New Ambulatory Clinic Hour Requirements

[doctorfunk7]

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Heard at one of my interviews of a possible change coming with regards to increasing the # of weeks of ambulatory clinic requirement for IM residents? I think it's supposed to be changed to something like ~130 weeks for all 3 years. I think it's currently something closer to a 100 weeks. If true, that would mean major overhaul in terms of curriculum structure with possible losses of electives and other rotations at almost every single residency program. Anyone else heard similar news?

 

[NotAProgDirector]

This is due to the overhaul of the RRC IM rules.

The old clinic rule was that you had to have 108 "clinic weeks" during your 3 years. A "clinic week" was a week with at least a half day clinic in it. Having two half day clinics in the same week still counted as 1 clinic week.

The new rule is that you have to have 130 clinic sessions total over 3 years. Having two clinics in the same week now counts as 2 clinics towards the 130 total. Plus, there was some talk that the definition of a "clinic" would be expanded -- such that home visits, or seeing a patient in a nursing home, or perhaps seeing one of your patients admitted to another service would all count, but at our last meeting the RRC seemed to be backing off on this open definition of a clinic.

Also, the new clinic rules state that the 130 sessions can be over 30 months (instead of 36). This would allow programs to have no clinics in the first few months of internship, or the last few months of PGY-3, if they want.

So, whether major changes will be needed depends on how your clinics are set up. We have one clinic weekly on inpt rotations and electives, and 2 on Outpt medicine months, so we get very close to the 130 already, so not much changed needed.

 

[Adcadet]

While not exactly the same thing....

There is consideration at our program to shifting some of our inpatient (specialty) experiences to outpatient experiences given the recognition that more and more can be done in the outpatient setting. In fact, I believe we're considering going as far as a 50/50 split between inpatient and outpatient.

But as a Phase 1 EIP program, I believe we're not required to follow the RRC guidelines until 2016 - link: http://www.acgme.org/acWebsite/RRC_140/140_EIPindex.asp

 

[gutonc]

While not exactly the same thing....

There is consideration at our program to shifting some of our inpatient (specialty) experiences to outpatient experiences given the recognition that more and more can be done in the outpatient setting. In fact, I believe we're considering going as far as a 50/50 split between inpatient and outpatient.

But as a Phase 1 EIP program, I believe we're not required to follow the RRC guidelines until 2016 - link: http://www.acgme.org/acWebsite/RRC_140/140_EIPindex.asp

This was done at my program several years ago with the Onc rotation. Since the vast majority of onc happens in the outpt setting (and that which happens in the inpt setting tends to be a couple of tumor types and management of chemo side effects and end-of-life issues) it was felt that you'd get better and broader exposure in the outpt setting than inpt. So now there is no house staff on the inpt onc service and residents will do 1-2 months of Hem-Onc ambulatory or consult service each year (at least 1 month/yr, more if you want it).

So a question to aPD re: the new rules. If one is on an ambulatory rotation w/ 10 1/2 day clinics/wk, would that count as 10 clinic sessions per week (giving you 40 of the needed 130 in a single month)?

 

[dragonfly99]

guton,
aren't they talking about 130 weeks of YOUR OWN CLINIC (i.e. "resident clinic") and not something else?

 

[gutonc]

guton,
aren't they talking about 130 weeks of YOUR OWN CLINIC (i.e. "resident clinic") and not something else?

Good question, I don't know. We also had a 2nd clinic but in general it was a specialty clinic which counted towards RRC requirements so I assumed ambulatory specialty clinics would count as well but perhaps not. We also did a 2 month rotation for the R2 and 3 years at a community site that included 3-5 1/2 days of Primary Care clinic over a 2 month period so perhaps this counts. Just curious if you could knock the whole thing out in a month per year of ambulatory clinic.

 

[NotAProgDirector]

So a question to aPD re: the new rules. If one is on an ambulatory rotation w/ 10 1/2 day clinics/wk, would that count as 10 clinic sessions per week (giving you 40 of the needed 130 in a single month)?

Yes, but you also can't go more than 4 weeks without a clinic. It might be possible to have lots of clinic in outpatient blocks, and then only short follow up clinics on inpt blocks.

guton,
aren't they talking about 130 weeks of YOUR OWN CLINIC (i.e. "resident clinic") and not something else?

Yes, must be your own continuity clinic, and must be a single clinic site/population. Of note, this is different than the Heme/Onc rules, where you're allowed to have 6 month rotations in various specialty clinics.

 

[gutonc]

Yes, but you also can't go more than 4 weeks without a clinic. It might be possible to have lots of clinic in outpatient blocks, and then only short follow up clinics on inpt blocks.


Yes, must be your own continuity clinic, and must be a single clinic site/population. Of note, this is different than the Heme/Onc rules, where you're allowed to have 6 month rotations in various specialty clinics.

Interesting...thanks. One other question. I know that one of the reasons the UW got dinged by ACGME a few years ago was that the residents who had VA clinic had minimal/non-existent access to female patients. Does this "single site" rule address that in any way? I had a VA primary care clinic as well and can count on 1 hand the number of women patients I had on my panel (interestingly, they all had a history of breast cancer).

I actually don't like the Hem-Onc rules b/c I don't feel like it gives you a real continuity experience. One of the reasons I chose the program I did is that we have a 2 year (required but you can do it all 3 years) general Hem-Onc continuity clinic at the VA where we function as primary. This is in contrast to most of the programs I interviewed at where you would spend 6 mos in Dr. X's Y-Cancer clinic and see Dr. X's patients and have to clear all management plans with them. I obviously still staff all my patients but before I see them I need to have a complete treatment/follow-up plan in place and all of the questions/problems/complications are handled by me.

 

[NotAProgDirector]

I know that one of the reasons the UW got dinged by ACGME a few years ago was that the residents who had VA clinic had minimal/non-existent access to female patients. Does this "single site" rule address that in any way? I had a VA primary care clinic as well and can count on 1 hand the number of women patients I had on my panel (interestingly, they all had a history of breast cancer).

25% minimum for each sex in your continuity clinic. New rules allow this to be a block experience -- i.e. VA clinics could add a few months of women's health clinics elsewhere to meet the 25% minimum