CHIUS Three Bridges Student Clinic...

CHIUSThreeBridges(3B)Student-RunClinic

CHIUS Three Bridges (3B) Student Clinic 2

TableofContents

ABOUTUS 3

CLINICOBJECTIVES 3

STUDENTS 4

STUDENTELIGIBILITY 4 STUDENTEXPECTATIONS 4 SHIFTSUPERVISORDUTIES 5

PRECEPTORS ERROR! BOOKMARK NOT DEFINED.

PRECEPTORELIGIBILITY 6 PRECEPTOREXPECTATIONS 6

CLINICORIENTATION 7

ORIENTATIONCHECKLIST–FORSTUDENTS 7

CLINICWORKFLOW 9

GENERALOVERVIEW 9 CLINICPREPARATION 9 CLINICDAYS–WORKFLOW 11

APPENDIX 18

A.EXAMPLEOFCLINICDAYSCHEDULE 18 B.WELCOMEINFORMATIONFORM-FORSTUDENTSANDPRECEPTORS 19 C.DOCUMENTSANDFORMS 20 QUEENSLANDPATIENTINTAKEFORM 20 PRECEPTORINVITATIONFORM 20 CERTIFICATEOFAPPRECIATION–FORPATIENTS 20 TEMPLATEFORCLINICSCHEDULE 20 TEMPLATEFORCLINICCALENDER 20 ORIENTATIONCHECKLIST–FORSTUDENTS 20


ABOUTUSTheCommunityHealthInitiativebyUniversityStudents(CHIUS)organizationisaUniversityofBritishColumbia(UBC)interdisciplinarystudentteamthatdevelopsandofferscommunity-basedclinicalandsocialinitiativestomeetthehealthcareneedsofmarginalizedpopulationswithintheVancouverinnercitycommunity.TheThreeBridges(3B)StudentRunClinicaddressesthismandatebyprovidinglearningandteachingexperiencesforstudentsandpreceptors,creatingmeaningfulopportunitiesforhealthcareprofessionalstudentstohelpthoseinneedintheircommunity.Studentslearnwithandaboutotherhealthcareprofessionals,includingtherolesthattheyplayoncontemporaryhealthcareteams,aswellastheimportanceofcivicduty,advocacy,servicetoothers,andthetenetsofprofessionalism.Underthesupervisionofpreceptorsandstaff,studentsinterviewpatientswithchronichealthconditions,andthroughaunique,team-basedapproach,provideappropriatecounsellinganddeliverinterventions.TheclinicoperatesoutoftheThreeBridgesCommunityHealthCentre,locatedat1292HornbyStreet,Vancouver,B.C.Regularservicesprovidedbythisclinicincludeaccesstoyouthdrop-inhealthclinics,publicandcommunitynurses,mentalhealthandaddictioncounsellors,dentalclinicsforchildren,speechtherapists,andnutritionists.ThestaffmembersattheThreeBridgesCentregenerouslysupportourclinicservice.Linktothe3Bclinicwebsite:http://www.vch.ca/locations-and-services/find-locations/find-locations?site_id=161ForanyquestionsabouttheCHIUSclinic,pleasecontactusat:[email protected]

CLINICOBJECTIVES1. AddressthegapsinchronicdiseasemanagementinVancouver’svulnerablepopulation,witha

focusondiabetesandpainmanagement2. ProvideaninterdisciplinaryclinicexperienceforHealthSciencesstudentsatUBCandthe

opportunitytolearnanddevelopclinicalexpertisealongsideotherhealthprofessionalstudents3. Promotedevelopmentofcommunicationandcollaborationskillsbyinteractingwithother

membersoftheinterprofessionalteam4. Providetheopportunitytopracticeprofessionalclinicalskillsunderthesupervisionofmentors5. Fosterasenseofcivicandsocialaccountability6. Broadenworldviewsandexposestudentstotheimpactofsocialdeterminantsonhealth


STUDENTSAsastudentattheclinic,yourrolesandresponsibilitieswouldinclude:-Reviewingpatientinformationpriortoclinicdaysandfamiliarizingyourselfwithrelevantmedicaltopics-Conductingpatientinterviewsinateam-basedformatusingastandardizedintakeform-Participatingincaseconferenceswithpreceptorstodevelopcareplansforpatients-Deliveringinterventionstopatientsasneeded(e.g.pharmacystudentperformingamedicationreview)-Documentpatientinformationontoanelectronicmedicalrecord-DebriefingattheendofthedaywithyourteamandpreceptorsPleaserefertotheClinicWorkflowsectionforamoredetaileddescriptionofstudentduties

STUDENTELIGIBILITYThefollowingoutlinesthestudentrequirementsforparticipatingintheCHIUS3Bclinic:

