How to Succeed as a Junior Resident

Chapter 9 How to Succeed as a Junior Resident


Continuity Clinic and Inpatient Wards



Theresa Hetzler, MD , Matthew J. Kapklein, MD, MPH



Continuity Clinic



Introduction


Continuity clinic provides a longitudinal educational experience spanning the 3 years of pediatric residency. Although continuity clinics vary from program to program, all afford a learning experience quite different from the inpatient ward or intensive care unit. It is an ideal site to work on all of the core competencies.



Medical Knowledge


There is a core fund of knowledge you will need to succeed. A thorough understanding of the well child examination and how to approach it is imperative. At each examination you must know the normal developmental and behavioral milestones, appropriate diet, and age-appropriate essential components of the physical examination, screening tools, anticipatory guidance, and immunization schedule. Although the immunization schedule may vary over time, risks and benefits of vaccine components are relatively constant. Likewise, age-appropriate developmental milestones and injury prevention can be committed to memory. Knowing these by heart will save you time during the visit.


You should be familiar with resources available at your continuity site to aid you in the encounter, as well as online resources.



Patient Care


The continuity clinic is the optimal setting for developing and assessing longitudinal therapeutic relationships with patients and families. You will learn the generalist’s approach to common ambulatory pediatric problems, as well as the specific skills needed to provide anticipatory guidance, developmental and behavioral screening, immunizations, preventive care, and coordination of care. The beauty of continuity clinic is that you will be able to observe your skills in these areas evolve over time.


Your role as primary care provider allows you to provide services aimed at maintaining wellness and preventing health problems. Following your patients over time, you have the opportunity to give them the tools necessary to become healthy adults. At routine well-child visits, you will give patients and their families age-appropriate anticipatory guidance to assist them between visits (see Chapters 16, Chapter 16 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24).


Here are some tips that will aid in mastering these skills. From the beginning, identify yourself as the child’s doctor, even though you are still in training. Give the family a business card with your name, the office or clinic number, and the off-hours emergency number. This will help establish continuity and help you gain the family’s trust. Assisting the family in scheduling follow-up appointments specifically with you will help establish an ongoing relationship. Maintaining your continuity log (specific procedures will differ by program) from day 1 will help you track your patient panel throughout your training.



Interpersonal and Communication Skills


Communication is key in working not only with your patients and their families but also within the health-care team. Effective communication requires use of appropriate language based on the educational, socioeconomic, and cultural backgrounds of your patients and their families. These will be unique to each continuity site and each patient encounter. For a successful visit, you must start on an appropriate playing field with your patient and family. By inquiring into the family situation and engaging in a brief conversation with the family, you can get a feel for the level of education and understanding of English. Based on these, the patient’s history should be elicited with questions aimed at an appropriate level of understanding. An interpreter should participate in any encounter in which you are not fluent in the language the historian speaks. Know your patients: Learn about the cultures seen in your practice setting, and do not hesitate to ask for help in understanding them.


In addition to communicating effectively with your patients, you will need to master skills to communicate effectively with the health-care team. In the continuity setting, this means nurses, receptionists, and schedulers as well as consultants, agencies, and other physicians (residents and faculty) on your team. Of equal or greater importance are your written communication skills. The medical record will be your connection to other practitioners and staff on days you are not present at the continuity site. Maintaining clear, legible, comprehensive notes will help make you an effective communicator (see Chapters 11, Note Writing, and 12, Oral Presentations Chapter 11 Chapter 12).



Professionalism


An important first step in professional behavior is demonstrating appropriate respect for the setting, your patients, and yourself. Regardless of where it is, your continuity site is your office, and you should look like a doctor while you are there. Grooming is important, as well as attire. Your program will let you know what is acceptable at each site. Your dress is a sign of respect for the relationship you have with your patient. Your verbal and nonverbal behaviors will also be a measure of your respect for that relationship.


During the encounter, listening attentively and responding compassionately and honestly are evidence of professionalism. Be honest with families when you do not know an answer, and seek help appropriately. Remember that these are your patients; acknowledge this ownership by demonstrating your reliability and accountability to your patients and responsibility for your decisions.


Maintaining confidentiality of patient information is especially important. Whenever you exchange information with other practitioners, make sure to have permission to do so from the patient or family. Be conscious of where you are discussing this information. Are you in a room set aside for patient discussions with your preceptor, or in a hallway outside the waiting room, where others may hear?


Many medical students and pediatric residents come from different socioeconomic and cultural backgrounds than the patients served by their continuity clinics. “Cultural competency” means being sensitive to patients’ cultures and recognizing the role of those cultures in all spheres, including the perceived need for health care and treatment compliance. It is important to become culturally competent in the populations for whom you frequently provide care.



Practice-Based Learning and Improvement


Residents develop longitudinal relationships not only with their patients, but with their continuity preceptors. This relationship is unique in residency because of its longevity and consistent contact. Most residents find it safe and comfortable, and often a mentoring relationship. Why is this important? Many residents struggle with soliciting feedback from supervisors and critically reviewing their own practice. The preceptor is in a unique position to give you ongoing feedback. Use your preceptor as a resource by asking relevant questions regarding diagnoses, therapies, management, and clinical practice.


Other resources at your continuity site include online resources, texts, and clinical guidelines. You should become familiar with resources at your disposal at your site. Texts available through the American Academy of Pediatrics (AAP), such as the Report of the Committee on Infectious Diseases (the Red Book) and Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, are valuable resources and should be available at your site. The Red Book provides you with current AAP recommendations for diagnosing, treating, and preventing infectious disease. Bright Futures provides comprehensive health supervision guidelines, including recommendations on immunizations, routine health screening, and anticipatory guidance. Access to current literature and the ability to interpret it will permit you to give your patients up-to-date, appropriate care.


To best serve your patients you must understand the community in which they live. Learn about the community you serve. Familiarize yourself with the health risks and needs of your population, and put them in the context of available resources. For many people, residency training also means moving to a new city or community. If you are unfamiliar with the community, take a field trip through the neighborhoods you are serving, learn about the specific ethnic groups or other subpopulations, and speak to long-time staff members at your continuity site familiar with the population and the available resources.

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Related posts:

  1. The Special Needs Child
  2. Diarrhea (Case 6)
  3. Physical Abuse (Case 53)
  4. Note Writing

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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on How to Succeed as a Junior Resident

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