Inpatient/Outpatient US Clinical Experience in Family Medicine in Houston

Information about this clinical experience:

This is a combined inpatient and outpatient experience during which you will be under the supervision of a board-certified family medicine physician. The preceptor holds staff appointments at several hospitals, including HCA Houston Healthcare and Cornerstone Healthcare. Through this experience, students will gain familiarity with how family medicine physicians practice hospital medicine at an institution specializing in long-term acute care. The outpatient component of this clinical experience will take place at several skilled nursing facilities. These two rotation components, including the type of patients and conditions you will see, are described in more detail below.

Long-Term Acute Care Hospital

Part of your day will be spent at a long-term acute care hospital. This is a facility which cares for patients with complex situations and acute medical needs. These patients are admitted here after discharge from an acute care hospital when they have high medical needs that prevent them from going home or to a nursing home. The most common admitting diagnoses include respiratory disease requiring ventilator support, skin ulcers, sepsis, pulmonary edema and respiratory failure, respiratory infections, chronic obstructive pulmonary disease, renal disease, and postoperative infections. You will be involved in the care of these patients. On a typical day, the patient census will include approximately 10 patients and, on average, two of these patients will be in the ICU.

Skilled Nursing Facility

The rest of your day will be spent at one of two skilled nursing facilities (SNF). Since 25% of hospitalized Medicare patients during your residency will be discharged to a SNF, this will be a valuable experience for you to take part in. The typical patient transferred to a SNF is older, has had a longer hospital stay, and requires more assistance for activities of daily living. Research shows that the transition from the hospital to the SNF is a particularly difficult time for patients as care is handed off from one group of physicians to another. Physicians involved in the care of SNF patients are given the responsibility of easing this transition, evaluating newly admitted patients to the SNF, and monitoring their daily care. Given that 23% of patients discharged to a SNF will be readmitted to the hospital within 30 days, the quality of care provided in this setting is crucial to patient outcomes, morbidity, and mortality. As part of the team caring for these patients, you will acquire essential skills in evaluating and managing these patients in a safe manner.

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision:

• Taking patient histories under supervision.

• Performing physical exams under the physician's supervision.

• Presenting patients.

• Have opportunities to research the literature to answer clinical questions at the point of care.

• Being involved in patient education.

• Spending time with other healthcare professionals to understand their roles and responsibilities.