Faculty EligibleyearsofstudyMedicine 1or2Pharmacy 3or4Nursing StudentswhohavecompletedTerm3PhysicalTherapy 2OccupationalTherapy 1or2SocialWork Any

STUDENTEXPECTATIONSStudentsareexpected:

• Tomaintainprofessionalbehaviorandappropriateboundarieswithpatients,preceptors,andstaff• Tomaintainappropriatepersonalpresentation(dressshouldalwaysbeappropriatetoa

professionalsetting)• Toseektodevelopfriendlyworkingrelationshipswithpeers,professionalcolleagues,andlearn

abouttherolethateachteammemberhaswithintheteam• Totakeadvantageofanylearningopportunitiesavailable• Toreflectontheirpracticeandadaptaccordingly• Toplanandprepareappropriatelyforassessment/treatmentsessions• Tomaintainopencommunicationschannels–clarifyingissues,debriefing,anddiscussingthoughts

orreactionstoanythingyoumayfinddifficultorupsetting,sothatissuescanbedealtwithconstructively


• Toadheretodocumentationguidelines,andcompleteinatimelymanner• Torespectandmaintaintheconfidentialityofpatientandworkplaceinformation• Toadheretoworkplacepoliciesandprocedures• Toutilizenonclientcontacttimeconstructively• Togiveactiveandconstructivefeedbacktowardsstaff,faculty,andothercolleaguestoimprovethe

CHIUSprogram

SHIFTSUPERVISORDUTIESTheshiftsupervisorwillbethestudentinchargeoforganizingandfacilitatingclinicoperations.ThispositionmaybefilledbyastudentfromanyhealthcarefacultyatUBC,withaminimumcommitmentperiodofoneschoolsemester:

• SeptembertoDecember–Twoblocksduration• JanuarytoApril–Twoblocksduration

Theshiftsupervisorwillbechargedwiththefollowingduties:Pre-clinicpreparation

• Thecreationofworkflowschedulesforeachclinicday• Thedistributionofawelcomeinformationformtostudentsandpreceptorsbeforeeachclinicblock• Thecreationofshortsummariesforpatientsreferredtotheclinicanddistributionofpatient

informationpriortothestartofeachshift.Theshiftsupervisormustusetheirdiscretioninsharingconfidentialinformationsothatidentifyingpatientinformationisremoved

• Tocallfollow-uppatientsthedaybeforetheirscheduledclinicvisittoremindthemoftheirappointment

• Tofunctionasthemainliaisonbetweenstudents,preceptors,andclinicstaffmemberswithregardstocommunication

• Checktheclinicemail([email protected])andreplytoanyinquiriesDuringclinic

• PurchasecartonofStarbucksCoffeeforpreceptorsandstudents(canbepurchasedrightacrossthestreetfromtheclinic)

• Arriveatclinic30minutesbeforestarttimetohelpwithsettingupfortheclinicday(thepreparationinformationisdetailedlateroninthispackage)

• Tobepresentforthedurationofeachclinicshifttohelpwithlogisticsandtrouble-shooting• Toleadthedebriefsessionattheendofeachday,aswellasatthecompletionofeachclinicblock• Assistwithcleanupattheendoftheday• Attheendofeachclinicblock,remindstudentsandpreceptorstofillouttheonlinequestionnaire

regardingclinicfeedbackPleaserefertotheClinicWorkflowsectionforamoredetaileddescriptionofshiftsupervisorduties


PRECEPTORSAsapreceptorattheclinic,yourrolesandresponsibilitieswillinvolve:-Supervisingstudentsthroughouttheprocessofinterviewingpatients,participatingincareconferences,anddeliveringinterventions-ProvidingfeedbacktostudentsonimprovingtheirinterviewingandclinicalskillsPleaserefertotheClinicWorkflowsectionforamoredetaileddescriptionofpreceptorduties

PRECEPTORELIGIBILITYToparticipateintheclinic,apreceptormusthavethefollowingqualifications:

1. Beoneofthefollowing:a. VancouverCoastalHealth(VCH)staffonpaidtimeb. UBCfacultyc. ApersonwithaUBCappointment*

2. Anup-to-datelicensewiththeirprofessionalcollege3. Malpracticeinsurance

*IfyouarenotVCHstaffonpaidtimeorhaveanyaffiliationwithUBC,thesubmissionofanapplicationforaUBCappointmentcanbearranged.Pleasecontactusaschius.clinic@gmail.comformoreinformationonthisprocess.

