Penn State Health Family & Community Residency at Mount Nittany Medical Center

As one of the few family medicine residency programs to utilize a longitudinal schedule, our primary goal in the Clinic First program is to improve resident predictability in the family medicine continuity clinic (FMC). Secondary objectives include a more well-defined patient panel and improved coverage of asynchronous work.

In our longitudinal schedule, residents change rotations every one to two weeks, and as such, their office schedule changed at the same interval.  Resident time in the outpatient clinic was based on availability after all inpatient, call, and rotation-specific time slots were addressed.  As a result, there was little predictability in terms of a resident FMC schedule, which subsequently led to difficulty in scheduling follow up appointments as well as frustration among clinic staff in addressing asynchronous work.

Based on the Clinic First concepts, with support of our chair, medical director and office manager, we made three significant schedule changes at the start of the 2019-2020 academic year.

  • All residents were assigned two fixed ½-day clinic sessions in the FMC – regardless of rotation. This predictable time slot improved both the scheduling of follow-up appointments (‘Resident A is always here Monday afternoon’) as well as lessened confusion in terms of asynchronous tasks (‘I can hold this item until Resident B is here Thursday morning’). Additional clinic sessions are added based on rotation availability, and the fixed sessions adjusted only for vacation, inpatient medicine, and night float. 
  • All residents and attending physicians were assigned to one six Clinical Teams. Each team consists of an attending physician and one resident form each year of training. Each team member assigned EMR proxy to one another, and traditional “paper” mailboxes were arranged by team to facilitate cross-coverage. Care Teams assignments were posted in each exam room, and follow-up appointments (if not with the primary provider) are now scheduled within the same Clinical Team.  The Clinical Teams were grouped into larger Care Communities to provide additional backup (see figure below).


PennState (2).JPG

  • FMC schedules were adjusted so that at least one provider from each team is in the office during each ½-day clinical session. If not possible due to vacation or other time off, a provider from the larger care community is assigned coverage.

The process is ongoing. Within a few months, residents and clinical staff began to embrace the team structure. With time and repeated appointments, patients have started to recognize the providers on their team, some even anticipating who the “new player” on the team may be in the next academic year.  Residents have enjoyed the stability of at least a part of their outpatient schedule, which has led to improved ease in scheduling follow up (‘Let me see if I can get you in next Tuesday afternoon, when I know I am in the clinic’).

There are three major objectives for the next six months:

  • While patients have generally been assigned to a team based on prior connection with a designated attending or resident, we are still establishing a process to identify the primary provider in the EMR. Since we are part of a much larger, complex organization, this process extends beyond the scope of our office.
  • Aim to keep the “fixed sessions” across all three years of training.
  • Develop a process for PGY3 hand-over of patients to incoming residents, while maintaining equity in terms of patient numbers, demographics, and disease severity.

PennState.JPG(L to R) Franklin Berkey, DO (Associate Program Director); Joseph Wiedemer (Program Director); Zenovia Tarmohamed, MD (PGY3)

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Penn State Health Family & Community Residency at Mount Nittany Medical Center

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