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Questions

During your time in subspecialty clinic elective, you should be learning about the referral process through history taking, physical exam, pre-referral work up, and patient experience.   You should also be learning about post-referral management for commonly referred conditions through observing conversations between specialist and family and/or clarifying specific post-referral management directly with attending.  Please complete the below form for each ½ day of elective time and upload to Medhub upon completion.  Your responses will be analyzed to help improve your subspecialty outpatient experience.

Choose the Subspecialty for Referral

Allergy/Immunology

Cardiology

Dermatology:

Development
Endocrinology:
Gastroenterology
GERD
Genetics:
Infectious Diseases:
Nephrology
Neurology
Nutrition
Ophthalmology
Oral Health/Dental
Orthopedics
Otolaryngology/ENT
Psychiatry
Pulmonology
Rheumatology
Surgery (General)
Urology
Physical Medicine and Rehabilitation:
Hematology/Oncology clinic:
Neurosurgery:
Pain Clinic:
Plastic Surgery:

Did you discuss the following for the above conditions (please review all and check off before Attending signs):

 

APPROPRIATENESS OF REFERRAL

 

Please comment on specifics:

 What work up or intervention will the specialist do for this patient? Please comment on specifics:

 When should the patient follow up (if at all), with whom (specialist and/or PMD), and why? Please comment on specifics:

 What are the roles for the specialist and/or for the referring provider after the consultation? Please comment on specifics:

Was the reason for initial referral clear to the family – if not, what could the referring doctor have done to make it clear?

Do you think the post-referral plan was understood by the family- if not, how could it have been better understood?
What did you learn that will change your management (ie. new medical knowledge, aspects of care coordination of care/referral process, etc)?
Clinic Date:
Open date/time selector
Clinic Location:
Resident Name:
Attending Preceptor:
Exit and clear survey