PRECEPTOREXPECTATIONSPreceptorsareexpected:

• Tomodelappropriateprofessionalbehaviorsandboundaries,exemplifyingappropriateworkingrelationshipswithallmembersofthemultidisciplinaryteam

• Tobeapproachableandavailableforquestionsandencouragestudentstotakeadvantageofanylearningopportunities

• Tomaintainopenchannelsofcommunications,facilitatingclarifications,debriefing,andgivingtimelyandconstructivefeedback

• Tomodeltimemanagementskillsandsupportstudentstodevelopskillsandstrategiesinthisarea• Toprovideinformationregardingdocumentationstandards,andgivetimely,consistentand

constructivefeedbackwithregardstodocumentation


CLINICORIENTATIONSiteorientationforbothstudentsandpreceptorswillbedonetwiceperschoolterm,atthebeginningofeachsemester(SeptemberandJanuary).Theorientationwillconsistofaclinicstaffmembergivingabrieftourofthefacilityandit’sequipment,aswellasabriefexplanationoftheclinicmodel,intakeprocess,andoverallworkflow.Orientationtotheuseoftheelectronicmedicalrecords(EMR)systemwillbeavailableasarecordingonline,whichshouldbeviewedpriortoastudent’sstartdate.ArequisitionformtoapplyforanEMRloginnameandpasswordshouldbefilledoutamonthinadvanceofthestartdateaswell.The‘StudentExpectations’and‘Workflow’sectionsofthismanualshouldbereviewedbyallstudents(andpreceptors)beforetheirfirstclinicshift.ForstudentswithlittleornoexperiencewithwritingSOAP(subjective/objective/assessment/plan)notes,thefollowingisausefulresourcethatexplainsthebasicsofaSOAPnote:www.wikihow.com/write-a-soap-note.StudentsarealsohighlyencouragedtoparticipateinthegeneralCHIUSorientationinSeptember,whichintroducesstudentstostrategiesinworkingwithsensitivepopulations.Forsomestudents,theCHIUS3Bclinicmaybetheirfirsttimeworkingwithmarginalizedpopulations,andthissessionwillhelppreparethemtobetterhandlechallengingsituationsthatmayariseduringtheirtimeattheclinic.ThisorientationisheldannuallyinSeptemberandisopentoallhealthcarestudentsatUBC.

ORIENTATIONCHECKLIST–FORSTUDENTSThefollowingitemsmustbecompletedpriortothestartofeachclinicblock:Forms:**onlyifyoudidnotfilltheseoutandhandtheminattheCHIUSgeneralorientation

o EMRloginrequisitionform

o VancouverCoastalHealth(VCH)confidentialityform

• Pleasebringthecompletedformwithyouonyourfirstclinicday

• Availableat:http://studentpractice.vch.ca/orient.htm

Modulesandvideos:

o StudentPracticeEducationCoreOrientation(SPECO)module

• Availableat:http://studentpractice.vch.ca/orient.htm

o EMRtrainingvideos

• Video#1(2min,19sec):https://www.youtube.com/watch?v=3kfzD2Gse8Y&list=PLb-

I3FkiTnJhhtuLfrIY9AWG3tXaq2n35&index=1


• Video#2(51min,52sec):

http://www.screencast.com/users/PCCEMR/folders/EMR%20HELP%20VIDEOS/media/bb368b8a-1d40-4f79-8e84-f7ec74f4eaf9

Readings:

o Reviewofthe‘StudentExpectations’and‘Workflow’sectionsoftheClinicManual

• Availableat:http://www.chius.ubc.ca/chius-clinic/chius-interdisciplinary-clinic/

o SOAPnotetutorial(optional)

• Availableat:www.wikihow.com/write-a-soap-note

Theabovechecklistalongwithlinkstodocumentsandvideoscanbefoundat:http://www.chius.ubc.ca/chius-clinic/chius-interdisciplinary-clinic/


CLINICWORKFLOW

GENERALOVERVIEW• Therewillbe4clinicblocksscheduledduringeachacademicyear(seeappendixforexampleof

cliniccalendar)o Firstsemester–2clinicblockso Secondsemester–2clinicblocks

• Studentswillberequiredtocommittoanentireclinicblockforcontinuityofpatientcare• Eachclinicblockwillconsistof3clinicdays(Days1,2,and3)biweeklyonSaturdays(from9:30am

-1:00pm)overaperiodof5weeks• Eachclinicdaywillbescheduleddependingonthenumberofnewpatientsandreturningpatients

beingseen• Studentswillbesplitintotwoteams(Team#1and#2),eachconsistingofonestudentfromeach

ofthefollowinghealthdisciplines:o Medicineo Pharmacyo Nursingo Physicaltherapyo Occupationaltherapyo Socialwork

