IMG Boot Camp Beverlee Ciccone Ph D David

IMG Boot Camp Beverlee Ciccone, Ph. D. David Fox, M. D. Robert Solomon, M. D. Montgomery Family Practice Residency Norristown, PA

IMG Boot Camp-Objectives n Scope of the issue n Strengths/weaknesses of n Behavioral science aspect n Solutions IMGs

International Medical Graduates Strengths Life experience n Strong work ethic n High level of commitment to medicine n Appreciative of training/opportunity n Strong family bonds/support system n Respect for authority n

International Medical Graduates Challenges n Less clinical experience n Less technically oriented [a strength? ] n Less focus on prevention n Less emphasis on behavioral science

International Medical Graduates Challenges Hospital and office n Documentation n Insurance n Role of nurse/ancillary staff Residency n Hierarchy n Question judgment of attending

The Niagara Syndrome Life is like a river for many people, they just jump in the river of life without ever deciding where they want to end up, so they quickly get caught up in the current, current events, current challenges, current fears. And then they come to the forks in the rivers, they don't consciously decide which way to go, they just go with the flow of the river (the flow of the majority instead of being directed by their own values and goals) and as a result they feel out of control but they continue to drift downstream until one day the sound of the raging water wakes them up and they realize they are 5 feet from Niagra Falls and they are in a boat with no oars and then they say "Oh shoot", but it’s too late. They are going to take a fall, it may be a financial set back or the break up of a relationship or maybe even a health problem, in almost all of the cases the fall could have been prevented by making better decisions up stream. -Anthony Robbins-

TO AVOID THE NIAGRA SYNDROME, THE MONTGOMERY FAMILY PRACTICE RESIDENCY PROGRAM DECIDED TO BE PROACTIVE AND CREATED IMG BOOT CAMP

What is an IMG Boot Camp? A COMPREHENSIVE ORIENTATION FOLLOWED BY A SERIES OF CLINICAL ROTATIONS THAT ARE EACH ONE WEEK IN LENGTH AND COMPRISE THE CORE CLINICAL AREAS OF THE RESIDENCY PROGRAM

Orientation Schedule Duration: 2. 5 weeks n Areas covered n n Administrative Logistics n Schedules n Policies & Procedures n Clinical Logistics n Family Medicine Service n OB/GYN service n Night float n Documentation of procedures and cases n Discharge summary dictations n Billing and Coding issues

Orientation Schedule n n Introduction to Behavioral Science n Introduction to Balint n Cultural awareness n Navigating the medical system as a geriatric patient n Habitat for humanity Clinical lectures/practicums n Joint examination n Suturing n ACLS n Approach to the EKG n Approach to the Newborn examination Retreat Graduation Picnic

What is an IMG Boot Camp? A COMPREHENSIVE ORIENTATION FOLLOWED BY A SERIES OF CLINICAL ROTATIONS THAT ARE EACH ONE WEEK IN LENGTH AND COMPRISE THE CORE CLINICAL AREAS OF THE RESIDENCY PROGRAM

Why is it necessary to have an IMG boot camp? n n Provides initial exposure of all the core clinical areas that a 1 st year resident will be exposed to during the intern year by the end of July Provides for an immediate needs assessment of all the 1 st year residents by the end of July n n n Individualized education plans can be created Residents with significant gaps can be identified Assists in creating rapport among all the residents in the program

The Four Core Clinical Areas Family Medicine Inpatient Service n Obstetrics n Night Float n Outpatient office hours n

Family Medicine Inpatient Service Receive daily sign out from night float team n Daily work rounds n Daily progress notes n Daily rounds with the attending n Patient admissions from the E. D. n Patient discharges (Dictated) n Daily interaction with ancillary staff n Give daily sign out to the night float team n

Obstetrics Admit OB patients to labor and delivery n OB admitting histories and physicals n Manage labor and delivery n Determine cervical dilitation n Participate in outpatient OB clinic n Round on newborns and manage neonatal issues n Procedures: circumcision, episiotomies, AROM, assist in c-sections n

Night Float Receive sign out from inpatient family medicine service n Admit family medicine patients and specified internal medicine patients from the E. D. n Manage inpatient acute calls that arise at night n Manage active labor and delivery n Attend to neonatal issues in the nursery n

Outpatient office hours n n n Work one on one with the faculty during office hours See patients, present the case to the attending, write S. O. A. P. note Learn how to: n n n n Code and Bill Manage referrals Arrange for outpatient testing Perform common office procedures e. g. urinalysis, wet mount, EKGs, ear lavage, etc. Be directly observed on video during a patient encounter Meet the part time faculty Interact with nurses, office managers, medical records, and triage nurse

