University of British Columbia
Pediatrics Residency Program
Resident Continuity Clinic Guide
Last Updated November 2014
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TABLE OF CONTENTS
TABLE OF CONTENTS........................................................ - 2 INTRODUCTION ............................................................... - 4 OBJECTIVES ..................................................................... - 4 GROUP PRACTICE ............................................................ - 5 RESIDENT GROUPS......................................................................... - 5 LOCATION ...................................................................................... - 5 TIMING........................................................................................... - 5 RCC SCHEDULE ............................................................................... - 6 MEDICAL STUDENT ........................................................................ - 6 -
PATIENTS ......................................................................... - 7 PATIENT POPULATION ................................................................... - 7 RECRUITING ................................................................................... - 8 DURATION OF FOLLOW UP ............................................................ - 8 -
LOGISTICS ...................................................................... - 10 CHARTING .................................................................................... - 10 TEST RESULTS............................................................................... - 10 ACCESSING OUTSIDE LAB RESULTS.............................................. - 11 PHONE TRIAGE............................................................................. - 13 PATIENT SCHEDULING ................................................................. - 13 -
HANDOVER.................................................................... - 15 PATIENT DATABASE ..................................................................... - 15 DIRECT PHONE OR EMAIL HANDOVER ........................................ - 15 -
SUPERVISION AND EVALUATION .................................... - 17 ADMINISTRATIVE SUPPORT ........................................... - 18 -
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RCC ETIQUETTE .............................................................. - 19 Teamwork .................................................................................... - 19 Communication ........................................................................... - 19 Planning ....................................................................................... - 19 Follow up ..................................................................................... - 20 Professionalism............................................................................ - 20 -
FAQs.............................................................................. - 21 USEFUL JARGON ............................................................ - 25 RESIDENT TEAM LIST...................................................... - 26 CONTACT INFORMATION ............................................... - 27 Administrative Support................................................................ - 27 Supervising Staff .......................................................................... - 27 Clinic Director .............................................................................. - 27 RCC Committee............................................................................ - 27 -
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INTRODUCTION
As pediatrics residents, we are exposed to the majority of our
patients briefly, usually during a hospitalization or single clinic
visit. We are thus very well-trained in managing acute
pediatric issues, but were lacking the continuity of care that
would help us learn the management of chronic pediatric
conditions and follow a child through normal growth and
development. Participating in a resident continuity clinic in a
longitudinal fashion during our core pediatrics years will fill
this gap in our training and help us better transition into our
future practices as general pediatricians and pediatrics
specialists.
OBJECTIVES
In the resident continuity clinic, we will:
- See new general pediatrics patients referred from the
ER, any subspecialty clinic or from community GPs
- Follow patients we have managed while on CTU, in the
ER or in the intermediate nursery in the outpatient
setting
- Take ownership of our patients and our clinic by seeing
patients independently, selecting and requesting
investigations, following up on results, and arranging
consultations
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GROUP PRACTICE
Starting January, R1s are involved as regular doctors in the
clinic. R4s are phased out in January, but will help out when
staffing is an issue.
RESIDENT GROUPS
There are 4 resident teams, each consisting of 10-12
residents. These teams will function as group practices, much
like Pediatricians in the community. Each team will be
responsible for 1 clinic afternoon (Monday, Wednesday,
Thursday and Friday). These teams were formed to ensure
that a minimum of 2 residents, and a maximum of 3, will be
available per clinic afternoon.
LOCATION
The resident clinic will take place in Area 7 of the Ambulatory
Care Building where the current General Pediatrics Clinic is
located. You can reach this clinic at local 2130.
TIMING
Each resident is scheduled for one afternoon clinic (12:455pm), approximately every 2 weeks, during rotations that
allow for RCC protected time off. Note that the first 15
minutes prior to clinic start are dedicated to CPS statement
review. Residents are responsible for referring to the RCC
schedules that are routinely sent out to find out what dates
the resident is expected in clinic.
