Continuity Clinic: Stony Brook Children's Resident Continuity Practice

 

At the beginning of intern year, all Pediatric residents are assigned to one of our primary care offices, which are located in the surrounding communities.  Residents typically spend a full day per week at their clinic site and remain at their assigned site on the same day of the week, with the same preceptors, throughout their three years of training. This allows them to establish a true continuity panel of patients. In addition, this consistency helps residents build a strong relationship with their patients, preceptors, co-residents and office staff. Continuity clinic becomes our residents' home away from home.

We are proud to note that our Stony Brook Pediatrics primary care offices have achieved Patient-Centered Medical Home (PCMH) Level 3 recognition from the National Committee for Quality Assurance (NCQA).  PCMH is a model of care that puts patients at the forefront, improves quality of care and the patient experience, while reducing health care costs.  Residents are an integral part of the PCMH model. They have the opportunity to work with social workers, case managers, and other community partners, which are all aspects of the medical home.

 

Clinic

clinic

  

In general in continuity clinic, residents manage their own patient panels under the supervision of a general pediatric attending preceptor.  While needed schedule changes have been made in light of the pandemic, the premise of continuity clinic has remained the same - residents are responsible for all aspects of patient care, including following up on their patients' labs, returning phone calls, completing forms, and patient billing.  This model encourages residents to develop a unique longitudinal relationship with their patients and families over the course of their residency and offers a true representation of ambulatory pediatric care.  It also fosters independent learning and teaches resident physicians the importance of taking ownership for the acute care and well-child care of their patients.  Residents manage pediatric patients of all ages, across a range of diagnostic complexity.  Residents care for patients with acute and chronic illness, and provide care for children of all developmental levels.  They learn to refine anticipatory guidance with regard to their patient’s and family’s future health care needs, and educate them and their families on the necessities for normal growth and development, as well as social, emotional, and nutritional needs. 

Residents also recruit patients from the Newborn Nursery, Neonatal Intensive Care Unit, Ward, and other units to follow up in their continuity clinic after hospital discharge.  Our EMR system provides easy access to both inpatient and outpatient encounters, labs, and radiologic studies, which allows the physician to have his or her patient’s comprehensive medical record readily available.  Parents are comforted by the knowledge that their physician in the office already knows their child’s history, making the transition from the hospital to the community a smoother process.  

 

kid with teddy bear

 

A resident who desires a career in outpatient primary care has the opportunity to additionally complete our two to four-week Primary Care Elective, which consists of full-day primary care pediatric experiences throughout the entire rotation.  Residents also customize their elective schedule to focus on populations to which they would like more exposure by selecting from among all of our Stony Brook Children's primary care sites and the many private practices within our community network.

All of our continuity sites participate in the nationally recognized Reach Out and Read Program and help promote early literacy by offering new, age-appropriate books at well child visits. We have also recently partnered with the "Talking is Teaching: Talk, Read, Sing" Campaign of the Too Small to Fail initiative. This campaign aims to promote increased communication between parents and their children from early infancy years in order to encourage brain development and early literacy. Through this resident-driven collaboration, we have incorporated the campaign's posters into our exam rooms to serve as conversational prompts, and videos to the TV sets in our antepartum suites to educate parents on the importance of the parent-child dialogue. We also received a $4,000 grant that was used to replenish our ambulatory clinics' book supply and diversify the current book selection. We have incorporated both bilingual books and books with racially diverse characters that are better representatives of the communities in which we practice.

Our ambulatory sites' response to COVID-19 has exemplified Stony Brook Children's commitment to providing the children of Suffolk County and their families with the best and safest possible care. Pre-screenings, screenings upon entry, the elimination of the waiting room, and strict adherence to CDC social distancing and personal protective equipment guidelines are some of the many ways in which our offices have adapted. From an educational perspective, monthly Resident Continuity Practice curriculum has continued and transitioned to a virtual format. During the first full week of each month, residents and preceptors come together on Microsoft Teams to discuss diagnoses and concepts essential to the care of children and young adults, ranging from GERD to Autism Spectrum Disorder. While residents learn the most from being with patients, the educational curriculum provides them with illness scripts, combined with pearls from the bedside shared by their preceptors, to empower residents to better educate their patients and their patients' families.

Upon completion of residency training, our residents are well-prepared to enter into Primary Care, Academia, or private practice, as well as move on to fellowship training.