Urgent Care
I.
Rationale
Urgent Care Medicine is the provision of immediate medical service offering outpatient care for the
treatment of acute and exacerbation of chronic illness and injury. The Urgent Care elective provides
services to adult patients with a wide range of acute and chronic medical conditions. A comprehensive
fund of knowledge and skills are required to provide such care. Urgent Care providers are often the first
to diagnose acute and chronic medical conditions. In addition, Urgent care providers begin management,
obtain appropriate consults and make necessary referrals for effective patient care.
II.
Goals
The goal of the Urgent Care rotation is to teach family medicine residents the Urgent Care model of
practice which is to evaluate an acute complaint. Emphasis is placed on appropriate evaluation of signs
and symptoms to make accurate diagnosis to guide appropriate triage and treatment decisions. Skills
focus on case presentations centered on the acute complaint, recognizing high risk conditions, efficiency,
rationing of resources, utilization and interpretation of laboratory data, appropriateness of referrals and
consultations.
III.
Objectives
By the end of the Urgent Care rotation, each resident will demonstrate the following under each
competency category:
Medical Knowledge
A.
B.
C.
D.
E.
F.
Properly evaluate signs and symptoms for accurate diagnosis.
Recognize high risk conditions and triage appropriately.
Utilize and interpret available laboratory and imaging resources in an effective manner.
Recognize indications for urgent consultation.
Recognize indications for referral.
Perform common clinic procedures such as: tonometry, fundoscopy, flourescein corneal exam,
arthrocentesis, soft tissue injections, I&D, suture, removal, splinting, anoscopy, pelvic exam
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Dir
Review
360 ᵒ evaluation
Other
Last updated March 7, 2013
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Patient Care
A. Provide an effective, focused, problem based case presentation.
B. Create appropriate assessments and make therapeutic decisions based on correct interpretation
of data, use of resources and recognition of high vs low risk conditions.
C. Demonstrate sound judgment, insight and prioritization skills in order to make appropriate clinical
choices.
D. Safely and proficiently perform medical procedures that minimizes patient’s discomfort and maintains
sterile precautions.
E. Demonstrate efficiency and improve time management skills.
F. Be able to manage the following common urgent medical problems:
1. Neurology and Psychiatry
a. Headache
b. Vertigo
c. Dizziness
d. Depression/Anxiety
e. Syncope
f. Insomnia
2. Ophthalmology
a. Eye Pain
b. Red Eye
c. Eye Trauma
d. Visual Change
3. ENT
a. Ear pain
b. Tinnitus and Hearing Loss
c. Allergic Rhinitis
d. Epistaxis
4. Oral and Dental
a. Dental pain
b. Mucocele
c. Oral Candidiasis
d. Oral HSV
e. Sialolithiasis
f. TMJ
5. Cardiology
a. Chest Pain (Typical vs Atypical)
b. Palpitations
c. HTN (Newly dx, chronic, urgency/emergency)
6. Pulmonary
a. Cough
b. Dyspnea/SOB
c. Hemoptysis
7. GI
a. GERD/Dyspepsia/PUD
b. Vomiting/Diarrhea
c. Abdominal pain
d. Rectal bleeding/pain
e. Hemorrhoids
f. Dysphagia
g. Jaundice
h. Cirrhosis/ascites
i. Hepatitis/Transaminitis
Last updated March 7, 2013
8. Urology
a. Hematuria
b. Nephrolithiasis
c. Scrotal pain
d. Dysuria
e. Urinary Retention
f. Urinary incontinence
9. Gynecology/Women’s Health
a. Pelvic Pain
b. Vaginal Bleeding/Menorrhagia
c. Vaginal discharge
d. Breast Pain/Discharge/Mass
e. Galactorrhea
10. Musculoskeletal
a. Neck pain
b. Shoulder pain
c. Wrist/Hand pain
d. Back pain
e. Hip pain
f. Knee pain
g. Ankle/foot pain
h. RA
i. OA
j. Gout
k. Fractures-Closed simple
11. Soft Tissue
a. Animal Bites
b. Foreign body/Puncture wounds
c. Paronychia
d. Ingrown toenail
e. Ulcers-DM, Venostasis
12. Dermatology
a. Dermatitis (Contact, Eczema)
b. Herpes Zoster
c. Burns
d. Scabies
e. Tinea
f. Warts
g. Psoriasis
h. Drug eruptions
i. Rosacea
13. Endocrine
a. Diabetes (New onset, chronic, DKA)
b. Hyperthyroid/Hypothyroid/Thyroiditis
c. Thyroid nodules
14. ID
a. Tooth abscess
b. URI
c. Sinustitis/Otitis
d. Pharyngitis/Tonsillitis/Peritonsillar abscess
e. PNA/Bronchitis
f. Gastroenteritis
g. Diverticulitis
Last updated March 7, 2013
h. Pyelonephritis
i. UTI
j. Prostatitis
k. STDs
l. Cellulitis/Abscess
15. Renal
a. Renal failure (Acute, chronic)
