Skip to Content

You are here

Continuity Clinics

Introduction

 

Each resident will have outpatient clinical practices at both the University Hospital and the VA. Instead of the traditional practice of having a half day of continuity clinic during each inpatient rotation, we have chosen in our program to separate these. Continuity clinics are scheduled in week-long blocks every 6 weeks, and residents on inpatient services do not have outpatient responsibilities (other than keeping up with their inboxes to follow up on tests and labs they may have ordered on their outpatients).

As regards the issue of keeping up with inbox messages regarding outpatients, we set the following expectations:
 

  • Notes: Should be dictated or written within 24 hours of the patient encounter
  • Test results: Should be communicated to the patient or surrogate via MyChart message, letter, phone call, or request for the clinic nurse to phone the patient within 3 days of the result
  • Patient queries: Should be answered by one of the above methods within 24 hours of the query

There are six half-day continuity clinics in each clinic week, plus two specialty elective half-days and two half-days for reading, research, or quality improvement projects.

At the UW, residents work under the direct supervision of an attending neurologist, meaning that the attending sees each patient with the resident after the resident completes his or her initial assessment. These clinics are staffed by Drs. Beinlich, Frost, and Josiah.

At the VA, residents work under indirect supervision with direct supervision immediately available. This means that the attending may or may not see each patient, particularly the well-established ones, but is always in-house to see any patient when clinically indicated. This allows for graded responsibility over time, as residents become more proficient neurologists. These clinics are staffed by Drs. Jantzen, Jones, and Stanek. Each resident will have a mix of 1-2 new patients and 2-4 follow up patients per clinic, with the numbers starting lower and increasing slightly with experience and efficiency.

Goals

The goal of the continuity clinics is for residents to learn to provide longitudinal care to patients with a wide variety of neurological diseases, as occurs in a general outpatient practice.

Objectives and Evaluation Matrix

As with all of the individual neurology rotations described in this section, the specific objectives of the continuity clinic are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the resident’s evaluation, which is completed by his or her clinic attending twice each year. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).

Schedule

As above, these clinics alternate between the UW and VA, on an afternoon that will be determined according to clinic space needs and the resident’s predecessor. In other words, if a graduating resident had a Wednesday afternoon clinic, one of the incoming PG2s will likely be assigned to Wednesday afternoons. Overall, the clinics are spaced out so that we don’t have too many residents in clinic at the same time.

If a clinic must be cancelled for a vacation, professional conference, etc., then this must be requested at least 60 days in advance. This allows the department to review the request internally and still comply with the UW and VA hospitals’ policies, which require 45 days’ notice.

Suggested References

Daroff, R. B., & Bradley, W. G. (2012). Bradley’s neurology in clinical practice. Philadelphia, Pa.: Elsevier/Saunders.

Brazis, P. W., Masdeu, J. C., & Biller, J. (2007). Localization in clinical neurology. Philadelphia: Lippincott Williams & Wilkins.

Patten, J. (1996). Neurological differential diagnosis. London; New York: Springer.

Victor  1920-2001, M., Ropper, A. H., & Adams  1911-2008, R. D. (Raymond D. (n.d.). Principles of neurology. New York: McGraw-Hill, Health Professions Division.

Latest revision: 02-26-2016