• Eachteamwillworkindependentlyofeachotherwithsupportfromstaffandpreceptors• Oneachclinicday,eachteamwillconducteitherONEnewpatientintakeorONEtoTWOpatient

follow-ups• Eligiblepatientswillbereferredtotheclinicbytheirfamilyphysicianat3B–thereferralform(see

appendix)mustbefilledoutandsenttotheShiftSupervisoratleastoneweekinadvanceoftheirscheduledappointmenttime

CLINICPREPARATIONClinicDay1–thefollowingtobedone1weekprior1.TeamassignmentsShiftSupervisorResponsibilities:

• ShiftsupervisorwillreviewrosterofincomingstudentsandassignstudentstoeitherTeam#1orTeam#2whiletakingstudentexperienceandyearsofstudyintoaccount.Teamassignmentswillbedistributedtostudentsviaemail

StudentResponsibilities:• None


2.PatientpreparationShiftSupervisorResponsibilities:

• Shiftsupervisorwillreviewreferralformsforallnewandreturningpatientsscheduledandsummarizemainissuesinemailform,tobedistributedtostudentsforresearchandpreparationpurposes.Medicationlistshouldbeincludedintheinformationdistributed.Abriefdescriptionofthetypeofdwellingthepatientresidesin,andwhatcitytheycallhomeshouldalsobeincluded.Onenewpatient,ORonetotwofollow-uppatientswillbeassignedtoeachinterdisciplinaryteam

• Shiftsupervisorshouldbepreparedtogiveabrieforalsummary(<1minutes)ofeachpatient’sprimaryissuesatthebeginningoftheclinicshift

StudentResponsibilities:• Studentsshouldusetheweekbeforetheclinicdaytoreviewpatientinformationandconduct

preliminaryresearch(ifnecessary)onrelevanttopicsinpreparationfortheclinicday3.SchedulepreparationShiftSupervisorResponsibilities:

• Shiftsupervisorwilldraftascheduleforeachteamthatbalancestimeforpatientfollow-upaswellasassessmentofnewpatients.Thescheduleshouldavoidhavingpatientsarriveatthesametime,andattempttospreadoutthetimesthatpreceptorswillbeneededbyeachteam(inparticularthestudent/preceptordiscussiontimeandteamdiscussiontime).Thisschedulewillbedistributedtoclinicstaff,preceptors,andstudentsviaemail.(Seeappendixforexampleofclinicschedule)

StudentResponsibilities:• Studentsshouldbeawareoftheirschedulefortheday

ClinicDays2and3–thefollowingtobedone1weekprior1.Returningpatientpreparation(**thismaybedoneatendofpreviousclinicshift)ShiftSupervisorResponsibilities:

• ShiftsupervisorwillreviewSOAPnotesrecordedontheEMRsforreturningpatientsfrompreviousclinicdays.Theywillmakenoteofanyplannedfollow-upinterventionsanddeterminethetotalamountoftimethatwillbeallottedforfollow-upforeachpatient(SOAPnotesshouldincludeabriefdescriptionofplannedinterventionsaswellasanestimationoftimeneededfordelivery–e.g.“Pharmacy-reviewofbloodglucoselogbookandcounsellingonstrategiesforimprovingmanagement;15minutes”)

StudentResponsibilities:• Studentsshouldpreparefordeliveryoffollow-upinterventionsbydoingresearchingapplicable

resources2.Patientpreparation

• ThisstepsameasDay13.Schedulepreparation

• ThisstepsameasDay1


CLINICDAYS–WORKFLOWCLINICDAY1EXAMPLE

• Shiftsupervisorwillarriveat8:45amatthe3Bclinictosetupforthedayo Connectwithsecurityguards,unlockconferenceandclinicroomso Obtainkeycards(4)fordistributiontostudents(2;1cardperteam),preceptors(1),and

forthemselves(1)o Setuplaptops(oneineachconferenceroom)andbringuptheEMRsofthepatientswho

willbeinterviewedintheroomo Setupaudio/visualequipmentinconferenceandclinicroomsforpreceptorviewingo Logintoadditionalcomputers(inthepreceptorviewingroom)andpullupEMRsof

patientsforthedayo Ensurethereareadequatecopiesofallforms(Summaryofcareplanform)onhando Writeonthewhiteboardthedifferentteamgroups(ifitisthefirstday),andwriteoutthe

schedule• Studentswillarriveat9:15amatthe3Bclinicandmeetinthemainconferenceroom• Preceptorswillarriveat9:15amatthe3Bclinicandmeetinthemainconferenceroom

I.IntroductionsandAssigningofRoles-ForallStudents,Staff,andPreceptorsIntroductions,siteorientation,andassigningofroles(duration:30minutestotal)

