How many patients will I be scheduled to see in a half day?
For your first few sessions in the IMC as an intern, you will likely only have 1-2 patients to see. Slowly over time, this number will increase to a max as 6 as an intern and 8 as a senior (Categorical IM). You can expect 2-6 patients scheduled per half day, depending on your year of residency.
Can patients be added to my schedule?
Patients can be added to your schedule if there is a cancellation, no show or a same day visit. These are generally for acute complaints, but other issues may be apparent after they are seen. We try to avoid overload for any one clinician, but the goal is to provide access to care if we can. If you are getting behind and faculty are not already aware, please let them know and they will look for a solution with you.
Do I have to be in the clinic all day?
If you are scheduled to see patients for the half day, arrive by 8 AM for the morning and 1 PM for the afternoons. Check in with your assigned faculty member when you see them. If you don't have any patients scheduled until later on in the half day (common if you are on med team), you may be given permission to come back at a certain time.
What if I am running late due to weather, car trouble or some other unexpected event?
If you are running late and it will effect patient care, call or text the chief resident through Epic Chat. The team will work to adjust your schedule if necessary.
You should plan to attend all didactics, meeting now in the resident library from 8-8:30 on Tuesday, Wednesday and Thursday mornings.
Didactics are scripted learning cases that introduce you to 12 different patient conditions using embedded links to diagnostic and treatment guidelines. Prepare by reading through the case and using the links to answer questions. You will be expected to prepare for each didactic. If you are assigned to Present or Back Up Present, start the session at 8 AM. Read the case aloud and ask participants to offer answers to the questions before providing the answer. Finish promptly at 8:30 AM to allow time for the IMC Huddle. Each Didactic has a Back Up Presenter who should also be able to lead the session if the Presenter becomes unavailable.
For more information on Didactics, and this month's schedule use the button, "Didactics" below.
IM Business Curriculum
On the second or fourth Tuesday, your AM schedule will be open to participate in the IM Business Curriculum. This curriculum is modular- short segments, and changes based on which modules you have completed already. You will receive an email detailing which module you are scheduled for and how to complete a pre-test or reading before the session. Unless you are assigned self study there is a brief small group session at 8:45 (usually held in DOM Conference Room B), followed by a brief application assignment for the module. This training includes healthcare reimbursement, creating a therapeutic relationship with your toughest patient, using population health tools to identify care gaps, leading a clinical team and understanding and addressing bias and healthcare disparities.
If you are unable to attend this session please notify Dixie Bennett(*53690) in the Department of Medicine. You will be reassigned or given a self-study version of the module.
You can preview the IM Business Curriculum by using the Button above this section.
Change Team Meeting
The Change Team is a interprofessional design team that is implementing the patient centered home model at our office. This care has been shown to improve quality and outcomes in the IMC. The team, which includes residents, faculty and staff, designs and conducts rapid tests of change to expand and improve our care. This learning experience helps residents begin to develop skills they will need to lead clinical improvement teams.
You will be assigned a half day in the Summa Anticoagulation Management clinic. This learning experience will familiarize you with evidence-based protocols that are used by hospital pharmacy staff to ensure safe levels of anticoagulation for patients with a broad selection of conditions. Check to be sure you know the location of the clinic and report there for your half day. There is also a didactic session that will reinforce the safety and selection of anticoagulation protocols.
Should I use Pre-Charting?Billing Tips
Yes. If the patient has not 'Arrived' you should double click on their name on your schedule to enter the Pre-Charting area.
Pre-Charting is a great feature that allows you to start a note before the patient is being seen. This is the time to: use Chart Review to check prior encounters, visits with consultants, lab results; add/remove items from the problem list; plan expected health maintenance; Use Up To Date to advance your knowledge on diagnosis or management of conditions that you are expecting to see that day in the IMC.