b. Fluid and Electrolyte imbalance
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Dir
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
A. Demonstrate effective listening, narrative and nonverbal skills for effective patient care.
B. Perform an effective, well organized case presentation with a focus on the acute complaint.
C. Communicate and counsel patients and their families effectively regarding working diagnosis, workup and treatment.
D. Demonstrate respectful and collaborative relationships with colleagues and other clinic employees.
E. Document care appropriately in the medical record.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Dir
Review
360 ᵒ evaluation
Other
Last updated March 7, 2013
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
A. Demonstrate respect, compassion, integrity and honesty.
B. Role model responsible and ethical behavior, including acknowledgment of errors.
C. Consider the needs of patients, families, colleagues and other clinic staff; including sensitivity to
different cultural/socioeconomic backgrounds, and avoiding judgmental behaviors.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Dir
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice-Based Learning
A. Demonstrate a commitment to self-assessment and improvement by listening and incorporating
provided feedback.
B. Effectively apply evidence based medicine by using information technology resources available. (e.g.
UptoDate, Visual Dx)
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Dir
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems-Based Practice
A. Effectively access hospital, clinic and ancillary resources as well as consults and referrals.
B. Appropriately use practice guidelines.
Last updated March 7, 2013
C. Effectively use a systematic approach to improve patient care in clinic.
D. Comply with all documentation requirements. (e.g. ATEMM procedures, date/time/sign all notes,
iMed, Consent, write legibly and avoid use of unapproved abbreviations)
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
Program Dir
Review
360 ᵒ evaluation
Other
IV.
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Instructional Strategies (see above)
This is a four-week rotation and should be attended by the resident for a minimum of 5-6 half days per
week. The other 4-5 half days per week will be spent in the resident’s continuity clinic and in didactics.
Readings can be obtained from Section VII and should also be solicited from the Urgent Care attending.
V.
Evaluation Strategies (see above)
A.
B.
C.
D.
Observation of the resident by the Urgent Care attending.
Procedure/diagnosis documentation by the resident.
End of rotation evaluation.
AFP Monographs (see below) Pre and Post Tests
VI.
Implementation Methods
The rotation is offered as a PGY3 elective. The Urgent Care rotation is an outpatient experience. The
resident will further his/her rotational experience by continuing to see his/her continuity clinic patients 34 half days per week and by attending Family Practice didactics on one half day per week.
Location:
Lynnette Sells, MD
3720 Holcomb Bridge Road
Norcross, GA 30092
770-263-1000 ofc
440-263-7770 fax
Nick Beaulieu, MD
920 Ponce de Leon Avenue
Atlanta, GA 30306
404-815-1957 ofc
404-815-1954 fax
Last updated March 7, 2013
James Yost, MD
Physician’s Immediate Medicine
2575 Peachtree Parkway
Cumming, GA 30041-2407
770-205-9777 ofc
770-888-8779 fax
Family Practice Center: 5 ½ days per week in the Family Medicine Clinic, 4 ½ days in the Urgent Care
Clinic.
Call/Vacation: Call will be with the FMS @ Emory University Midtown Hospital. Vacation is permitted.
Supervision: Residents will be supervised by preceptor. Residents should document all procedures in
their residency passport.
Conferences: The resident is expected to attend Family Medicine Didactics Conferences.
VII.
Required Readings
AFP Monographs: Adult Office Urgencies (FP Essentials #289)
Childhood Office Emergencies (FP Essentials #338)
Last updated March 7, 2013