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Efforts will be made to schedule you every 2 weeks in RCC
unless:
 You are on vacation
 You are on an away rotation, an off-site rotation (that
is far from BCCH)
 You are on an elective rotation
 You are on CTU or Night Float
 You are post-call
MEDICAL STUDENT
In the morning medical students have full autonomy to see
patients on their own but afternoon clinics are reserved for
RCC; where residents have their own patients booked.
Students are advised to tag along with one resident, where
the resident might give them an opportunity to do a part of
history or examine a system. Even if none is done, they
(students) can learn from residents on how to take an
organized history, interacting with parents, examining child
etc. Also, unless the clinic is very busy, residents should see all
patients and avoid having MSI see patients on their own. The
main reason is supervision of an MSI is different from
supervising a resident. Pediatricians have to spend more time
to review with a student.
RCC SCHEDULE
The RCC Committee will periodically issue a RCC Schedule for
residents (2-3 residents per clinic afternoon). This often comes
out many months ahead of time. Once the draft is out, it is the
resident’s responsibility to identify scheduling conflicts (eg
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scheduled for clinic during vacation / conference leave, etc.)
and notify the RCC Committee so we can make appropriate
changes. Once the final schedule is out, any conflicts
identified will have to be dealt with by the resident
themselves. Typically, this involves trading shifts with another
resident, ideally from the resident’s own group, or from
another group if no one is available. Once a switch is made, 3
people need to be notified: Charlett, your attending and the
RCC Committee scheduling person. An up to date RCC
schedule will be posted in Clinic, on the notice board in the
Resident Lounge and on the Resident Website.
PATIENTS
PATIENT POPULATION
Patients will either be referred to the Resident Continuity
Clinic or be recruited by the residents themselves. Here are a
few examples of where patients come from:
° Referrals from the BCCH Emergency Department,
Pediatric Subspecialty Clinics, or community GPs
° Patients who have been admitted to the Clinical
Teaching Unit (CTU), Intermediate Nursery (IN) who
live in Vancouver and who do not already have a
pediatrician can be recruited.
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°
Patients referred to a pediatric subspecialty clinic who
are deemed by the subspecialist to have a condition
that can be appropriately assessed and managed by a
general pediatrician
RECRUITING
Residents must take initiative to recruit their own patients.
This is the best way to ensure that the continuity clinic
experience is as valuable as possible. There are pamphlets
available on the 3M (grey filing cabinet behind the unit clerk)
as well as in the clinic space (near Charlett’s computer). Every
resident should also have their own personalized business
cards which can be distributed per resident’s discretion. You
can carry your own stash, and there is also a Roladex near the
Blue computer on 3M and by Charlett’s computer in the clinic.
Residents need to make sure there is always a supply of their
cards in each Roladex so that anyone can hand them out on
the resident’s behalf.
DURATION OF FOLLOW UP
This will be decided on a case by case basis. Ideally, patients
will be followed for the duration of the resident's core
pediatrics training. However, a patient who is being followed
for a particular issue which has been dealt with may be
discharged from the clinic if deemed appropriate by the
resident and supervising pediatrician. An example of this is a
child who was being followed up shortly after an admission
for bronchiolitis and is doing well, or an infant with a first
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febrile urinary tract infection who is well and all follow up
investigations are normal. Children who are discharged from
the clinic should have further follow up with their primary
care physician.
Patients who still need follow up after a resident is finished
their core pediatrics training should be transferred to another
(more junior) resident. Ensuring adequate follow up is the
responsibility of the resident who has taken charge of those
particular patients.
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LOGISTICS
CHARTING
Hospital charts will be available at each visit and should be
updated appropriately including documentation of the
encounter as well as a dictated summary of every clinic visit.
In addition, the patient’s chart will have a growth chart which
requires regular updating.
An excel spreadsheet is available on the RCC computer
desktop. Log in as 3HResident (Password 3h3h3h) and a
shortcut to RCC Patient Database is on the desktop. Choose
the sheet corresponding to your clinic day, and please log all
relevant patient information. This serves both as a patient log
and as an up to date “to do list” to which your colleagues can
refer when they are seeing your patients on your behalf.
