Continuity Clinic

Purpose

To overall purpose of the continuity skills is to develop and demonstrate skills as a consultant cardiologist in the outpatient setting and to learn to address chronic cardiovascular disease management issues on a long term basis.

The goals of the ambulatory experience are to provide exposure to outpatient cardiology practice, including both consultative and continuity experiences, and to provide a means for clinical follow-up of patients recently discharged from the hospital. This experience provides an opportunity to follow and manage patients for a full 3 years in an outpatient setting. Fellows participate in a continuity clinic at both UIHC and the IC VAMC one-half day every week during the course of the 3 year cardiology fellowship program. Fellows see an average of 2-3 new patients and 3-5 return patients on their clinic day. Fellows are directly responsible for care of the patients to which they have been assigned. At the VA, one attending physician is present full-time during the clinic to supervise fellows in training. At UIHC, each fellow works with a single faculty physician providing a unique view of the practice patterns of a given faculty physician.

The patient population at the Iowa City VAMC Clinic currently includes mostly adult males. Patients are referred to the clinic for a wide variety of reasons including routine management of common cardiology problems, preoperative evaluations before non-cardiac surgery, evaluations for potential revascularization procedures (surgical and interventional), post-revascularization follow-up, follow-up of recently discharged patients, and referrals for complex cardiology problems. Medical records are easily accessed through the VA electronic medical record system (CPRS). Laboratory data and results of radiology and other diagnostic tests are also readily accessible through the electronic medical record. Computer terminals are provided in each clinic office room. At least one administrative staff member (case manager) from the cardiology section is routinely available during this clinic to assist fellows and staff physician. The cost effectiveness of various options in treating outpatient cardiovascular disease will be discussed between the faculty member and fellows. Clinical follow-up of patient outcomes will be used for quality assessment with discussions focused toward quality improvement. Fellows will be instructed on relevant issues of risk management as pertaining to patients with cardiac disease.

The Cardiology Clinic at the University of Iowa Heart Care Center (UIHC) serves male and female patients with a wide variety of cardiovascular diseases. Both primary cardiac care and tertiary, consultative evaluations are provided on a routine basis. Fellows work with an individual staff member based on fellow preferences and allocation by chief fellow and the fellowship program director. Fellows are primarily involved with provision of care and follow these patients longitudinally through the course of the 3-year fellowship experience.

Responsibility

The fellow evaluates new cardiology referrals and provides follow-up care for patients with cardiovascular diseases. The fellow performs the initial evaluation, formulates a plan of care, and presents the case to the attending cardiologist. The fellow is responsible for ordering and following up on all appropriate studies.

Supervision

Attending cardiologists are present for all clinics. All patients are presented to the designated staff physician in the clinic.

Learning Objectives

  1. Evaluate patients in the outpatient clinical setting who have a wide variety of general cardiovascular disorders by taking a thorough problem-directed history, performing a careful physical examination, and generating a differential diagnosis and plan of care. (A, B)
  2. Learn to treat common cardiovascular disorders in the outpatient setting in accordance with established practice guidelines. (A, B, C)
  3. Learn to generate a well-organized written consultation that clearly conveys the management plan. (D, E)
  4. Provide follow-up care to assess success and adverse effects of treatment. (A, B)
  5. Learn to accurately code and bill for services. (F)
  6. Gain an appreciation for the role of the ancillary staff members in the outpatient clinic setting, including the nurses, administrative staff, and social workers. (D, E, F)

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