resident continuity clinic (rcc) manual 2016-2017 · juliana giraldo humaira nael joe oliver maria...

RCC Clinic Manual, Babic B. (Revised 2016, BB)

Resident Continuity Clinic (RCC)

Manual 2016-2017


Table of contents Page

1. Introduction to RCC clinic 3 2. Rotation specific learning objectives 4

3. Resident allocation 2016-2017 6

4. MUMC 2G RCC clinics 8

a. Survival tips 8 b. Navigating Community Wide scheduling 10 c. RCC expectations 11

5. Community RCC clinics 13


Dear Pediatric Residents, Welcome to your resident continuity clinic! Resident continuity clinics have been demonstrated to improve resident learning and autonomy, as well as resident-patient relationships. Resident continuity clinic should enable you to integrate many of the specific objectives achieved in previous ward and subspecialty rotations. You will have a unique opportunity to build communication, management and professionalism skills while providing quality care to patients. We hope that this rotation will be a relevant experience that consolidates your previous learning and challenges you to see your potential as consultant pediatricians. Some of you are assigned to the 2G clinic at McMaster and some of you are placed in the community offices. Regardless of location, you are responsible for pre-reading, completing timely patient assessments, reviewing with supervisor, counselling, documentation and billing of the encounters. You will be expected to see 3-4 patients per clinic, generally 1-2 new and 1-2 follow-ups. It is crucial that you stay committed to the assigned clinic dates, as that is the only way to ensure continuity for you and for the patients. You should review each patient with the assigned staff within the allotted 10 minutes. One mini MAS should be done per clinic and you should choose which aspect of the patient encounter you want observed. The final ITER will be completed yearly. In addition, you will complete the staff evaluation forms as well as rotation evaluation at the end of the year. All evaluations can be found on One45. We welcome your constructive feedback as we continue to improve your educational experience. Your RCC clinic resident rep is Lindsay Fleming, and your faculty rep is Bojana Babic. Don’t hesitate to contact either one of us if you have any questions or concerns. Sincerely, Bojana Babic [email protected]


Rotation Specific Learning Objectives Resident Continuity Clinic is a longitudinal continuity experience starting in PGY-2 until graduation. This experience should allow residents the opportunity to develop an understanding and appreciation for the longitudinal nature of general pediatric care (and most of its subspecialties). Under graduated supervision, residents are expected to be primary physicians and decision makers for their patients. Residents will be able to manage a variety of acute and chronic general pediatric conditions. They will gain better insight into therapeutic relationship of patient-physician as it evolves over time. There is emphasis on learning practice management and health resources utilization. This longitudinal experience should enable the resident to be prepared for independent practice capable of assuming a consultant’s role.

(A) Medical Expert

(1) The resident displays knowledge of common acute and chronic problems encountered in consulting pediatrics.

(2) The resident demonstrates an understanding of normal/abnormal development, nutrition and behavioral issues.

(3) The resident can take comprehensive histories and perform accurate exams in patients of different ages.

(4) The resident is able to outline an appropriate management plan including relevant investigations, subspecialty consultations and resources (allied health/community).

(B) Communicator

(1) The resident demonstrates age appropriate interview techniques. (2) The resident demonstrates sensitivity to emotional and cultural issues, as

well as knowledge of confidentiality limitations. (3) The resident presents cases in an organized and succinct fashion and

dictates notes summarizing the assessment and management plans in a timely fashion.

(C) Collaborator

(1) The resident collaborates with his/her colleagues ensuring resident coverage for all clinics if a switch is required.

(2) The resident works well with all members of the clinic. (D) Manager

(1) The resident shows awareness of cost/benefit issues in the management of patients.

(2) The resident should demonstrate knowledge of appropriate shadow billings.


(3) Residents in the “Community Stream” should develop an understanding of how a busy consulting pediatric office functions.

(E) Health Advocate

(1) The resident actively promotes involvement of the patient and family in medical decision-making.

(2) The resident is aware of the importance of communication between all members of the health care team including public health, schools, pediatric subspecialties, allied health and family doctors. (3) The resident shows knowledge of community resources available to help their patients (i.e. COPE, Child Welfare, Contact, and other regional resources)

(F) Scholar

(1) The resident recognizes the importance of continuing medical education and demonstrates reading around cases.

(2) The resident’s knowledge and skills continue to progress as expected during the longitudinal nature of this clinic.

(G) Professional

(1) The resident understands the importance of meeting commitments to patients, families and colleagues.