Orientation—Introduction to Behavioral Science n n n Retreat “Balint” Professionalism Cultural Competency The Family in Family Medicine Family Systems – Genograms The Doctor-Patient Relationship Direct Observation Navigating the Medical System as an Elderly Patient Scavenger Hunt Habitat for Humanity

“Balint”-Type Experience Expectations n Anxiety n Learning n Collegiality n Asking for help n Disclosure n Trust n Dealing with conflict situations n

Professionalism Vignettes n Running late n Etiquette with n Patients n Attendings n Ancillary staff n Upper-year residents

Cultural Competency Model Psychosocial topic/issue Cultural Comparison: n How was this issue handled/treated/regarded in your culture? n What is different about how it is handled/treated/regarded here? Examination of one’s own feelings n n How do I feel about this issue? How do I feel about how it is handled here? What makes me feel uncomfortable in this situation? What biases/influences do I have to be careful to control?

The Family in Family Medicine Ages and Stages Family Systems Genograms The Doctor-Patient Relationship

Direct Observation Greetings/rapport-setting n Positioning n Eye contact/note-taking n Open-ended questions n Addressing children/elderly patients n Collaborative vs. authoritative n Ability to understand/be understood n

n Navigating the Medical System as an Elderly Patient n Scavenger Hunt n Habitat for Humanity

n n SCAVENGER HUNT in Norristown Thursday, June 22, 2006 – 1: 00 p. m. Split into two teams – you will need a car and map Office n n n n n Suture material Liquid nitrogen Preceptor’s room/Library Vaccines in refrigerator Syringes Lab, and file for patient lab orders (by docs) Pap tracking system Your chart box; your preceptor’s box Triage nurse Fish tank Patient education material Sample closet for MFPC meds Microscope Rotation goals and objective binder MSDS Manual (Material Safety Data Sheets) (billing area) Accordion file for patients Script/form pick-up Video computer for observing outpatient visits Telephone Language Line

OB/Gyn Clinic – 2 nd Floor Mc. Shea Bldg. n n Colposcope Sample closet Pre-natal prescription pads Hospital n n n n Pathology Dept. - slide Emergency Dept. – ankle brace Cath Lab-signature from Dr. Vaganos or Dr. Magargee or lab tech Inpatient dialysis – signature from tech Medical Records – get Percina’s signature Radiology – retrieve jacket of Dr. Fox Vascular lab- Marty’s signature Pharmacy – signature of Jim Salerno or Dave Mihalic Heart station – blank echo report form Labor and delivery - paper boots Nursery- Faith’s signature Inpatient physical therapy – PT’s signature Case Management – case manager’s signature n Montgomery Home Care and Hospice – Fornance Street – signature n Montgomery County Emergency Psychiatric Services, Building 50, On the grounds of Norristown State Psychiatric Hospital Stanbridge & Sterigere Streets – get a signature n Norristown High School, 2900 Eagle Drive (off Whitehall Road) What is the date on the stone to the right of the entrance?

n Planned Parenthood, Wood & Powell Streets What is on their Planned Parenthood sign? n Montgomery County Department of Health, Human Services (Clinic) 1430 De. Kalb Street (at Fornance), 2 nd floor Pick up some new copies of “Resource Guides for Norristown Area Families” n Senior Center, 536 George Street Pick up a schedule for the Speaker’s Bureau n ACLAMO, 512 West Marshall Street Pick up an updated brochure n Children with Special Needs - Early Intervention Program, West Main Street, go through main doors (canopy) Pick up brochure from receptionist n Central Montgomery County Mental Health/Mental Retardation Center 1100 Powell Street --- Get a signature

n Norristown Transportation Terminal, Lafayette and Swede Streets Pick up a bus schedule n Rittenhouse Pine Nursing Center, 1700 Pine Street Get a signature n Social Security Office, 1700 Markley Street Pick up an application for a social security number n Roosevelt School, Markley and Sterigere Streets What is behind the school? n Via Veneto, 1803 Markley Street WATER ICE FOR STAFF (SEVERAL FLAVORS OF YOUR

Resident Feedback n What is helpful n n Clearly outlining responsibilities and logistics Chart writing n n n How to present a case to an attending On-Call responsibilities n n H&P, ICU notes, Progress notes, OB notes What is expected i. e. responsibilities When should the upper year be called More teaching of suturing techniques and teaching of joint examination More experience writing orders