Turn clinical encounters into study sessions
Here are two questions I wish I asked more often when I was a resident. By asking these questions you can turn every patient encounter into an opportunity to prepare for your exam.
1. “What else could this be?”
Challenge yourself to come up with a differential diagnosis for everything you see. Three reasons this is useful:
When the exam comes around, you’ll quickly be able to answer any question on what else it could be
You’ll pick up on important or life-threatening diagnoses if you’re skilled at considering them for every presentation
You gain the most benefit from your preceptors by learning HOW they come up with clinical decisions, or rule in or rule out diagnoses. Why was that sinusitis and not a viral URI? (Hint: the sinusitis guidelines have a great mnemonic for this: PODS). Why was that gout and not septic arthritis? Why was that OCPD and not OCD?
2. “What do the guidelines say?”
At the end of the day, take a look at your billing sheet (see PEARLS FOR PRACTICE below) and pay close attention to the diagnoses. Remember, for your exam you need to know the national (not provincial!) guidelines, so be sure to ask if there’s a national guideline for the topic. If you do this, you may be surprised to find there are guidelines or position statements on topics you might not have suspected: sinusitis, asthma in preschoolers, Bell’s palsy, and tongue tie (new for 2015) – all great family practice exam topics.
A great tool for this is the CMA infobase for clinical practice guidelines. Remember however to study the national guidelines, because the CMA infobase lists provincial guidelines as well.
If I could do residency over again (heaven forbid) I would try to ask those questions more often. I also would have wanted a course to help me prepare for the exam – which is exactly some other recent family med grads and I have created The Review Course.
We had a large rush of sign ups at the early bird deadline, and because so many residents expressed interest we have worked hard to increased capacity - and are excited to announce we are extending the early bird rate! This rate will only last a short time so be sure to register now!
PEARLS FOR PRACTICE
Bonus question - for every patient encounter, ask: “How do you bill for this?” This job is not all about the money but if you don’t bill properly, you won’t be able to keep the lights on in your office. Not to mention an audit can be very costly if you’ve been billing incorrectly.
On my first day of my family practice rotation in residency, I was very resentful of my preceptors for telling me I would be responsible for doing the billing for all of my patients. “How could they dump such useless scut work on me!” I wondered.
However fast forward to two years later when I was finished residency and I completed my first day of independent practice – I had slowly learned all I needed to know, and knew exactly what to bill and how to do it. That would have been a terrible time to have to learn how to bill all on my own.
Make sure you challenge your preceptors to teach you how to bill, because learning it a bit at a time is so much easier than having to teach it to yourself. Ask them:
How to bill when 2 separate procedures or visits occurred on the same day
How to bill separately for workplace injuries
Evening and weekend modifiers for extra billing (if you’re lucky enough to work in a province that does that!)
Billing bonuses for chronic care, counselling, age etc.
What criteria you need in order to bill for a complete physical*
*This is the one that I would NOT trust my preceptors' answers for – make sure you bill based on your provincial fee schedule and follow it closely. I’ve gotten lots of incorrect advice from practicing doctors that would have had me paying back piles if I were audited. i.e. “if you listen to the heart, lungs, and abdomen that’s 3 systems and you can bill a full physical” – wrong.
Finally, residents often express concern that they don't get enough practice management teaching in your programs. Until curriculum changes, it's up to you to ask your preceptors to teach you their best tips. Also, you can ask your program staff to increase the number of practice management lectures in your academic days.