Community Oriented Primary Care (PGY-2)

Description of Rotation or Educational Experience

The Community Oriented Primary Care month is designed to illustrate the relationship of familial, community, and political systems on the care of patients. In a combined didactic and experiential rotation, the resident can independently study the patterns of health, illness, and disease in the practice population and develop community-based interventions to improve health status based on priorities of the next century.

The goal of the Community Oriented Primary Care rotation is as follows, with relevant ACGME competencies noted in parentheses. In this rotation, residents will:

Develop an understanding and appreciation for the relationship between familial, community, and political systems and their impact on the care of patients, including consideration of broader social, cultural, and economic issues through exposure to basic epidemiologic and socio-cultural principles and measures (systems-based practice; practice-based learning and improvement; patient care), including:

(a) the impact of race, socioeconomic class, and environment on patient health and health care, including an appreciation of barriers to care in a patient’s community and environment

(b) population epidemiology, reportable communicable diseases, and the interpretation of public health statistical information

(c) community-based disease screening, prevention, and health promotion, including health risk appraisal and its use in improving community health

(d) factors associated with differential health status among sub-populations, including racial, geographic, and/or socioeconomic health disparities, and the role of family physicians in reducing such gaps

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Receive training to perform those clinical procedures required for their future practices in the ambulatory and hospital environments.
• Receive training that focuses on the core principles of Family Medicine: including Continuity of Care, Family-Oriented Comprehensive Care Experience, Family Medicine Center Experience, Patient Care Experience, FMC Continuity and Accessibility, Medical/Surgical Experiences, and Inpatient Experiences.

Objectives

By the end of the rotation the resident is expected to have:

• Completed a family tour or other home visit with at least one of the resident’s own continuity patients.
• Submit for their portfolio a record of their experience, following debriefing with peers and instructors.

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• This rotation helps to fulfill family medicine-specific requirements in Community Medicine through a structured curriculum with didactic and experiential components.

Objectives

By the end of the rotation the resident is expected to have participated in:

• Didactic session on assessing risk of family and community violence in their patients.
• Didactic sessions on holism and context in assessing and treating patients in a broad manner, considering the larger world of their patients’ experiences.

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to :

Competencies

• Identify strengths, deficiencies and limits in one’s knowledge and expertise;
• Systematically analyze practice, using quality improvement methods, and implement changes with the goal of practice improvement

Objectives

By the end of the rotation the resident is expected to have:

• Completed an original research project including hypothesis generation, data collection and analysis, with findings presented to an audience of their peers; typically a population risk assessment and intervention.

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Work in interprofessional teams to enhance patient safety and improve patient care quality
• Participate in identifying systems errors and in implementing potential systems solutions

Objectives

By the end of the rotation the resident is expected to demonstrate knowledge of:

• Research methods in community medicine, including both qualitative and quantitative approaches
• Process of accessing community-based resources and mobilizing them in the care of patients
• Reading and discussion of an ethnographic work relevant to the predominate patient population of resident continuity clinics

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Compassion, integrity, and respect for others
• Accountability to patients, society, and the profession

Objectives

By the end of the rotation the resident is expected to have:

• Learning to work in a small team of interdisciplinary researchers towards the completion of the month-long research project.

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies
• Work effectively as a member of leader of a health care team or other professional group

Objectives

By the end of the rotation the resident is expected to have:

• Received and implemented training and coaching on effective presentations skills.
• Completed a community-based health education lecture, typically at a school or community center.

Teaching Methods

What teaching methods are you using on this rotation or educational experience?

• Didactic
• Firsthand experience

Assessment Method (residents)

How do you measure the resident’s performance on this rotation or educational experience?

• Faculty evaluations of the rotator’s performance
• Real-time feedback during direct observation
• Completion of required assignments.
• Placement of a copy of residents’ PowerPoint presentation of their original research project into residents’ portfolio.
• Placement of a copy of community-based health education lecture into residents’ portfolio.

• Resident is to generate self-observed behavior reports in each competency at least weekly over the course of this rotation.
• Following this rotation, the resident is expected to achieve 90% post-test score on the Community Medicine section of the shelf exam.

Assessment Method (Program Evaluation)

How do you evaluate whether this educational experience is effective?

• Resident evaluation of rotation

Level of Supervision

How is the resident supervised on this rotation?

• Faculty work directly with the residents during this month to assist with their various assignments.
• Faculty include: program director, department chair, director of behavioral science, biostatics and information technology faculty.

Educational Resources

List the educational resources

• Relevant orientation materials are indicated and/or given at the beginning of the rotation and used throughout.