: 7 half days of UIM, 2 half-days affiliated specialties, 1
half-day Academic.
• Conferences: Mon, Wed, Thursday 8am – 8:30am Morning Report; Fri 8am –
8:40am Team Meeting; 12 noon – residency conferences; Tues 8am – Grand
Rounds.
• Inbaskets: Follow up on labs, phone calls, paperwork and test results on your
patients. Cosign orders. Sign out your inbasket if you are on vacation.
• Paperwork Folders: Complete for your Team Color/number. Combined
residents complete their own each week. Attendings will complete the folder if
your color/number is on vacation. Will also complete for combined residents.
• Sign in each day on the whiteboard- this alerts the nursing staff that you have
arrived in clinic and avoids us having to page you.
• Types of Patients
• Chronic illness and new complaints
• Patients will be scheduled with a physician by their team color #. Those
who are too ill to wait to see their team color, overflow, etc will be seen by
their partners, 1st available UIM resident, or the GYN resident.
• You are also responsible for helping with Hospital Discharge patients, ED
patients, if needed.
• RAC –The resident must discuss all with the “attending of the day” during each
visit. Any clinical questions that arise should be brought to the attending at the
time of care. The RAC will begin seeing patients on time (8:30 am and 1:15pm) –
visits last 30 minutes.
• Discharge clinic – Of our 7765 total patients seen in UIM between 4/10-4/11,
35% were seen in MUSC’s ED and 20% were admitted to MUSC’s hospitals.
23% of these admissions were readmitted to MUSC within 30 days. The majority
of readmissions occur within 14 days of discharge. Our goal is to have outpatient
visits with all of our hospitalized patients within 7 days of discharge. During this
visit, we will concentrate on symptoms, medication reconciliation and support at
home (home health nursing, family help, etc. Established UIM patients who are
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discharged will be seen in their panel resident’s clinic if an appointment is
available within 7 days.
Sickle Cell Clinic – In an effort to improve continuity of care and reduce ED
visits and hospitalizations, we have a Sickle Cell Medical Home for
approximately 50 patients of our patients at high risk for admission. We aim to
provide comprehensive care for these patients including open access
appointments for any complaint. Regular continuity clinic sessions will be held
Mon, Wed and Fri afternoons. Patients wishing to be seen at other times will be
added onto the urgent SS schedules every morning. We will be giving IV fluids
and pain medications to these patients as needed in accordance with an acute care
plan developed by the Sickle Cell team. Residents will not be directly involved
with this care.
PCMH – Our practice has been designated by the NCQA as a Level 3 Patient
Centered Medical Home. This model of care focuses on the following principles:
a personal physician, physician directed medical practice, whole person
orientation, coordinated/integrated care, care that is safe and high-quality,
enhanced patient access, and appropriate payment.
Continuity and Follow-Up –
• You are responsible for all results coming back to Epic that you have
ordered. If you are on vacation, it is your responsibility to get coverage for
your inbasket by someone on your team color. Make sure you grant access
to inbasket to all physicians on your team color # and case manager. To
cover you will need to ‘attach’ to their “In-baskets after they have granted
you “permission”. See epic tools for directions.
• Follow up on all labs, test results for your patients. Communicate all
results to the patient with either: letter sent via Epic, phone call you
document in Epic, or My Chart release (See “More Epic Tips for details)
• Go over your list of patients and let your Case Manager know if there is a
clear error. If the patient has not seen anyone in our practice consistently
and they are assigned to you, they are now your patient. We will use this
list to give you personalized, individual feedback on clinical measures.
• Your Case Manager has a paperwork folder for your Color + number team
(i.e. Pink 1) – complete this every day and return. No paperwork should
go to individual mailboxes (cubbies in the back room)
• Please ensure every patient that you see has scheduled follow-up with
their primary care physician. Add the appropriate physician’s name in the
comment box under “Follow-up” in Epic so that the patient gets back with
the appropriate physician. (See Epic Tips)
Documentation: Your notes should be completed within 24hr of seeing the
patient and preferably prior to leaving clinic the day you saw the patient. You
should not delay seeing patients who have arrived in order to write your clinic
notes. If you bring a patient back quickly for follow-up, communicate the reason
for this in your note – be clear!
Medications: You are expected to update the Medication list each visit and eprescribe all needed prescriptions at the time of the visit. Please give sufficient
refills (up to 11 refills) or enough to f/u visit. If you do not your nurse will be
Resident Expectations
paging you. If a patient is on long term pain medications, please ensure that there
is a physician/patient controlled substance agreement. Patients on Pain
Agreements are required to be seen q 4 months by their primary care MD. Pharm
D’s are available to assist with management of those patients on long term
anticoagulation, provide diabetic education, smoking cessation counseling, and
assist with medication management.
Education: Update your Portfolio weekly during the month
• Complete Self-assessment at the beginning of the month
• Outline 3 learning goals per month
• Outline 3 mini-CEX goals per month
• Complete 7 on-line Hopkins modules per month
• Present Morning Report using structured curriculum (per schedule)
• Attend all conferences
• Meet with your faculty 2 weeks into the block– sign off on your MidPoint
evaluation checklist
Academic ½ days:
• Attend scheduled lectures and meetings
• Complete patient care paperwork, labs, test results, letters, etc. for Team (i.e. Blue
1)
• Work on QI project and publications/presentations related to clinic
• Complete on-line ambulatory curriculum (Hopkins) and Board Review
• Morning Report Prep
• Update your portfolio weekly
Clerical:
• Continuity a resident issue – designate f/u resident on the AVS in comment
section
• Vacation – add team color to the vacation form; 1 from each color must be in
clinic
• AMION schedule for clinic done at least 2 months in advance
Attending Duties
• Beginning of the month
– Residents will be oriented and set goals for the information below; record
in portfolio
• 2 weeks
– Review the following with residents:
• Learning Goals 3 (Self-assessment)
• Mini-CEX goals 3 (Resident choice)
• On-line curriculum progress 7
• Morning report progress 1
• Aging Q3 Acove progress
• Feedback on performance: complete the MidPoint Evaluation form
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Learning goals
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Mini-CEX goals
On-line curriculum goals
Morning Report assignment
End of the month
– Whole team evaluates at week 3
– Meet with resident to do feedback if needed or desired