Resident Education for Ambulatory Medicine

New Module: Serious Illness Conversations
Calling all interns: Download the current resident handbook to know how the clinic works, how to format your notes using templates and how to become more efficient.

Seniors might want to review the manual since it has been made more concise and tips reflect current best practice for documentation.
IMC 2019 Resident HandbookIntern Epic Checklist
Simple Billing TipsResident Billing FlowsheetComplete Ambulatory Billing Sheet

Key Points on Pro Fee Billing

Changes in the IMC for how we see patients starting July 1, 2019

We began Professional Fee Billing in the residency clinic starting in July, 2020. Up until now, billing has been handled as a hospital service. Pro Fee billing is a way of more accurately capturing reimbursement for services we perform. This industry standard also will help residents address their learning need for business skills required when they become employed as physicians upon graduation.

Leads for this project: Kamal Dayal MD; Office Manger, Lisa Geer.

Dr. Dayal asks that all residents and faculty be aware of the following Key Points regarding our Pro Fee Billing:

Key Point 1: Residents will be assigned to attendings.

This will be mailed out as a weekly assignment schedule and posted in the IMC.

Key Point 2: PGY-1's in their first 6 months of internship MUST have an attending see the patient for at least some part of the visit.

This usually occurs briefly after the resident has staffed the patient. As we increase the number of staff faculty over the next few months, they will be available to enter more senior resident rooms as well.

Key Point 3: Level of Service (LOS in your Navigation Menu) matters now!

Remember those EL4 or NL3 buttons we click randomly? Well, now they mean something. The Tip Sheets available on this page will help you decide which Level of Service to choose for your visit. On the most basic level, if the attending didn't see the patient, it's probably an EL3. If the attending did see the patient it's probably an EL4, as long as you addressed at least three problems during the visit. This is a huge generalization but it will help us hit the ground running. Ask an attending if you aren't sure! (Notes billed incorrectly will start to show up in the faculty boxes for to be corrected so it's best to get it right the first time.)

Key Point 4: Signing notes on time is still important!

Both the resident and the attending have to sign the note before it can be billed.

Key Point 5: Pre-staff your patients with your attendings!

It doesn't have to be exhaustive, but preparing for clinic and telling your attending what you expect before hand leads to a much smoother clinic day!

Our lead team has visited clinics where're-fee billing is already in place. We realize this represents a big change, especially for how we train PGY-1's, but all our PGY levels will be affected. It will allow for more direct observation, make the IMC less intimidating for PGY-1s who are just trying to figure things out and create a more collaborative working environment in the IMC.

Our clinic includes a staff pharmacist, pharmacy students and resident who can help you find the appropriate formulary choice at the lowest cost.
$4 Medication List

Working in the IMC:  Video Learning Center

Working in any ambulatory setting requires learning the workflow and how to make the system work for you and your patient. In this series of videos, our faculty shares their expertise designed to strengthen your ability to prepare, conduct and document an ambulatory visit efficiently. Whether you are an intern on IMC month or a senior preparing for practice, you will glean new practical tips from each video.

Navigating a Patient Visit   
Dr. Katherine Tatar    
(11:24)

Dr. Tatar walks you through the basics of navigating a chart during an office visit.

Precharting     
Dr. Katherine Tatar
(12:52)

Dr. Tatar discusses the basics of precharting, which includes reviewing information and pre-visit documentation.

Medication Reconciliation
(6:27)
Dr. Michelle Cudnik

Dr. Cudnik discusses the nuances of performing an accurate outpatient 'med rec'.

Patient Calls
(13:19)
Dr. Kamal Dayal

Dr. Dayal gives examples about different types of patient messages you might encounter in the outpatient setting.

Result Notes
(6:55)
Dr. Brad Moore

Dr. Moore talks about the importance of documenting notes about patient results, and how to do it.

Medication Refills
(12:40)
Dr. Brad Moore

Dr. Moore discusses how to appropriately prescribe medication refills in the outpatient setting.

Problem Lists
(40:33)
Dr. Irene Chenowith

Dr. Chenowith talks about problem lists, an extremely useful (and important!) but often ignored part of the EMR.

Preventative Health
(21:20)
Dr. Emily George

Dr. George talks about the basic principles of preventative health as well as the nuances of managing it in our outpatient EMR.

Serious Illness Conversations

One of the most important communication skill sets physicians must learn is holding an effective conversation with a patient about their serious or advanced condition. The way a physician does this can improve patient engagement and patient outcomes. How does a physician bring up the topic, address patient unwillingness to discuss or address their condition and guide them through decisions that honor patient preferences?

In this learning module, you will:

1. Learn terms commonly associated with end of life
2. Learn a structured, evidence-based, patient-centered approach to conducting a conversation about serious illness
3. Actively incorporate the patient's values, goals and choices surrounding any life limiting illness

This module is required for interns and recommended for all residents. The entire course requires 2 hour to complete, but you can start and finish in shorter segments.

The module uses a series of videos with interactive features. Additional materials recommended by the course authors are made available for download from this web page. To begin the course, follow this link (use the password provided by email):


Serious Illness Course
Valuable resources recommended for this learning experience:
Serious Illness Conversation Guide For residents
Learn an outline to use when conducting a serious illness conversation.
Download Short Guide
Serious Illness PowerPoint
Review key concepts of this module by downloading this slide set.
Serious Illness Conversation Slide Set
Serious Illness COnversation Guide (LonG Version) with examples
This expanded guide includes tips and examples to gain a broad mastery of this skill.
Download Full Guide
Advance Directives Packet
Choices- Living Well at the End of Life is a guide produced in association with the Ohio State Medical Association and the Ohio Hospital Association to answer questions to guide patients and families through their decision-making about end of life.
Advcance Directives Packet
Fostering a Therapeutic relationship


This article reviews the key steps you can take in any patient encounter to build a working partnership.
Form A Therapeutic Relationship
Showing Empathy in a way Patients can Recognize
Use these statements in your encounter to be sure the patient can tell you accept them and affirm them as a person.
Empathy Article