NOTE: if the patient does not show up, the pre-charting encounter will auto-delete in 30 days. All of the work that you put into the problem list will not be lost. Your note however will be deleted. If your note contains key information that you do not want to lose, you can add it to the “specialty comments” box on the synopsis tab.
Which templates should I be using for my notes?
There are two templates that we recommend you use. It depends on whether you like to free text your assessment and plan or type it in the problem list! The two dotphrases are: IMCGENNOTEPBPAPV1 or IMCGENNOTEFTV1. You can “steal” these from faculty smartphrase lists or talk to your attending to see if they can help you get these!
What has to be done before I print the After Visit Summary (AVS)?
You should enter Visit Diagnoses, any new or future Orders, any Medication refills, any referrals (consults), any Patient Education, Patient Goal, Level of Service, Follow up information including ALL of the following: When, with which provider, & for what reason (e.g. return in 2 weeks for BP check with Dr. Smith).
What's up with Transition Notes? Why can't I close my note?
You cannot close your note because an Express Lane is added when the appointment type is selected by Scheduling and there are unpopulated fields designates as (***). To complete the Express Lane look through your Note for (***) or use the Alert warning to navigate to the segment that needs completion. As soon as you address these areas the note will close.
Billing: How do I select the proper Level of Service for a visit?
You will learn this over time. Ask your staffing attending to start out. There are several sheets posted in the bullpen that explain which level to pick. Use the Billing Tips Button to access the tip sheet that will help you. At the most basic level: if the attending goes in the room you will most often check a EL4. If the attending does not go in the room it will likely be EL3. Always confirm billing code with attending while staffing.
Do I need to set Patient Goals for patients with one or more chronic disease?
Yes: Goals are a great evidence based way to engage passive patients and to understand what they need to assume some of their own self care. We are focusing on completing goals especially on all diabetics, but it is good practice to use in all your patients with any ongoing health issue. See the tip sheets under the PCMH Tab on this page to document these correctly in order to meet documentation criteria for Patient Centered Medical Home (PCMH)
Which faculty member will supervise me for my half-day session?
There is a list of faculty assignments posted on the whiteboard in the bullpen next to the virtual visit room.
Should I talk with the faculty supervisor before seeing patients?
Offer to do so; the individual faculty member will give you their preference. In general most attendings will want you to come to clinic prepared to give short 30 second synopsis of what you believe needs done at the visit and any questions that you have or couldn’t answer during pre-charting.
Does the faculty member have to go in the room to observe me?
During the first half of the year this is required for all interns; during the second half it’s more optional. If the visit is complex and will be billed at a level 4 or higher the attending needs to enter the room for at least a short part of the visit. They may observe your instructions for the patient usimg the AVS (After Visit Summary) or any other part of the visit.
When I finish my note, how will I know which faculty member to list as my supervising physician?
Always list the faculty member who staffed the patient with you. You must select this person as supervisor when signing yiour niote.
How will I be evaluated?
Faculty members who have worked with you will be looking for a single thing you could begin doing to improve. To make this more useful, volunteer anything you are working on (time management, preventative screening, behavioral health, etc.) with your faculty member and they will try to give you feedback specific to your learning target.)
Remember: It is a relatively short time in your professional life that you will have skilled faculty members eager to make you more efficient, more observant or more communicative with your patients. Tell them what you are working on and get them in the room to observe you and give you advice while you are still in training and have this benefit available.
How Do I use Translation Services?PCMH-Talking Points
Check with the MA to use the iPad on Wheels. The touch-screen prompts are self explanatory. Even though many family members will offer to translate, in some cultures they will feel a need to alter what you say to satisfy norms. For example, only the eldest son may be able to discuss a serious disease with an elder. Offer to engage a trained translator and the family member can still offer their additions or stay involved in the interview.
What are Talking Points and when should I use them?
Some conversations with patients are awkward or require special training. Talking Points include the language you should use, how to place orders and how to satisfy the Health Maintenance on multiple items. These were developed by specialists who share their tips with us. You can access all Talking Points using the Button.