• Generalroundtableintroductionsofstudents,preceptors,andstaff(15minutes)• Forthefirstdayofeachblock:Siteorientationtolocationofclinicrooms,washrooms,emergency

exits,etc.bystaffmember(15minutes)• Shiftsupervisorwillgiveabriefrundownoftheday’sscheduleaswellasverbalsummariesofthe

twonewpatients• ShiftsupervisorwillcollectVCHconfidentialityformsfromstudents• Teamswillsplitintopre-assignedgroups(Teams#1and#2)anddecideonassignmentofspecial

roles:o Onetime-keeper–thisstudentwillkeeptheteamonschedulebyredirectingpatientsas

neededandensuringequalopportunityforeachstudenttoconducttheirinterviews.Preferablyastudentwithpriorexperiencewithfacilitatinggroupdiscussions.Thisstudentwillalsobeinchargeoftheaccesskeycardfortheday

o Twodocumentarians–thesestudentswillrecordpatientinformationontotheirEMRusingalaptopduringinitialpatientintake,dividingthedutiesasnecessary.Preferablystudentswithpriorexperiencewritingclinicalnotes

IIa.ForaTeamSeeingaNewPatientStep1.Patientchartreviewandpreparationfornewpatientinterview(duration:30minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorshouldliaisebetweenfrontdeskstaffandstudentsfrombothteamstoletthemknowiftheirpatientsareontimeorrunningbehindschedule


StudentResponsibilities:• Studentswillreviewthechart(bothpaperandelectronic)oftheirassignedclientscheduledforthe

dayandobtainpertinentinformation• Studentsshouldusethistimetodeterminewhatinformationtheyrequirethatismissingfromthe

patientrecords,andwhatquestionstheyplantoaskthepatiento Itmaybehelpfulforeachteamtosplitfurtherintorelatedprofessions(e.g.medicine,

pharmacy,andnursingseparatefromPT,OT,andsocialwork)whendecidingwhichstudentwillaskcertainquestionsthatmayoverlapareasofexpertise

PreceptorResponsibilities:• Preceptorsshouldbeavailableduringthelatterpartofthistimeforconsultationbystudentsifany

questionsariseduringthechartreviewStep2.Patientinterview(duration:60minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorwillgreetpatientinwaitingroomandinvitethemtotheirassignedconferenceroom

StudentResponsibilities:• Studentswillgreettheirpatient,introducethemselves,andproceedtotakeafocusedhistory• TheDocumentarianswillrecordinformationgatheredontothepatient’sEMR(inSOAPnote

format,focusingontheSubjectiveandObjectiveheadings)• TheTime-keeperwillhelpfacilitatetheinterviewbyensuringitdoesnotexceed60minutesin

lengthPreceptorResponsibilities:

• Preceptorscanviewalivefeedofthepatientinterviewintheconferenceroomsfromanearbyclinicroom.Theywillhaveaccesstothepatient’sEMRandmayrefertothisandgathermoreinformationwhilewatchingtheinterview.

Step3.Studentandpreceptordiscussion(10minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorwilltakepatientbacktothewaitingroomforthedurationofthestudent,preceptor,andteamdiscussion.Thepatientcanbeencouragedtousethiswaitingtimetofilloutassessments(e.g.McGillPainquestionnaire),readpamphlets,orgrabacoffeeorteawhiletheywait

StudentResponsibilities:• Studentscanusethistimetolookupadditionalinformation,anddiscussindividuallywith

preceptorstheirideasontheassessmentandplanforthepatientsPreceptorResponsibilities:

• PreceptorsshouldbeavailableduringthistimetodiscussassessmentwithstudentsStep4.Preceptorandteamdiscussion(20minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorcancheckonthepatientiftheyarenotneededbytheotherteamduringthistime• Shiftsupervisorshouldgetasenseifthepatientwillhavetoreturnforafollow-upappointmentor

notatthispoint


StudentResponsibilities:• Studentswillreconvenewiththeirpreceptorsandclinicstaffandpresentthepatient’scasein

conferenceroom• Students,withinputandassistancefrompreceptorsandclinicstaff,willidentifymissing

information(ifany)and/orexaminationsrequired• Students,withinputandassistancefrompreceptors,willcollectivelycomeupwithanappropriate

diagnosisand/orcareplanforthepatient.• Issuesidentifiedandinterventionsrequiredwillbecategorizedasacuteorfollow-up• Studentsshouldfilloutthe“SummaryofCarePlan”form,highlightingthegoalsoftherapyand

counsellingpointsforeachpatientrelevanttoeachprofession(seeAppendixforform)PreceptorResponsibilities:

• Preceptorsshouldbepresentduringeachteam’sgroupdiscussiontoprovideinputandadviceStep5.Patientmanagement(duration:30minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorwillmeetthepatientinthewaitingroomandinvitethembacktotheirassignedconferenceroom

