Continuity Practice at the North Hudson Community Action Corporation at Englewood

Our residents receive their outpatient training at the NHCAC at Englewood during their 2-week ambulatory blocks. This clinic is both a Federally Qualified Health Center and a Patient Centered Medical Home where our residents are able to develop a continuity practice in a supportive environment and serve the local community. Residents see a combination of hospital-discharge, new patient, urgent care and telemedicine visits and have the opportunity to hone their leadership skills as Charge Resident, a unique resident role that serves to lead the clinical flow of each clinic session and practice working in an interdisciplinary team. Each resident is part of a Clinic Firm that oversees the care of a group of patients longitudinally with protected time to practice panel management, specifically in chronic disease and preventive health measures. The onsite faculty preceptors are always available, with a resident faculty ratio of 4:1. Other services in our clinic include OB/GYN, Pediatrics, Podiatry and Dental.

Residents generally attend a total of four continuity clinic sessions and one subspecialty office session per week. PGY2s exploring a career in primary care can gain additional exposure to the private practice setting through a second clinic site within the Englewood Health Physicians Network (EHPN). We also offer our PGY3s the opportunity to participate in a longitudinal subspecialty clinic experience of their choosing in order to better prepare for fellowship.

One half-day each week of ambulatory block is protected for an academic session that includes case-based discussions using the Yale Office Based Medicine Curriculum and Johns Hopkins Ambulatory Modules as well as evidence-based medicine and community medicine conferences. There is dedicated time built into the schedule for mentorship, to complete quality improvement projects and protected time for independent study and self-care.

All core inpatient rotations are completed at Englewood Hospital. These inpatient rotations are designed to successfully prepare residents for postgraduate experiences, caring for a broad variety of patients with diagnoses ranging from “bread and butter” cases to those with more complex conditions. Our Hospitalist service, including all teaching teams, have transitioned to a “Geographic Localization” model where each resident team is localized to a single hospital unit with the majority of their patients on that floor. This model has led to improved efficiency and better communication between our residents and members of the healthcare team with plans underway to begin structured interdisciplinary rounds. The structure of each rotation is designed to provide residents with increasing supervisory and teaching responsibility as they gain clinical experience and develop and hone different skills each year. During these rotations, the residents are exposed to patients with diverse cultural and socioeconomic backgrounds and pathologies. Our residents experience multidisciplinary collaboration as they care for their patients. It is also here that residents learn the tenets of managing patients participating in our Bloodless Medicine program. All of our core inpatient rotations utilize a Night Float system to provide cross-coverage.

Team A/B/Rh

The Team A/B/Rh rotation forms the backbone of our inpatient rotations. Each team comprises one PGY2 senior and two interns under the supervision of a Hospitalist with a patient cap of 20 with the goal to maintain census closer to 16 to ensure and prioritize adequate time for discussion and teaching. The Hospitalist leads formal teaching rounds daily, often at the bedside, and offers real-time support in patient care, teaching and discharge planning. Each hospital floor is designed to take care of a specific subset of patients, affording residents exposure to a wide variety of clinical cases and pathology as they rotate through these three teaching teams.

Team O

The Team O rotation is designed as a manager service and mirrors a traditional 7-on, 7-off Hospitalist schedule. The team consist of one PGY3 who works directly under the supervision of a Hospitalist. The PGY3’s role is that of a junior attending. Each team works seven 12-hours shifts and has the following 7 days off. During their inpatient weeks, residents admit and manage patients as well as provide medical consultation. In addition, the Team O resident acts as the primary responder for the Emergency Code team during evening hours. The Emergency Code team responds to all rapid responses, stroke codes and code blues for the hospital.

During their days off (ADMIN shifts), residents participate in our Patient Safety curriculum where they learn about the importance of recognizing, preventing and responding to medical errors and participate in root-cause analyses. Additionally, residents complete Perioperative Medicine and Medical Consultation e-learning modules through the Society of Hospital Medicine and gain skills in Coding and Billing through the American College of Physicians online learning.

Acute Care Resident (ACR)

The Acute Care Resident or “ACR” rotation is a 4-week rotation designed to give PGY3 residents an opportunity to hone their clinical skills in the areas of medical evaluation, triaging, coordination of care and transitions of care. The ACR is the primary physician responder and leader of our emergency response team. Under the supervision of the triaging intensivist, the ACR evaluates patients requiring emergency response, as well as those recently discharged or downgraded from critical care. They stabilize patients and provide immediate emergency response care when necessary, ensuring that all patients are appropriately triaged and managed at the correct level of care.

Night Float

The Night Float team provides cross-coverage and admits all new patients and transfers for all inpatient services. All night float residents work Sunday-Friday, with 2 days off per week. The PGY1 residents provide cross-coverage for all inpatient teams while the PGY2 and PGY3 residents do all admissions for Teams A/B/Rh/O PGY1 and PGY3 residents act as the primary responders for the Emergency Code team overnight. All Night Float residents are supervised by a Nocturnist and assisted by a Nurse Practitioner during emergency codes.

The ICU rotation is one of the most popular among our residents. Residents rotate trough the ICU and each year have a graduated level of responsibility. On average, each resident will complete four 2-week blocks of ICU per year. 

We have a “day-team/night-team” model, which allows improved resident-patient continuity, nursing communication and transitions of care. During their ICU rotations, residents learn to manage cases requiring medical, cardiac, surgical and neurologic critical care. Our ICU residents participate in high yield critical care focused case-based and EBM-related didactics. They will also perform various procedures such as central venous and arterial line placement, ventilator management, endotracheal intubation and diagnostic/therapeutic thoracentesis. 

During this rotation, residents work under the close supervision of an Intensivist and receive direct supervision and feedback for certain procedures, allowing them to achieve procedural competence. We currently have close to 24-hour Intensivist coverage, making the teaching experience for both the day and nights teams nearly identical.

Residents receive formal training in Geriatric Medicine in their PGY1 year and learn the skills needed to care for our aging population. During this required 2-week rotation, residents work directly with experienced board-certified Geriatricians to gain exposure in a variety of outpatient settings, including office-based practices, assisted living centers and skilled nursing facilities. Core objectives include learning how to perform a comprehensive geriatric assessment and how to manage common geriatric syndromes. At the culmination of the rotation, our PGY1 residents lead a Geriatrics Case Conference covering a high-yield topic in Geriatric Medicine, incorporating principles of Evidence-Based Medicine and High Value Care.

All PGY3 residents complete 2 weeks of Emergency Medicine. Residents are supervised by Emergency Medicine attendings and learn the basic principles of Emergency Medicine including triage, procedural skills and transitions of care.