(2) The resident recognizes his/her limitations in consulting pediatric practice and seeks appropriate assistance

6 RRC Clinic Manual, Babic B. (Revised 2016, YH, BB)

Resident Allocation 2016-2017

MUMC 2G Clinic:

Caroline Diorio

Brianna Empringham

Ashley Mackey

Rebekah Smith

Attila Ahmad

Noreen Choe

Fawaz Al-Anzi

Haifa Al-Faraidi

Juliana Giraldo

Humaira Nael

Joe Oliver

Maria Chacon

Hannah Geddie

Abeer Hegazi

Kristin Inch

Vidushi Khatri

Lukas Kieswetter

Jennifer Klowak

Daniel Mulder

Community Clinics:

Drs. Orovec, Babic and Ramji: o Lindsay Fleming, Jessica Dooley

Dr Seigel: o Sarah O’Connor

Dr Hallett (Waterdown office): o Katelyn MacKenzie and Meredith Noel

Drs. MacNay and Chitayat: o Christine Tenedero

Dr. S. Wahi:


o Madeline Burdick and Mena Bahnam

Drs Alderazi/Bonsu: o Robin Mackin, Kendra Komsa

Dr. Nwebube: o Nadia Mansoor (as of January 2017)

Dr. Hunter (Ron Joyce): o Ania Van Meer and Anushka Weerarathne

Kitchener Waterloo: o Jessica Norris o Mallory Fox o Matthew Purser


MUMC 2G RCC Clinics

Survival tips to new residents in the Resident Continuity Clinic (or SRC = Senior Resident Clinic)

Topic Tips Questions If you have any questions, please feel free to ask the RN. She will be happy to

assist you.

Any feedback is greatly appreciated and improves clinic for all

No Show If a patient is a “no show”: dictate a letter outlining this so the family physician is aware

Communication Please bring and wear your pager in clinic. This is how the RN communicates that your next patient has arrived and to keep the clinic flow efficient. Also, text messages are less disruptive than knocking on the door to relay this information.

All patient/family communication will be relayed by the RN via email unless it is urgent. Please check your e-mails periodically for any communication and respond in a timely manner. If the matter is urgent, the RN will attempt to page you or the supervising pediatrician.

o It would be appreciated that you communicate when you are away (e.g. vacation, conference) so that the RN is aware in case any patient / family wishes to communicate with you.

Please be courteous to the 2G Business Clerks. If you have a question, and the Business Clerk is busy registering a patient, please wait until this process is completed before asking your question.

In all communication, please state which resident clinic you are in. For example, if you want to pick up your clinic documents on Wednesday, be prepared to state which resident clinic you are in. The Business Clerks do not have the resident schedule to refer to.

Dictations Timely dictation! o The goal is to dictate before leaving clinic. o Always put the dictation number on the Sovera face sheet. This way, if

the dictation does not appear in Meditech you have a way of tracking it for Transcription Services.

Once your dictation is completed, place your documents in the left upper cabinet in muster station 2 in the 2G clinic. Please include all documents, including patient labels. The RN will sort and send the appropriate documents to Sovera. The cupboard says “General Pediatrics.”

Clinic Prep Your clinic list, RMA billing and new referrals are prepped by the 2G Business Clerks on Wednesday and can be picked up late Wednesday.


Topic Tips Transitions If the follow-up appointment is scheduled for the next resident year, please

dictate a comprehensive summary as a courtesy to the next resident, who will be seeing the patient as a follow-up appointment.

Clinic space Space is at a premium in clinic. We only have one clinic room per physician assigned to us. This poses a challenge for efficient clinic flow. It has always worked because everyone works together to facilitate this process.

Documents There are 2 carts with clinic documents; one for patient education documents and one for clinical forms. If the RN is in clinic, then she will ensure that they are available. If she is away (e.g. on vacation), they can be located either in muster station 5 or the 2G supply room. Please feel free to locate these carts if the clinic nurse is away and then return them to the supply room once the clinic is done.

At the front of the 2G clinic, behind the front reception area are slots for consult forms, test requisitions etc. These slots are clearly labelled.

o If the RN is in clinic, she will place the forms in the appropriate slots, but if she is away (e.g. vacation) then it will be your responsibility.

o Another tip, if the test or consult is urgent, please clearly label this on the form. The triage process is different for any urgent referral or test.

o Also, please state the supervising pediatrician on any forms. For example, nuclear medicine will not accept any form that does not clearly state the pediatrician’s name.

If a patient’s Diagnostic Imaging CD from an external source needs to be uploaded into Meditech, a DI form needs to be completed stating to upload to the system. If you wish to have it interpreted by our radiologist, just add this as well to the form. Place the CD and form in an envelope with it clearly labeled on the front of the envelope to go to Film Library. The RN will assist with this if she is in clinic. Otherwise, give the envelope to one of the 2G Business Clerks.

If you use the back of the outpatient progress note, please leave room for a patient label.

Bookings There is a process for booking new patients into the clinic and this always includes a paper process.

o For patients discharged from hospital, a discharge order AND a green referral form should be written and is sent by the ward Business Clerk to the 2G clinic.

o For ER patients, a referral form is faxed to the 2G clinic (Fax#: 905-521-5056).

o If you plan to follow this patient yourself, you will need to know the exact date and time of the appointment from your SRC clinic schedule as well as the resident code (RES1, RES2, RES3 or RES4).

o It is wise to email Wendy and/or Yvonne


Topic Tips There is a clinic template for scheduling (2 new and 2 follow-up patients per

clinic). If this template schedule needs to be overridden, please communicate with the RN before proceeding to book the patient.

