does your prelim IM program make you cover continuity clinics for categoricals?

[sparkly]

I have a question for all of you who have done prelim IM years: were you pulled in to cover the "continuity clinics" for categorical IM residents and interns when they were rotating on wards and on call?

I was just wondering how standard this was in prelim programs- I am closing the year and have been slammed with covering these clinics. The idea is that, since I don't have my own clinic, I'm fair game to cover those of the categoricals.

Ironically, these clinics are supposed to provide continuity of care, but oftentimes I'm there, filling in for that AM/PM, with these patients who frequently have no chart and I have no idea why they're there...and I'll never see them again.

I was also wondering what your thoughts were on the subject (I'm not a fan, if you haven't gotten that already).

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[gutonc]

Ironically, these clinics are supposed to provide continuity of care, but oftentimes I'm there, filling in for that AM/PM, with these patients who frequently have no chart and I have no idea why they're there...and I'll never see them again.

I was also wondering what your thoughts were on the subject (I'm not a fan, if you haven't gotten that already).

If it makes you feel any better, categorical residents get called on to do this too. They also have no idea what's up with the patient and will never see them again. It also happens in the real world because everybody gets a vacation now and then and somebody has to see the patients.

Suck it up buttercup.

The fact that the charts aren't available means that your hospital needs to sack up and get an EMR in place.

 

[sparkly]

I didn't consider it as being practice for the future (as an attending filling in for one of your colleagues on vacation). Good point. I wonder, though, do people cancel/reschedule their clinics if they're on vacation in the real world, instead of having someone else perfunctorily see your patients?

An EMR would be wonderful to have. it would definitely make clinic more manageable. right now it's pretty painful.

I didn't know that other programs had categoricals filling in for other categoricals- at my program it's exclusively the realm of prelims who are called to fill in for the categoricals. Interesting.

 

[dragonfly99]

I agree with guton.
This is common.
As an IM resident, I also had to work some ER shifts (on top of normal clinic hours) when I was on outpatient clinic months, just b/c the ER needed extra help. The residency is going to use you, the intern, to do work. Thats how it works. Prelim IM usually gets off easier than regular IM, just due to the simple fact that you don't have a continuity clinic every week.

It is kind of weird that someone would have to fill in for the intern who is on call...we always still did our clinics when we were on call, and usually post call as well...while in clinic, the other intern and resident just had to do our work for us, and/or admit all the new patients, or at least enter perfunctory orders until we got out of clinic for the day.

 

[sparkly]

I guess I should be glad that I'm not called in to do ER shifts! Clinic is vastly preferable to the ER, in my mind. At least that's the case in our hospital's ER- there are some very difficult patients down there (I did a 1 month rotation earlier in the year). And their shifts are 10 hours long.

It's true, interns are there to work, whereas medical students are there to learn- it's taken me a while to learn that, after graduating med school.

Hmm, probably it had proved to be too much for the on-call/post-call admitting team to handle an intern or two interns and/or the resident being away in clinic, and that's why they have a substitute handle their clinics for them?

thanks for your input! I have more perspective on this policy now.

 

[gutonc]

In my residency program, they changed your continuity clinic day when you were on wards so that it was your pre-call day, no matter what day of the week that was. And when you were in the ICU, no continuity clinic at all. So this means that there are people who need to be seen when their usual resident doc isn't around.

This was a way better system than where I went to med school where not only would residents sometimes have clinic on call days, they would have clinic off-site and would be gone from 11:30a - 7p, get back and have to do all the admits that had stacked up with just holding orders while you were in clinic.

 

[dragonfly99]

This was a way better system than where I went to med school where not only would residents sometimes have clinic on call days, they would have clinic off-site and would be gone from 11:30a - 7p, get back and have to do all the admits that had stacked up with just holding orders while you were in clinic.

That's heinous. At least our clinics were in the same building/hospital building. But where the hell was the clinic that it took 1.5 hrs to get from the hospital to the clinic, or vice versa?

My least favorite days as an intern were the ones where I was post call and then had to go to my continuity clinic and try to stay awake so my clinic patients didn't think I was totally not paying attention!

 

[gutonc]

That's heinous. At least our clinics were in the same building/hospital building. But where the hell was the clinic that it took 1.5 hrs to get from the hospital to the clinic, or vice versa?

Brooklyn. The Univ/County hospitals and the VA are about a 45 minute trip apart by public trans or @ by car @ rush hour. So if you were on wards at one of them but had your clinic @ the other it was a total nightmare.

Personally, I liked the way my residency program did it, even though all our clinics and hospitals were no more than a 20 minute walk apart at the worst.

 

[DOCTORSAIB]

I have a question for all of you who have done prelim IM years: were you pulled in to cover the "continuity clinics" for categorical IM residents and interns when they were rotating on wards and on call?

I was just wondering how standard this was in prelim programs- I am closing the year and have been slammed with covering these clinics. The idea is that, since I don't have my own clinic, I'm fair game to cover those of the categoricals.

Ironically, these clinics are supposed to provide continuity of care, but oftentimes I'm there, filling in for that AM/PM, with these patients who frequently have no chart and I have no idea why they're there...and I'll never see them again.

I was also wondering what your thoughts were on the subject (I'm not a fan, if you haven't gotten that already).

Wow, this sounds rough. I'm a prelim IM intern and we aren't required to do PCC clinic nor are we ever pulled to cover a categorical.

The categoricals have half a day per week of clinic. When they're on ward months (which is most months) another resident will over see the 2 interns on their team until clinic is done at 5pm. Then they come back to the hospital to write a few quick R2 notes and they're done. It's a great system. Very low stress.

You're right, what continuity is there if you will never see these patients again.

Look at the bright side, we're almost done!