TEST RESULTS
All test results and consultation reports will be sent to the
attending staff. The resident will follow up themselves on all
investigations that have been ordered. The resident must
communicate by email/phone with their attending to confirm
that they have reviewed the results and notify them of what
actions have been taken. Residents will also be responsible
for communicating results to families when necessary.
Bloodwork and imaging done in hospital will be accessible on
eChart or EVE or iStentor. If outside lab, done either at
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LifeLabs or BC Biomedical, the results can be accessed through
eChart (eHealth Viewer). Most consultations done at BCCH
will be available through EVE. For those consults that are not
posted to EVE (Genetics, CPS, etc.) or outside consultations
(Psychoeducational assessments, Sunny Hill Assessments, etc.)
will be filed in a folder next to Charlett’s desk. You will be
responsible for checking this folder on a regular basis if you
are expecting a report.
ACCESSING OUTSIDE LAB RESULTS
°
°
Open your patient list in PowerChart
Click on eHeath Viewer
°
Enter Patient’s PHN as directed
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°
Access Labs by clicking on “Labs (PLIS)”
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PHONE TRIAGE
The families and patients will be able to call the clinic between
visits and leave a message for a particular resident. That
resident will be notified when someone calls and is expected
to answer the phone calls from a family/patient within 24
hours. These phone conversations should be documented in
the chart of the patient and should also be discussed with the
preceptor. Currently, if the resident is on vacation /
conference / away on elective, and is unable to respond to the
call, the message will default to the RCC MRP. We are working
on implementing a system that would keep resident in the
loop and responsible for their own patients.
When the calls are received by Charlett, she will either email
you (for non-urgent issues) or page you (for more urgent
issues.)
PATIENT SCHEDULING
To book an appointment in the clinic, please call the ACB Area
7 (ext 2130) and book directly with Charlett. New consults
received from the ER or community physicians will be booked
into empty clinic slots. New consults will be booked for 1 hour
slots and follow ups will be 30 minutes.
You can view the schedule ahead of time through PowerChart
to find out which patient you and your team are expected to
see. To avoid keeping patients who are new to you waiting,
we suggest you review the patient’s chart before coming to
the clinic.
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HANDOVER
PATIENT DATABASE
We are using an Excel Spreadsheet with 4 Sheets, one for each
group, to keep track of patients. The document serves both as
a database to easily identify the Most Responsible Resident
(MRR) for any given patient, as well as serving as a handover
tool. This document must be updated at the end of each clinic
day by the resident. It contains a list of items that must be
followed up prior to next patient visit as well as a “to
do/address/re-assess” list for the next planned visit. This is a
safety in case the MRR will not be the one seeing the patient
at the next visit due to unforeseen circumstances (and no
formal email handover took place). The database can be
accessed on any computed by using the 3HResidents Login
and finding the document on the U:/ drive.
DIRECT PHONE OR EMAIL HANDOVER
If a resident cannot attend his/her clinic because of an
emergency and a patient cannot be rescheduled, then the
resident must ensure that the patient is seen by another
member of their team. Or, if a patient requires follow-up
sooner than the resident is scheduled for their next clinic,
then another member of the team should follow this patient
and liaise with the most responsible resident. In this situation,
proper verbal or emailed handover should take place between
the primary resident (MRR) and the covering resident to
ensure efficiency of the clinic and good continuity of patient
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care.
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SUPERVISION AND EVALUATION
Each resident will be assigned to a certain staff pediatrician.
Currently, Dr. Virji supervises on Mondays, Wednesdays and
Friday afternoons, occasionally replaced by Dr. Smith. Dr.
Greenmand covers Thursday afternoons. Although the
resident is responsible for following up all tests and consults
and for communication with families, the Attending
Pediatrician is ultimately responsible for patient care. It is very
important that residents communicate with attendings when
interpreting results and making recommendations outside of
clinic hours. This is best done by email.
They also act as role model for the residents. They must
review and sign the patients’ charts at the end of each clinic
and be available to the resident by phone or email when
necessary. Verbal feedback should be given to the resident at
the end of each clinic. A One45 evaluation will be filled out for
each resident once every four months. Similarly, the resident
will be asked to fill out One45 evaluations of staff and clinic
itself on a regular basis. Residents will also be solicited for
anonymous feedback by the RCC Committee as this is a
resident driven initiative and improvements need to be
identified and driven by residents.
Dr. Janet Greenman is the RCC Director and will oversee all
RCC related matters and help guide this clinic as it expands to
meet the community’s needs and our educational
requirements.
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ADMINISTRATIVE SUPPORT
The clinic has its own administrative support as well as its own
telephone number available to the patients (Charlett McClay,
ext 2130). She will be responsible for the scheduling and
confirmation of patient visits, preparation of charts, retrieval
and sorting of test results and scheduling of special tests. She
will also answer clinic calls and communicate messages to the
appropriate residents between 8am and 4pm from Monday to
Friday.
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RCC ETIQUETTE
Teamwork
°
°
If a colleague doesn’t show, please page/text them
If you see a patient on behalf of your colleague, please
refer them back. They should do the same when
seeing one of your patients on your behalf.
Communication
°
°
Keep Patient database up to date
Email or phone communication in advance if you plan
on having someone else see one of your patients on
your behalf. Email or phone MRR with updates about
the patient you saw on their behalf.
Planning
°
°
°
Divide up patients at the start of clinic so workload is
balanced and you can get out on time for afternoon
rounds.
If there is a long wait time before your first patient,
see if you can help out by seeing Gen Peds patients
(i.e. not assigned to RCC- so long as also not assigned
to MSI), or make use of your time by reading.
Allow 1h for new patients and 30 minutes for followup visits.
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Follow up
°
°
°
Outside labs and imaging now available through
eHealth Viewer/PowerChart
Consults that cannot be found on EVE will be filed next
to Charlett and available for our viewing.
Please stay on top of your consults and results.
Professionalism
°
°
°
°
Arrive on time; if you must deal with a ward
emergency, you must call the clinic and let Charlett/
your attending know.
As soon as RCC schedule is out, look for any
vacation/conference/call conflicts
Remind your rotation coordinator, ahead of the start
of the rotation, of your RCC clinic dates and ask not to
be post-call on those days.
Should you have an unexpected conflict, you must find
someone to replace you (keep us in the loop). If you
are really in a bind, Charlett can schedule fewer
patients on that day if there is enough notice
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FAQs
What if a patient needs medical care in between clinic visits?
Between 08:00 and 16:00, families can call the clinic and
speak to Charlett who will notify the resident by pager (or
email if it is not urgent).
If they need immediate attention, the patient will be referred
to the ER. The resident should call the ER and advise them
that the patient is on their way.
If they do not need emergency attention, the resident can
book the patient to be seen at the clinic at the soonest
appropriate time. These phone assessments should all be
reviewed with the supervising staff.
Outside of working hours: the patient should be taken to the
emergency room in case of emergency. In non-emergent
situations, the family can call on the next working day.
The resident is to be contacted if one of his/her patients
presents is admitted to the hospital and should be able to
participate in the care of his/her patient, along with the
treating team.
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Am I expected to go to clinic while on PICU, NICU and
Oncology wards?
Yes, all departments are aware the Resident Continuity Clinic
is protected time from 12:45-17:00 for pediatrics residents.
However, YOU will be responsible to alerting them to your
specific clinic day as this is variable between residents.
For now, the only in-hospital rotation during which you will
not be expected to go to clinic is CTU and Night float. This
may change in the future depending on feedback that
residents give us.
What if I want to book a patient in on a different day than
the one that is assigned to me?
Try to avoid doing this. You can follow up your patients on
your clinic day or on the alternate week. As there is limited
physical space in the clinic.
You can also book your patient in to see another resident as
long as it is OK with Charlett (ext 2130) and the other resident.
What if I am discharging a patient from CTU and want to
follow them in clinic shortly after?
That’s perfect! You are encouraged to see patients even while
you are on CTU (it’s just not mandatory). Make sure with
Charlett (ext 2130) that there is room on your team’s clinic
day and make sure that you are available as well.