The template for all clinics are: o Morning clinic is from 9-12 at muster station 2 and we have rooms 5, 6,

7 and 8 o Afternoon clinic runs from 1-4 at muster station 2 and we have rooms

6, 7 and 8

Switches If you switch with another resident, please communicate this to the RN in addition to the other key medical individuals. You are responsible to ensure that you maintain patient continuity.

o If any patients need to be rescheduled please communicate this at the time of the switch to the RN and other key individuals.

o If rescheduling is not possible, please pass on a report to the resident who will be seeing the patient in clinic.

o The RN will update and post any changes to the resident schedule. This schedule is printed and posted at muster stations 1 and 2 in the 2G clinic.

Navigating Community Wide Scheduling

Enter into Meditech

After entering your USER ID and PASSWORD, choose “Community Wide Scheduling”

Type RES1, RES2, RES3 or RES4 then Return

Use arrows to select the appointment date you wish to view

Press “A” for appointments, and a list of your patients for the selected date will appear with

their booked appointment times


Use arrows to highlight and select the patient of interest

Type “M” or click on “Modules to move into a standard Meditech list of options for that patient

MUMC 2G RCC Clinic Expectations

Pre-read about each patient by reviewing available notes on Meditech or reviewing referral letters faxed to the 2G clinic; come prepared with any notes, handouts or action plans that may be needed for each patient. If the clinic nurse is absent, prepared harts are available for pick up the morning of the clinic in the business clerk area.

Arrive at least 5 minutes before clinic begins to gather and organize any necessary paperwork and review any documents that may not available on Meditech.

Dress in professional attire - OR greens, jeans etc. are not acceptable for clinic.

Time management recommendations:

o 1 hour for new consultations (40min history and physical exam, 20 mins to review with

staff and counsel patient/their family)

Patient names

listed here


o 30 mins for follow-up (20 min history and physical exam, 10 mins to review with staff

and counsel patient/their family)

Mini-MAS must be completed with each RCC clinic. The resident and staff will pre-identify which portion of the history, physical examination, or counselling session will be observed for a patient at the beginning of clinic. Staff will come into the clinic room, observe the encounter and provide feedback.

Residents are encouraged to write billing codes for each patient encounter on clinic billing sheets

Residents are expected to dictate each patient encounter. Dictation job ID numbers are to be written at the bottom of each chart. Dictation must be completed the same day.

Patient charts can never leave the clinic.

Residents are expected to follow up on the investigations ordered and review them with the staff. If investigations are done outside of the hospital, staff is expected to forward the investigations to the resident for review.

If a patient is a No Show, please dictate a brief letter to the referring physician/family doctor so that they are aware and ask for the appointment to be rescheduled if still warranted.

If there is a schedule conflict, the resident is expected to find his or her own replacements and notify the RCC clinic resident rep of the switch. She will notify the RCC clinic nurse who will make changes to the schedule.

It is the resident’s responsibility to know when their RCC clinic takes place. Missing a scheduled clinic will result in documentation of unprofessional behaviour and the resident will be required to meet with the program director to discuss the reason for their absence.

Residents should forward formal evaluations via One45 every 6 months to their clinic supervisor.


Community RCC Clinics

Resident Scheduling

2nd and 3rd year residents will be booked for their half-day RCC clinic once a month.

4th year residents will be booked for their half-day RCC clinic twice a month.

During out of city electives, residents may miss clinics for that month and can make up

this missed time on a different rotation if acceptable to their attending

A half day will be chosen that is mutually agreeable to the resident and the staff

supervising the continuity clinic

Residents will be requested for availabilities at least 6 months is advance

Residents will follow patients whom they have seen previously to encourage continuity

Patient Booking Residents will ideally see 3 or 4 patients per half-day (i.e. 2 consults, 2 follow-ups OR 3 consults)

Booking times are suggested as follows:

o 1 hour for new consultations (40min history and physical exam, 20 mins to review with

staff and counsel patient/their family)

o 30 mins for follow-up (20 min history and physical exam, 10 mins to review with staff

and counsel patient/their family)

Education/Evaluation

A mini-MAS is to be completed by residents with each RCC clinic. The resident and staff will pre-identify which portion of the history, physical examination, or counselling session will be observed for a patient at the beginning of clinic. Staff will come into the clinic room, observe the encounter and provide feedback.

Education occurs on a case-by-case basis around each patient during discussion.

Residents are encouraged to learn how to bill for each patient encounter

Residents should forward formal evaluations via One45 every 6 months to their clinic supervisor. Professional Behavior

Pre-read about each patient by reviewing available notes or reviewing referral letters faxed to the clinic; come prepared with any notes, handouts or action plans needed

Arrive at least 5 minutes before clinic begins to gather and organize any necessary paperwork and review any documents that may not available on Meditech.

Dress in professional attire - OR greens, jeans etc. are not acceptable for clinic.