StudentResponsibilities:• Studentswillperformanyadditionalhistorytakingand/orexaminationsasnecessary

o DocumentarianswillrecordadditionalinformationontotheEMRasneeded• Studentswillcommunicatethecareplanthathasbeenpreviouslyestablishedbythe

interprofessionalteam,usingthe“SummaryofCarePlan”formasaguide• Thepatientcanthenchoosetoreceiveintervention(s)duringthecurrentappointmentordefer

untilnextappointment• Iftheclientchoosestoreceiveacuteinterventionsatthecurrentappointment,interventionscanbe

deliveredas:○ Individualconsultsbyaparticularstudentofanappropriatefield(e.g.thepharmacy

studentperformingamedicationreview),oramultidisciplinaryconsult(e.g.OTandSWstudentsdiscussinghomesupportstogether)

• Studentswillonlyperform/deliverinterventionsuptotheircomfortlevelundertheguidanceoftheirpreceptorasappropriate**NOTE:Ifapreceptorisnotonsite,theyshouldbeconsultedpriortotheprovisionofanyinterventions(e.g.byphone)

PreceptorResponsibilities:• Preceptorscanviewalivefeedofthepatientmanagementintheconferenceroomsfromanearby

clinicroom.Theywillhaveaccesstothepatient’sEMRandmayrefertothisandgathermoreinformationwhilewatchingthesession.

Step6.ArrangeFollow-UpAppointment(duration:5minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorwillleadpatientbacktowaitingroomandliaisebetweenthemandfrontdeskstafftochooseatimeforafollow-upappointmentifneeded


• Shiftsupervisorshouldobtainacontactphonenumberfrompatient,andverbalconsenttoprovideaphonecallreminderonedaypriortoanyfuturefollow-upappointments


PreceptorResponsibilities:• None

IIb.ForaTeamSeeingaFollow-upPatientStep1.Patientchartreviewandpreparationforfollow-uppatientinterview(duration:15-30minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorshouldliaisebetweenfrontdeskstaffandstudentsfrombothteamstoletthemknowiftheirpatientsareontimeorrunningbehindschedule

StudentResponsibilities:• Studentswillreviewthechart(bothpaperandelectronic)oftheirassignedclientscheduledforthe

dayandobtainpertinentinformation.Theyshouldbefamiliarwithpriorgoalsoftherapyandcounsellingpointsestablishedonpriorclinicvisits

• Studentsshouldusethistimetodeterminewhatinformationtheyrequirethatismissingfromthepatientrecords,andwhatquestionstheyplantoaskthepatienttoassesstheirprogresssincethelastclinicvisit

o Itmaybehelpfulforeachteamtosplitfurtherintorelatedprofessions(e.g.medicine,pharmacy,andnursingseparatefromPT,OT,andsocialwork)whendecidingwhichstudentwillaskcertainquestionsthatmayoverlapareasofexpertise

PreceptorResponsibilities:• Preceptorsshouldbeavailableduringthelatterpartofthistimeforconsultationbystudentsifany

questionsariseduringthechartreviewStep2.Follow-uppatientinterview(duration:45minutes–variablebasedoncomplexityofpatient)ShiftSupervisorResponsibilities:

• Shiftsupervisorwillgreetpatientinwaitingroomandinvitethemtotheirassignedconferenceroom

StudentResponsibilities:• Studentswillgreettheirpatient,introducethemselves,andassessthepatient’sprogresssincetheir

lastclinicvisit• TheDocumentarianswillrecordinformationgatheredontothepatient’sEMR(inSOAPnote

format,focusingontheSubjectiveandObjectiveheadings)• TheTime-keeperwillhelpfacilitatetheinterviewbyensuringitdoesnotexceed45minutesin

lengthPreceptorResponsibilities:

• Preceptorscanviewalivefeedofthepatientinterviewintheconferenceroomsfromanearbyclinicroom.Theywillhaveaccesstothepatient’sEMRandmayrefertothisandgathermoreinformationwhilewatchingtheinterview.

