Primary Care Residency Track MUSC Residency Program Director: Mike Southgate, MD Grant Director: Bill Basco, MD, MS

What is it? An effort to improve entry into primary care community practice by reducing time in hospital- based training Increasing training time in community practices Specifically training these residents in interprofessional activities in order to better prepare them to function in a multi-professional PCMH

What’s Different? Pediatric Residency has 36 blocks (4 wk periods) PCT Residents will spend 9 blocks in primary care oriented training during their 3 years in training This more than doubles the time spent in primary care settings compared to current residency The PCT residency program will add the community-based rotations by adjusting the PL2 and PL 3 years of the PCT residents

Timeline for PCT Residents Month 0-6Mo. 7-12Mo Mo Mo Mo New Experiences as part of PCT 4.5 months in Community Practice sites Attend SC AAP Meeting Complete Interprofessional Faculty Development Institute (IFDI) Complete Advocacy or PCMH Project in Community Practice Didactic Component Pediatric Department Residency Teaching sessions: Morning Report (M-Thur, 8 a.m. via teleconference if away); Noon Conference (M-Thur, 12 noon via teleconference if away); Grand Rounds (Friday 8 a.m., via teleconf. If needed). MUSC General Pediatric Residency Program Continuity Clinic at Pediatric Primary Care Site Intern (PL1) RotationsModified PL2 rotationsModified PL3 rotations Learning QI constructs Group Planning for Project Plan Project/Possibly Conduct Project Complete Advocacy or PCMH Project in Community Practice Attend Present Poster at SC AAP Chapter Meeting Present PCMH or Advocacy Project at PAS Yellow indicates experiences unique to PCT

Required in Current Residency Review Committee requirements (25 required blocks): – –Inpatient: 5 blocks – –ER: 4 blocks – –NBN Nursery: 1 block – –ICU: 5 blocks (3 months NICU, 2 blocks PICU) – –Adolescent : 1 block – –Behavior/Development: 1 block – –Subspecialty: 7 blocks (don’t have to be inpatient) – –Advocacy: 1 block

Breakdown of Blocks for PCT Therefore, the required blocks will take up 25 of the 36 available to PCT residents, leaving 11 for other activities. Nine of those blocks will occur in the PCT community training sites, with the other 2 available as electives in addition to the electives the residents have available as part of their subspecialty allotment of 7 blocks.

What Will Potentially Be Removed? * 1 Subspecialty wards 3 Inpatient General Wards 1 Elective 1 NICU 2 Elective/NFF 2 ED 1 Pediatric Surgery * Note: schedule can be modified to some degree with input from trainees, so these are proposed

PCMH Education: We plan experiential PCMH learning for the PCT residents. PL1 and PL2 years complete directed readings about the PCMH. Work with Practice Manager in Georgetown to learn about – –Rural Health Clinic and Federally Qualified Health Center Designation – –Learn billing and collection issues EBM/QI project will be completed in one of the community sites, designed to evaluate, improve, or implement a functionality of the PCMH.

Community Preceptors and Sites Henry Lemon, MD, MSCR – MUSC Children’s Care, Northwoods. – –14,500 visits per year. – –65% Hispanic, 24% black, 8% white, and 3% other. – –Insurance 93% Medicaid,2.6% private insurance, 4.4% uninsured. – –6 weeks here in each of Years 2 and 3 of residency Paul J. Hletko, MD –Georgetown Pediatric Center (GPC). – –28,000 visits per year. – –Patient population 52% Black, 40% white, 8% Hispanic. – –Insurance 67% Medicaid, 23% private insurance and 10% uninsured. – –3 MONTHS here in each of Years 2 and 3 of residency

Novel Benefits for PCT Trainees: Attend State AAP meeting yearly Be in the forefront of our tele-education efforts Be in the forefront of our tele-medicine efforts with subspecialists Get to learn what it is really like to be an ambulatory physician Get to experience increased ambulatory training while also being at a tertiary center Learn more about practice management than regular track residents Planning to add additional Devel Peds and or Child Psychiatry time Become part of a community, and learn how a physician operates in a community

Frequent Concerns You are not obligated to go into primary care, nor is there a financial penalty for not doing so You ARE obligated to stay in PCT (not switch to MUSC’s other track) as space may not be available in the current categorical track You are obligated to fulfill the community training time – this can’t be modified because of the grant obligations Georgetown housing paid for Travel to-and-from Northwoods and Georgetown reimbursed

Questions? Residency Coordinator – – –Becky Hasegawa: Residency Program Director – – –Mike Southgate: Grant Director – – –Bill Basco: