Today is Wednesday, Aug. 15, 2018

Department of

Department of Internal Medicine

Residency Programs

Our Med-Peds Clinic

Overview:
Our Med-Peds clinic is a combined faculty-resident practice. This model is well recognized NATIONALLY to be the optimal model for primary care training. Why, you ask? It is due to the fact that this model the closest approximation of private practice enabling residents to feel ready for primary care in any setting.

Clinic Staff for Medicine Pediatrics at UCAs a combined faculty resident-practice we embrace a true "group practice" model. All of our patients, whether seen by a resident or faculty member, get the same excellent level of care. As a resident YOU are the primary care provider, so when your patients need you during the day, the staff in clinic will call YOU! You share clinic call on evenings and weekends with the faculty during which you are able to take the first call with patient questions with a faculty member always available for back up. In addition, because we know sleep is important, we have a nurse triage system that takes the first call for patient issues/questions after 10pm and they only contact you if they cannot advise the patient.  

History of our Med-Peds Clinic:
We opened our combined Med-Peds resident-faculty clinic February of 1995. It was the vision of ideal primary care: residents and faculty practicing shoulder to shoulder caring for adults and children in sickness and in health. If that sounds like a marriage, it is because it required commitment from the faculty and residents involved!

In August of 2001, we moved into our current state-of-the-art facility. This office space was designed with significant input from our Med-Peds physicians and staff. The exam rooms are large, and with 17 rooms in the clinic we are usually able assign each resident two rooms per clinic session. The rooms have beautiful, new equipment that allows for multiple functions, including any type of visit for children and adults as well as office-based gynecological exams.

Our Preceptors:
Our preceptors are the "secret sauce" that makes our Med-Peds clinic the amazing place it is. We have faculty that practice in clinic and precept the residents when they are not seeing their own patients. In addition, we have a large group of Med-Peds physicians that practice in the community and have a vested interest in "growing" the next generation of Med-Peds physicians that they take time out of their busy practices to come to clinic once per week to precept our residents. Our preceptors, numbering near 20, are excellent clinicians and have a expertise in transition medicine, care of the underserved, primary care innovation and redesign, clinical decision making, billing, and much more. We promise you that this group of individuals will make you an excellent primary care physician by the time you leave residency

Our Clinic Staff:
We have been very fortunate have a team of staff (nurses, medical assistant, and clerical staff) who are dedicated to our patients, the physicians, and each other. This core group of individuals keeps our practice working like a well-oiled machine, and we are most grateful to them.

Clinic Structure for Residents: 
You have one clinic a week during wards and ED, and two clinics a week during electives. Our Med-Peds Chief takes great care in scheduling these clinic sessions to ensure you maximize you time on both the wards and during your clinic half days. At the start of an academic year each resident is assigned a set "clinic day of the week" and we try to schedule their sessions on this day as long as inpatient ward schedules allow. This allows the formation of partnerships with fellow residents who also have clinic on that day in "clinic teams" that cover for each other on vacations, work on specific quality improvement projects, and provide mentorship and guidance to each other. Why is this important? For a few reasons! You can use your partners to improve continuity and coverage when you are out of the office. It allows for a "private practice" feel during residency (6 partners instead of 30!). It also fosters close working relationships that you maintain for the duration of residency with residents from all four classes. And come graduation, it is easier to transition patients from graduating seniors to their intern partners.

Balance of Pediatric and Adult Patients in Clinic:
We have been most fortunate to have an even balance in pediatric to adult percentages. Our residents are easily able to meet the pediatric and internal medicine RRC requirements for numbers of patients, pediatric/adult balance, and numbers of clinic weeks and sessions.

Types of Patients We See in Clinic:
Our residents are fortunate to see a diverse spectrum of diseases as well in their clinic population, while also having ample opportunity to practice well, preventative care. Our payor mix consists of roughly 60% Medicare/Medicaid, 30% private insurers, and 10% indigent care. There are also some special experiences that we are able to offer in clinic because of our unique skills as Med-Peds practitioners -- something that you will have in your future as well! This includes transitional care from the pediatric subspecialty clinics. These populations include adults with childhood and congenital disease such as congenital heart disease, autism, Down Syndrome, William's syndrome, prune belly, and tuberous sclerosis. Our Med-Peds clinic holds a monthly subspecialty clinic in collaboration with with pediatric genetics faculty to provide care for adults with neurofibromatosis and other genetic disorders. We are also fortunate that our Med-Peds clinic hosts a cutting-edge primary care clinic for adults with Sickle Cell Anemia that are moving from pediatric to adult care. We are the only pediatricians for UC student health, so we see the children of UC students from all over the world. Our clinic also sees a rapidly growing Latino population thanks to a few Spanish speaking providers (including a number of our attendings).

Innovation in Primary Care:
Our residents also have the opportunity to participate "centering" group visits during which they experience the penultimate in patient-centered when they assist in facilitating group visits during which groups of patients learn disease management and provide each other with support. The centering visits involve groups of patients with diabetes, chronic pain, healthy life styles, and mothers and infants recovering from addiction. Our clinic is also part of of the CPC+ program. Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation.

What is Clinic Like for our Residents:
Because our faculty work along side the residents seeing patients, we are able to offer as close, "real life" experience for the residents. We have a very strong focus on continuity in patient care and work to ensure patients assigned to our residents are able to see them whenever possible. As a resident we want your patients to see YOU as their doctor, with your resident and faculty partners available to see them in emergencies when you are not available.  When you visit our program, please review our data, which we review biannually to assure the residents are seeing enough breadth and depth of patient care!

Preceptor Ratios:
We usually have 3 preceptors per half day for 6 to7 residents, including someone to help out should things get busy. All of the preceptors are Med-Peds trained and are committed to medical education. The residents spend one year their clinic days 3 assigned preceptors, but rotate every year to new group of preceptors. That means they have in depth mentoring experience, but their experience is not limited to just 3 people! The goal is to teach evidence based medicine for both preventive care and disease management.

Training in Practice Management:
Since we have many patients with private insurance, the residents get hands on experience with practice management. That means you learn how to work effectively in the managed care setting by providing patient care in an environment that focuses on providing effective and evidence-based care at the lowest cost. We also have multiple conferences on practice management as well as our annual Med-Peds career day.

Procedure Training in Med-Peds Clinic:
Our clinic experience has a strong emphasis on office gynecology. Other procedures our residents have an opportunity to learn during clinic or as part of our Primary Care Track include arthrocentesis, joint injections, splinting, cryotherapy, punch biopsies, I/Ds of abscesses, fluorescein/woods lamp exams, tympanometry, and pure tone audiometry. In addition, suturing, splinting, and stress testing training are available on other electives and during required ED rotations. 

Overarching Goal of Your Ambulatory Training During Residency:
Every five years we survey our graduates about all aspects of their residency experience and training. Results from these surveys indicate that our residents feel they are extremely well trained in primary care and competent to enter careers in primary care (if they should elect to do so!) at the end of residency! It is our goal that at the end of residency you are a top notch clinician and able to take any job you would like when you finish residency (whether primary care, hospital medicine, or moving on to fellowship training). Your success is our success!

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More Information

For more information on the Medicine-Pediatrics Residency Program, please contact us at:

Medicine-Pediatrics Residency Program
UC Department of Internal Medicine
231 Albert Sabin Way
Mail Location 0535
Cincinnati, OH 45267-0535

Phone: 513-584-0397
Fax: 513-584-0369
Email: ucintmed@uc.edu

Program Director:
Jennifer K. O’Toole, MD, MEd
Associate Professor of Internal Medicine and Pediatrics