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There are RCC business cards available in the Roladex next to
the CTU Blue computer on which you can write your name
and the date and time of your patient’s appointment.
Brochures about the clinic will also be available shortly.
What if Charlett pages me or emails me when I am away on
vacation or post-call?
If she pages you for an urgent matter and you do not respond
in a timely manner, Charlett will always have the option of
paging the attending staff involved with that patient.
How do I document phone conversations or any important
communications in the chart?
In the same way that you always do it...you need to write a
note on a history sheet and have it put into the clinic chart.
You can even just type/write up a quick note about your
conversation with the patient’s name, date, etc. on it and give
it to Charlett to be filed in the chart.
How many patients will we be seeing per clinic?
Generally, you should be seeing 1-4 patients per clinic,
depending on how many other residents there are in clinic at
the same time.
Initially, you may only be seeing 1 new patient per clinic. That
way you can “build up your practice” from scratch!
You may also be seeing follow-up patients who were formerly
followed by the General Pediatrics Clinic and who are
appropriate for the RCC.
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Will I be in clinic for the whole afternoon?
Yes, you are expected to be at the clinic by 12:45 with your
colleagues. You will be responsible for seeing your own
patients and patients new to RCC will be divided amongst your
group members.
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USEFUL JARGON
RCC: Resident Continuity Clinic
MRR: Most Responsible Resident- Usually refers to the first
resident who saw the patient or did the initial consult.
Otherwise, it is simply the resident who has the most
continuity with the patient.
MRP: Most responsible Physician- One of the RCC
Pediatricians (Attendings) who is ultimately (and medicolegally) responsible for the care of the patient and supervision
of the resident caring for that patient.
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RESIDENT TEAM LIST
Group 1
Monday
Group 2
Wednesday
Kamal Abdulwahab (R3)
Alison Nutter (R3)
Michelle Sherwood (R3)
Arash Adjudani (R2)
Henry Stringer (R2)
Elizabeth deKlerk (R1)
Michelle Lai (R1)
Juliana Wu (R1)
Matthew Carwana (R1)
Samara Laskin (R1)
Melanie Finkbeiner (R3)
Lanna Olson (R3)
Lana Shaiba (R3)
Trisha Patel (R2)
Alison Lee (R2)
Candace Creighton (R1)
Vickie Chow (R1)
Kristen Favel (R1)
Jennifer Cutting (R1)
Rebecca Ronsley (R1)
Group 3
Thursday
Group 4
Friday
Stephany Quinn (R3)
Jessica Breton (R3)
Anas Manouzi (R3)
Mike Fazio (R2)
Anamaria Richardson (R2)
Carmen Tait (R2)
Isaac Elias (R2)
Rachel Li (R2)
Faith Cormier (R1)
Keira Dheensaw (R1)
Colin Meyer-MacAuley (R3)
Alysha Dedhar (R3)
Victoria Cook (R3)
Meghan Gilley (R3)
Irvin Janjua (R3)
Megan Kilvert (R2)
Caroline Malcolmson (R2)
Steven Rathgeber (R2)
Charmaine Wong (R2)
Jennifer Sibley (R1)
Sofie Lopez (R1)
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CONTACT INFORMATION
Administrative Support
Charlett McClay
cmcclay@cw.bc.ca
Supervising Staff
Dr. J. Greenman
Dr. M. Virji
janet.greenman@cw.bc.ca
mvirji2@cw.bc.ca
Clinic Director
Dr. J. Greenman
janet.greenman@cw.bc.ca
RCC Committee
R1 –
R1 –
Elizabeth.DeKlerk@cw.bc.ca
Jennifer.Cutting@cw.bc.ca
R2 – Mike Fazio
R3 – Jessica Breton
mike.fazio@cw.bc.ca
Jessica.breton@cw.bc.ca
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Please do not hesitate to contact us for any concerns,
comments, suggestions that you may have for the clinic. This
is a work in progress and we would appreciate any feedback!
-RCC Committee
Last Updated January 2014
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