FHC Intern Orientation


Rotation Liaison: Dr. Aury Garcia 

Email: avg2117@cumc.columbia.edu

Rotation Goals and Objectives

Introduction to Farrell Health Center Rotation

PGY 1 -  FHC 1

Rotation Goals: To establish Farrell Health Center as the medical home for residents and provide skills to successfully care for patients in the ambulatory setting.

 

Objectives:

ACGME Competencies

Professionalism

1. Resident must attend all patient care and teaching sessions.

2. Resident must be on time for all patient care and teaching sessions.

3. Resident must participate and prepare for all patient care and teaching sessions.


Systems-Based Practice

1. Residents will demonstrate an understanding of office policies and procedures in the FHC.

2. Residents will understand the roles and responsibilities of members of their team.

3. Residents will develop a medication prescribing framework and effective prescribing skills.

4. Residents will understand the role of the ancillary team in the FHC.


Medical Knowledge

1. Residents should demonstrate basic medical decision-making capabilities

2. Residents should be able to correctly select and subsequently interpret basic clinical tests

3. Residents should begin to integrate social and behavioral considerations with biomedical knowledge in patient care

Rotation Schedule


The FHC schedule is individualized for each intern based on many factors including the overall FHC schedule, attending/resident/clinical staff availability. Please make sure to review the Orange Farrell schedule to confirm your patient care sessions: https://docs.google.com/spreadsheets/d/1YJrvhx9wRLcVB9eyQJFgEGQpwq8zqdsWg7O6RZoiiqI/edit


Rotation Schedule: CLICK HERE FOR WEEKLY SCHEDULE 


Plan to work Monday through Friday except for holidays/as indicated below.  You will have weekends off.

Please email Dr. Aury Garcia with any questions or concerns about your schedule.


 *When assigned to RN shadowing, if there are any unforeseen issues (ex: staffing issues, RNs out sick, etc) then use this time as admin instead

 *UNLESS INDICATED AS ZOOM, MEETINGS WILL BE IN-PERSON IN FARRELL CONFERENCE ROOM


Zoom Links:

K. Desai: TBD

J. Dempster: TBD

J. Berenyi:  TBD

CMAS/QI: per separate rotation information section

IDT: These meetings occur monthly within your assigned Farrell teams. IDT will always fall on a Wednesday morning and should occur via zoom. You should each be receiving emails (along with your assigned Farrell team) from meeting coordinator Cynthia Martinez-Feliz containing the list of patients to be discussed and the Zoom link with password. You do not need to attend other team's IDT meetings.  


Rotation Expectations


Other useful information: 

QI and Comm Med:  corresponding zoom meeting links as applicable and further information and learning goals for QI and community medicine activities are on the residency site on their respective pages. For any recurring Friday morning zoom meetings, the zoom room should be the same going forward. 

Didactics: find this zoom meeting link on the residency website. This zoom will be the same for Thursday afternoon lectures going forward. When on any outpatient rotation, attendance at didactics is expected.

IDT: Interdisciplinary team meetings occur monthly within your assigned Farrell teams. IDT will always fall on a Wednesday morning and should occur via zoom. The goal at these meetings is to discuss identified cases and their management strategies while ensuring dialogue and coordination between care providers, care coordinators, social work, community health workers. All residents should be receiving emails (as part of their assigned Farrell provider team) from meeting coordinator Cynthia Martinez-Feliz containing the lists of patients to be discussed and the zoom link with password. You are not asked to attend other clinic team's IDT meetings, only your own.  When on outpatient rotation, attendance at IDT meeting is expected.

Shadowing attendings/residents:  This is an opportunity for you to learn FHC physician best practices. Use this time to pick up skills in efficiency (starting notes, working on notes, placing orders, communicating with staff, and precepting).

Shadowing Nursing: These sessions will give you the opportunity to see how non-physician team members participate in patient care and which situations (apart from vaccines alone) call for RN involvement, counseling 

Session with Social Work: This is an opportunity to learn how best to collaborate with social work and social work assistants, what situations call for social work referral or consultation; situations in which social work mental health needs to be activated vs. social work as it relates to connection to resources (community resources, food stamp assistance, etc) 

Patient Care: In addition to shadowing, you will have your first direct patient care sessions during FHC orientation. This is an opportunity to put the above skills to good use and start building your patient panel.

Professionalism lecture: With Dr. Rosenthal, who is also our biopsychosocial rounds facilitator, to discuss professionalism in residency.  

Admin time: Use admin time as you need; recommended use is to pre-read for future patient care sessions, finish notes, or do other clinical readings. This time is also available for other important external things that may need to get done before the year gets busier 

ABFM Modules: Please be aware that if you would like, you can use admin time to complete an ABFM Self-Assessment activity. Overall, these self-study modules are helpful for clinical care, studying for our in-service training exam, and ultimately studying for and registering for the boards.  ABFM modules are not a strict requirement for this specific rotation, as there will be time built into later FHC rotations for this as well.  If you would like to get an ABFM module out of the way now, we recommend: Preventive Care

 https://portfolio.theabfm.org/ → click “access self-assessment activities”

FHC Orientation Checklists

1)   General EMR 

(These items are applicable throughout, including orientation sessions, Epic sessions, clinical shadowing, and direct patient care sessions) 

ACCESS: 

 

Inbasket: 

 

Patient:

 

Documentation:


Orders tab


Plan tab


Wrap up tab


Personalization


 Applying skills within a session


2) EPIC within patient care session: 

TABS:


iNYP:


MEDICATIONS TAB:


ORDERS:

·         Locate order input bar (bottom left)

·         Review preference sets and subcategories (labs, peds age-specific, studies, referrals, POC tests)

·         How to place an order for today’s visit

·         Placing future orders for labs/studies

·         How to check if appointments made/studies scheduled (Chart review)

·         How to order a CT lung screen (only paper order)

FLOWSHEETS:

·         Location within Epic

·         How to add new vitals within a visit

           

SHORTCUTS:

·         F2, ctrl+space

           

MISC:

·         Vaccinations tab

·         How to find and do Forms (school forms, M11Qs, etc)

·         Growth Chart Tab

 


3)    FHC Intro

 

4)    Shadowing Sessions with Nursing


5)    Shadowing Sessions with Resident or Attending

Active shadowing as much as possible; can try scribing notes in MD/DO sessions only if time allows


TEAM MEMBER ROLES:

Attention to various team member roles in session, discussion when team members are being involved in session what is it for?


          o   RNs: vaccination/medication administration, vaccination review/query, counseling (esp. within prenatal visits), WIC forms, assistance with contacting patients with abnormal results if MD cannot reach

          o   MAs: vision/hearing, blood draw, populate some of the school forms, etc

          o   Referrals to other team members, ex: podiatry, SW, nutrition, consultants

          o   Communication with team members within session; including calling, haiku messaging, appropriate use of color dots and flags



 


Recommended Reading

Student Run Clinics

Rotation Feedback and Evaluation