Today is Thursday, Oct. 18, 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.  From day one of your residency you are partners in our office, serving your patients alongside our experienced, top-notch faculty.   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 contact YOU!

On elective months starting your second year, you learn telephone medicine by taking clinic call after hours, always with the support of faculty 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 IMG_5011faculty and residents involved!   As a combined Med-Peds office we serve whole families.  We even have a number of families for which we see three or four generations! Understanding the whole social and family history allows us to provide holistic care understanding health and illness in the context of the family.  

In August of 2002, we moved into our current state-of-the-art facility in Hoxworth Center. 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 office has been a certified Patient Centered Medical Home (PCMH) since 2009.  Our advanced medical home design is the framework that allows us to provide comprehensive primary preventive care and chronic disease management of complex adults and kids all in one place.  We work together as a multidisciplinary team of physicians, nurse practitioners, nurses, lactation consultants, medical assistants, care managers, pharmacists, diabetic educators, social workers, and clerical support staff in order to provide coordinated, compassionate care for each patient. In 2015, we earned the National Press Gainey Top Box award for being in the top 1% in patient satisfaction with clinic. In 2017 we started a patient and family advisory council (PFAC) to involve patient feedback in our practice.

Balance of Pediatric and Adult Patients in Clinic:
We have been most fortunate to have an even balance in pediatric to adult percentages which we intentionally sustain by always remaining open to newborns.  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 ages as well as medical diseases in their clinic population.  Our payer mix consists of roughly 60% Medicare/Medicaid, 30% private insurers, and 10% indigent care. As Med-Peds, our clinic werves as a site for 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, tuberous sclerosis, and childhood cancer survivors. Our Med-Peds clinic holds a monthly subspecialty clinic in collaboration with pediatric genetics faculty to provide care for adults with neurofibromatosis and other genetic disorders.  We also serve as a medical home for adults with Sickle Cell Anemia.   We are the only pediatricians for UC student health, so we see the children of UC students from all over the world. In addition we serve a large number of immigrants and refugees.   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 practice is one of a select number of primary care offices chosen in 2017 to be part of the National Comprehensive Primary Care Plus program (CPC+).  CPC+ is a nationally advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. The goal is to redesign primary care to improve population health and relationship-based care management of chronically ill adults and children.  We are working with national leaders to pilot a new structure to improve the health of our community. 

In addition, we are certified by the Centering Healthcare Institute in Boston (CHI) to provide group visits using the evidenced based model of centering. Our residents have the opportunity to help facilitate in group visits during which they experience the penultimate in patient-centered healthcare.  In a centering group, patients learn from one another and gain self-management support to care for their health. We currently offer group visits for diabetes, chronic pain, healthy life styles, and opioid addicted moms and babies.

What is Clinic Structure and Experience like for our Residents?
As a resident we want your patients to see YOU as their doctor.  Your resident and faculty partners are available to see them in emergencies when you are not available.  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 your time on both the wards and during your clinic half days. At the start of an academic year each resident is assigned a primary "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 "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.   When you visit our program, please review our data, which we review biannually to see the breadth and depth of the resident patient care experience!

Our Clinic Staff:
We have been very fortunate to have an outstanding team of nurses, medical assistant, clerical staff, pharmacists, social workers, educators and care managers who are dedicated to our patients, the physicians, and each other. Caring for complex and vulnerable populations requires a robust team effort.  This core group of individuals are the rock that keeps our practice working like a well-oiled machine. Our residents, faculty, and staff work as a large extended family that relies on one another.  We value a strong caring team learning environment, where we can laugh and support one another in caring for our patients. 

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Our Preceptors:
Our preceptors are the "icing on the cake" that makes our Med-Peds clinic education so outstanding . We have dedicated experienced faculty and an NP that practice in clinic alongside the residents. In addition, we have a large group of Med-Peds physicians that practice in the community and take time out of their busy practices to come to clinic once per week to precept our residents.  They are excited to grow the next generation of Med-Peds Primary Care Physicians!!  Our preceptors, numbering near 20, are excellent clinicians and have expertise in transition medicine, care of the underserved, primary care innovation and redesign, clinical decision making, billing, school-based clinics, 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.

Preceptor Ratios:
We usually have 3 preceptors per half day for 6 to 7 residents, including someone to help out should things get busy. All of the preceptors are Med-Peds trained and are committed to medical education. Resident teams rotate clinic day every year to work with a new group of preceptors. This allows for robust experience learning from many of our top notch faculty.

Training in Practice Management:
Resident education in the “business” of medicine and practice management is key in today’s healthcare environment.  Our faculty have expertise in the many components of billing and coding for both private insurances as well as Medicare and Medicaid.   This means you begin to learn essential tools in coding and documentation early in residency so you leave residency with a foundation in billing.  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/D 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