Combined Inpatient/Outpatient US Clinical Experience in Family Medicine in Orlando

Information about this clinical experience:

During this inpatient and outpatient clinical experience, you will be under the supervision of a board-certified physician. The physician is the former Chairman of Medicine at AdventHealth. The physician has had extensive experience teaching international medical students and graduates, and this is part of what gives this doctor joy as a healthcare professional.

You will see patients with the preceptor at several different AdventHealth hospitals. There will be days during which you visit one hospital in the morning and one in the afternoon. On other days, you will spend your mornings in one hospital and the afternoons in the nursing home. The typical patient census in the hospital is 10-15 patients per day. You will see patients in the following areas:

• Medical-Surgical Unit

• ICU/CCU

• Progressive Care Unit (Step-Down Unit)

• Medical Telemetry

• Emergency Room

Your morning will begin with prerounds during which you will check in with patients to assess how they are feeling and inquire about any new developments or events that have occurred overnight. You will also touch base with the nurse to understand any nursing perspectives or concerns. After the pertinent data has been gathered, you will present your patients to the attending. You will then visit patients at the bedside with the attending.

Following attending rounds, you will accompany the preceptor to multidisciplinary rounds. This is a meeting attended by the attending physician, charge nurse and other registered nurses, case managers, and the pharmacist. During these rounds, every patient, new or old, is discussed as a group. A summary will be provided of the patient's reason for hospitalization, course of treatment, expected length of stay, necessary consults to be placed, plans for discharge, and follow-up care. Barriers to patient care and discharge will be raised and addressed. Your role will be to present your cases, answer questions, and take notes on action items for the patient's plan of care. After rounds are completed, you will work with the team to implement the day's plans. 

The outpatient component of the clinical rotation will take place in several nursing homes. Patients that reside in nursing homes have complex medical and social conditions making the care of these patients challenging. Research shows that, among graduating residents, over 20% feel unprepared to care for nursing home patients. As a result, the Institute of Medicine has urged residency programs to adopt nursing homes as sites for medical training. Therefore, your visits to the nursing home with the preceptor will be a chance for you to build the skills and knowledge needed to care for this patient population. The following articles, although a bit older, provide a great overview of important concepts in nursing home care:

Nursing Home Care: Part I: Principles and Pitfalls of Practice

Nursing Home Care: Part II. Clinical Aspects

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

• Taking patient histories under supervision.

• Performing exams under the physician's supervision.

• Presenting patients.

• Access information in the EMR (Epic)

• Ordering tests and medications

• Requesting specialty consultations

• Researching the literature to answer clinical questions at the point of care.

• Educating patients under supervision.

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

Please note that you will also have an opportunity to work with preceptor's nurse practitioner colleague which will be an excellent opportunity to build collaborative skills on an interprofessional team and understand their roles and responsibilities.