Step4.Studentandpreceptordiscussion(10minutes)


ShiftSupervisorResponsibilities:• Shiftsupervisorwilltakepatientbacktothewaitingroomforthedurationofthestudent,

preceptor,andteamdiscussion.Thepatientcanbeencouragedtousethiswaitingtimetofilloutassessments(e.g.McGillPainquestionnaire),readpamphlets,orgrabacoffeeorteawhiletheywait

StudentResponsibilities:• Studentscanusethistimetolookupadditionalinformation,anddiscussindividuallywith

preceptorstheirideasonthenewassessmentandplanforthepatientPreceptorResponsibilities:

• PreceptorsshouldbeavailableduringthistimetodiscussassessmentwithstudentsStep5.Preceptorandteamdiscussion(30minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorcancheckonthepatientiftheyarenotneededbytheotherteamduringthistime• Shiftsupervisorshouldgetasenseifthepatientwillhavetoreturnforafollow-upappointmentor

notatthispointStudentResponsibilities:

• Studentswillreconvenewiththeirpreceptorsandclinicstaffandpresentthepatient’supdatedstatusinconferenceroom

• Students,withinputandassistancefrompreceptorsandclinicstaff,willidentifymissinginformation(ifany)and/orexaminationsrequired

• Students,withinputandassistancefrompreceptors,willcollectivelycomeupwithanynewdiagnosisand/ormodifythecareplanforthepatientasneeded

• Issuesidentifiedandinterventionsrequiredwillbecategorizedasacuteorfollow-up• Studentsshouldfilloutanew“SummaryofCarePlan”form,highlightinganynewgoalsoftherapy

andcounsellingpointsforeachpatientrelevanttoeachprofession(seeAppendixforform)PreceptorResponsibilities:

• Preceptorsshouldbepresentduringeachteam’sgroupdiscussiontoprovideinputandadviceStep6.Patientmanagement(duration:30minutes–variablebasedoncomplexityofpatient)ShiftSupervisorResponsibilities:

• Shiftsupervisorwillmeetthepatientinthewaitingroomandinvitethembacktotheirassignedconferenceroom

StudentResponsibilities:• Eachteamwillperformanyadditionalhistorytakingand/orexaminationsasnecessary

o DocumentarianswillrecordadditionalinformationontotheEMRasneeded• Eachteamwillcommunicateanychangestothecareplanthathasbeenpreviouslyestablishedby

theinterprofessionalteam• Thepatientcanthenchoosetoreceiveintervention(s)duringthecurrentappointmentordefer

untilnextappointment• Iftheclientchoosestoreceiveacuteinterventionsatthecurrentappointment,interventionscanbe

deliveredas:


○ Individualconsultsbyaparticularstudentofanappropriatefield(e.g.thepharmacystudentperformingamedicationreview),oramultidisciplinaryconsult(e.g.OTandSWstudentsdiscussinghomesupportstogether)

• Studentswillonlyperform/deliverinterventionsuptotheircomfortlevelundertheguidanceoftheirpreceptorasappropriate**NOTE:Ifapreceptorisnotonsite,theyshouldbeconsultedpriortotheprovisionofanyinterventions(e.g.byphone)

PreceptorResponsibilities:

• Preceptorscanviewalivefeedofthepatientmanagementintheconferenceroomsfromanearbyclinicroom.Theywillhaveaccesstothepatient’sEMRandmayrefertothisandgathermoreinformationwhilewatchingthesession.

Step7.ArrangeFollow-UpAppointment(duration:5minutes)ShiftSupervisorResponsibilities:

• Shiftsupervisorwillleadpatientbacktowaitingroomandliaisebetweenthemandfrontdeskstafftochooseatimeforafollow-upappointmentifneeded


PreceptorResponsibilities:• None

III.Post-ConsultationWrap-up–ForStudents,Staff,andPreceptorsStep1.SOAPnotecompletion(20minutes)ShiftSupervisorResponsibilities:

• NoneStudentResponsibilities:Forteamswhosawanewpatient:

• StudentsfromeachteamwillsplitupandaddtheirownAssessmentandPlan(SOAPnoteformat)totheEMRoftheirnewpatient,undertheheadingoftheirownprofession

o e.g.Pharmacy§ Assessment-PatienthaspoorlycontrolleddiabeteswithanA1cof9.5%§ Plan(acute)–SuggestedpatientrecorddailyFBGsbeforebreakfast,lunch,dinner,

andatbedtimeinalogbook§ Plan(follow-up)–WillreviewFBGsinlogbooktwoweeksfromnowatnextclinic

visitanddiscussstrategiestohelpstabilizelevels(timeneeded~10minutes)Forteamswhosawafollow-uppatient:

• StudentswilladdnotestotheEMRofreturningpatientsundertheheadingoftheirownprofessiondescribingthedeliveryofinterventionsandifanyfurtherfollow-upisneeded,followingtheSOAPformat

PreceptorResponsibilities:• PreceptorsshouldbeavailabletoreviewthecompletedSOAPnotesandsuggesteditspriorto

reviewbythestaffphysician


Step2.Endofdaydebrief(10minutes)• Thestudents,preceptorsandstaffwillmeetintheconferenceroomattheendofthedayto:

a. Havearoundtablediscussionsummarizingcasesseenthroughoutthedayandlearningpoints

b. EvaluatewhatwentwellandwhatrequiredimprovementStep3.Clinicclean-up(5minutes)ShiftSupervisorResponsibilities:

