Outpatient Family Practice

Generally, first year resident will have 50-100 families, second year residents will have 100-150 families and third year residents will have 150+ families. Residents will maintain the charts, order appropriate tests and submit charges for services rendered.

Each first year resident must confer with the preceptor prior to discharging the patient on each visit. Second year residents are encouraged to confer during office hours. Third year residents will confer as needed. Charts must be reviewed and signed by a preceptor within 24 hours. Faculty will not review every out patient visit note. Representative out patient chart notes will be reviewed by the faculty as follows: 1st year residents - all notes will be reviewed and all cases discussed; 2nd year residents – half of the notes from each session will be reviewed; 3rd year residents - only one note from each session will be reviewed by faculty. Please make every effort to present for note review those cases that may have been discussed with/seen by the preceptor. A Quality Assurance set of indicators will be developed for your use in patient care and for faculty's use in evaluating notes. At least one faculty physicians serves as clinical preceptor for every clinical session. All invasive procedures must have faculty approval and direct supervision. "Externs" (visiting third or fourth year medical students) will see patients with attendings and upper year residents and be supervised directly by that attending or resident. All Medicare patient, Medical Assistance, and BC/BS patients MUST be reviewed at the same session with an attending regardless of resident year.

All residents are encouraged to familiarize themselves with the following procedures routinely performed in the Family Practice Center:

1. Glucose testing
2. Throat culture
3. UA and microscopic evaluation
4. KOH and hanging drop of vaginal smear
5. EKG
6. Spirometry
7. Colposcopy
8. Casting
9. Arthrocentesis and injections
10. Screening Audiometry
11. Dermatologic procedures

Every attempt will be made to have third year residents see four patients per hour, second year residents see three patients per hour, and first year residents will initially see one to two patients per hour. If more time is needed for a particular patient, it is the responsibility of the resident to alert the scheduling secretary to allow additional time for the anticipated visit. Interns and residents will be given add-on patients first to ensure that they see an adequate number of patients/session. Interns will start with three patients/session with a goal of five, PGY-2's with six patients/session with a goal of seven, and PGY-3's with eight patients/session with a goal of ten.

Each resident is expected to answer phone calls concerning his/her patients in the Family Practice Center and to document in the chart all patient contact (problems and recommendations.) In addition, if you are the designated person for your team you must answer the calls for all patients of your team located in the call back box including date and time. Additionally, all test results will be screened and initialed to document that the results of the test were observed. Ancillary actions should be taken and documented in the medical record as well. Acknowledgment and action on abnormal test results are the responsibility of the ordering physician or a designated physician (in the primary provider's absence).

Patients assigned to a particular resident remain under that resident's care until completion of the residency at which time patients will be reassigned to remaining residents on the same team. Changing physicians "mid-stream" is discouraged unless requested by the patient for valid reasons, after review by the Program Director.