• ShiftSupervisorwillcollectkeycardsfromstudentsandpreceptors• ShiftSupervisorwillpackupandsecureallaudio/visualequipment• ShiftSupervisorwilllockdoorstoconferenceroomandanyclinicroomsthatwereinuse

CLINICDAYS2AND3-NOTESClinicdays2and3shouldbesimilartoday1withafewexceptions:1.Allclinicparticipantsshouldarrive15minuteslaterthenscheduledonday1(nositeorientation)

• ShiftSupervisorat9:15amforclinicsetup• Everyoneelseat9:30amforateamhuddleandroleassignments

o Roleassignmentsmaybenewstudentsorthesameaslastday2.Endofblockdebriefattheendofday3(20minutes)

• Students,preceptors,andstaffwillmeetinthemainconferenceroomtodoadebriefofthedayaswellasthefortheentireblock

• Thefollowingquestionscanbeusedasaguide:1. Didanythingsurpriseyouonlearningabouteachother’sroles?2. Wheredidyoufindrolesoverlapped?3. Whatroleswereuniquetoeachprofession?4. Howcanyouworktogethermorecloselytoaddressthepatient’sconcernseffectively?5. Knowingwhatyouknownow,howwillthischangehowyouworkwithpatient’s/other

professionals?6. Didyouidentifyanyactions,processes,orissuesthathelpedorinterferedwithgroup

functioning?


APPENDIX

A.EXAMPLEOFCLINICDAYSCHEDULE


B.WELCOMEINFORMATIONFORM-FORSTUDENTSANDPRECEPTORSDear_______,PleasefindbelowsomeimportantinformationforyourperusebeforethestartofyourclinicshiftattheThreeBridgesclinic.Placementdates:_______Streetaddress:ThreeBridgesCommunityHealthCentreat1292HornbyStreet,Vancouver,B.C.,CanadaV6Z1W2YourShiftSupervisor:_______ShiftSupervisor’scontactinformation(emailandphone):_______Dresscode:BusinesscasualPleasebringapieceofIDshowingyouareeitheraUBCstudentorVCHemployee.Itisrecommendedyoubringaclipboardandpen/pencilfornote-takingpurposes.Transportation:Takingpublictransportationishighlyrecommended–theclinicisabouta3minutewalkfromtheYaletown-RoundhouseSkytrainstation,andiseasilyreachedbybusfromtheGranvilleSkytrainstation.Toentertheclinic,thereisadoormarkedwitha‘B’about10meterstotheleftofthemainentrancefacingHornbySt.Thisdoorleadstothemainconferenceroomandshouldbeunlocked.Ifitislocked,pleaseenterthroughthemainentranceandsigninwiththesecurityguardatthedoorandmakeyourwaytothemainconferenceroom(askthesecurityguardfordirections).Orientationchecklist:Itismandatorytocompletethefollowingchecklistbeforethestartofyourclinicblock:http://www.chius.ubc.ca/chius-clinic/chius-interdisciplinary-clinic/Suggestedpreparation:Familiaritywithinyourareaofpracticeinworkingwithpatientswithdiabetesandchronicpainishighlyrecommended.Knowledgeofcommonpracticesintheassessmentandtreatmentofthesepatients,aswellaslocalresourcesforreferralisadvised.


C.DOCUMENTSANDFORMS

QUEENSLANDPATIENTINTAKEFORMLinktodownloadorprint:http://chius-health.sites.olt.ubc.ca/files/2015/05/Queensland-Patient-Intake-Form.pdf

SUMMARYOFCAREPLANFORMLinktodownloadorprint:http://chius-health.sites.olt.ubc.ca/files/2015/05/Queensland-Patient-Intake-Form.pdf

PRECEPTORINVITATIONFORMLinktodownloadorprint:http://www.chius.ubc.ca/chius-clinic/chius-interdisciplinary-clinic/

CERTIFICATEOFAPPRECIATION–FORPATIENTSLinktodownloadorprint:http://www.chius.ubc.ca/chius-clinic/chius-interdisciplinary-clinic/

TEMPLATEFORCLINICSCHEDULELinktodownloadorprint:http://www.chius.ubc.ca/chius-clinic/chius-interdisciplinary-clinic/

TEMPLATEFORCLINICCALENDERLinktodownloadorprint:http://www.chius.ubc.ca/chius-clinic/chius-interdisciplinary-clinic/

ORIENTATIONCHECKLIST–FORSTUDENTSLinktodownloadorprint:http://www.chius.ubc.ca/chius-clinic/chius-interdisciplinary-clinic/

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