Community Outpatient Practice Experience
The Community Outpatient Practice Experience (COPE) program, developed in 1991, pioneered a new standard of primary care education for pediatric residents. It has entirely replaced the former residents’ hospital-based continuity clinic.
Interns are paired with preceptors by a match process after they have had an opportunity to meet three to four preceptors prior to or during orientation week. The intern works with the community pediatrician for one half-day per week throughout the three years of residency. This model of one-on-one pairing allows for optimum role modeling, feedback, and a continuum of teaching in an actual practice setting.
The educational objectives of the COPE program emphasize the development of a self-sustaining learning process that focuses on clinical problemsolving and decision-making skills. The curriculum is organized in a progressive manner, emphasizing health supervision and anticipatory guidance during the first year. During the second and third years, residents are expected to gain additional experience handling acute and common pediatric problems, chronic illnesses, and behavioral and developmental issues. In addition to clinical pediatrics, residents are exposed to telephone call management, scheduling of patient visits, and insurance and billing practices.
Ninety-five pediatricians participate in the program as preceptors. Preceptors are selected on the basis of their qualifications as outstanding role models as well as their enthusiasm for teaching. All preceptors are community pediatricians and each agrees to a three-year, unsalaried teaching commitment. More than 40 percent are graduates of the St. Louis Children’s Hospital/Washington University pediatric residency program. COPE practice types include solo or group practices that may be private practices, managed groups or public health clinics. COPE sites are located in rural, urban and suburban settings, and range in distance from 0.2 to 40 miles from the hospital.
Modeled after similar programs at the University of Utah and the University of Massachusetts, COPE is the only program of this type that places all residents of a large, tertiary-care oriented residency in the community. Residents in COPE have had a more comprehensive and richer experience compared with residents in the prior hospital-based continuity clinic. COPE residents have contact with more patients of all ages and learn more about well-child care, normal growth and development, and common problems, while seeing similar numbers of patients with chronic disorders. In addition to more diverse patient care, the intangible benefits cited by residents in COPE include having a mentor, working in the real world, spending time away from the hospital, and feeling welcome as part of the practice. The model in which COPE was developed has presented unique challenges — on the average, 15 residents leave the hospital each afternoon for COPE. This requires a commitment to teamwork among our house staff that we feel strengthens the residency program.
The COPE program has been enthusiastically supported by our residents, community and academic faculty. Residents have identified COPE as one of the highlights of the week. The COPE program allows each resident to gain an appreciation for the demands and rewards of primary care practice and be well prepared to make informed career decisions.
COPE in Perspective: The "big picture" of pediatrics
Sam Julian, MD, a resident at St. Louis Children’s Hospital (SLCH), spends one afternoon a week at Esse Health Pediatrics in suburban Crestwood, Mo., as part of the COPE program. His preceptor is Peter Putnam, MD, who completed his residency at SLCH in 2001.
Julian says his time in a primary care office provides a nice balance to hospital-based medicine. “I do a lot of developmental questioning in COPE that comes in handy when someone I admit to the hospital is not developmentally appropriate,” he says. “Along with that, I know what “normal” is, which makes picking up on abnormal much easier.”
Of the five to seven patient encounters in the typical afternoon, Julian might have one or two well-child exams with the remainder of patients presenting with conditions such as otitis, strep throat, or bumps and bruises. A more unusual case might crop up once a week.
When selecting a COPE site, Julian weighed several criteria: location, group practice, use of digital charts, and the preceptor’s personality. He also thought it might be important to be paired with a male pediatrician.
Putnam, who has been a preceptor for four years, enjoys teaching and felt it was important to give back to a program that he remembers as an “oasis” from the rigors of the hospital. He enjoys the camaraderie with his residents and maintaining a connection to SLCH. “Residents teach me how certain situations are cared for as well as discussing difficult or unusual hospital cases,” he says.
“COPE gives residents the big picture of pediatrics — keeping kids healthy as they grow and develop,” Putnam adds. “It’s encouraging to see the growth in knowledge and confidence from month to month and year to year as a resident becomes a pediatrician.”
Community Outpatient Practice Experience
The Community Outpatient Practice Experience (COPE) program, developed in 1991, pioneered a new standard of primary care education for pediatric residents. It has entirely replaced the former residents’ hospital-based continuity clinic.
Interns are paired with preceptors by a match process after they have had an opportunity to meet three to four preceptors prior to or during orientation week. The intern works with the community pediatrician for one half-day per week throughout the three years of residency. This model of one-on-one pairing allows for optimum role modeling, feedback, and a continuum of teaching in an actual practice setting.
The educational objectives of the COPE program emphasize the development of a self-sustaining learning process that focuses on clinical problemsolving and decision-making skills. The curriculum is organized in a progressive manner, emphasizing health supervision and anticipatory guidance during the first year. During the second and third years, residents are expected to gain additional experience handling acute and common pediatric problems, chronic illnesses, and behavioral and developmental issues. In addition to clinical pediatrics, residents are exposed to telephone call management, scheduling of patient visits, and insurance and billing practices.
Ninety-five pediatricians participate in the program as preceptors. Preceptors are selected on the basis of their qualifications as outstanding role models as well as their enthusiasm for teaching. All preceptors are community pediatricians and each agrees to a three-year, unsalaried teaching commitment. More than 40 percent are graduates of the St. Louis Children’s Hospital/Washington University pediatric residency program. COPE practice types include solo or group practices that may be private practices, managed groups or public health clinics. COPE sites are located in rural, urban and suburban settings, and range in distance from 0.2 to 40 miles from the hospital.
Modeled after similar programs at the University of Utah and the University of Massachusetts, COPE is the only program of this type that places all residents of a large, tertiary-care oriented residency in the community. Residents in COPE have had a more comprehensive and richer experience compared with residents in the prior hospital-based continuity clinic. COPE residents have contact with more patients of all ages and learn more about well-child care, normal growth and development, and common problems, while seeing similar numbers of patients with chronic disorders. In addition to more diverse patient care, the intangible benefits cited by residents in COPE include having a mentor, working in the real world, spending time away from the hospital, and feeling welcome as part of the practice. The model in which COPE was developed has presented unique challenges — on the average, 15 residents leave the hospital each afternoon for COPE. This requires a commitment to teamwork among our house staff that we feel strengthens the residency program.
The COPE program has been enthusiastically supported by our residents, community and academic faculty. Residents have identified COPE as one of the highlights of the week. The COPE program allows each resident to gain an appreciation for the demands and rewards of primary care practice and be well prepared to make informed career decisions.
COPE in Perspective: The "big picture" of pediatrics
Sam Julian, MD, a resident at St. Louis Children’s Hospital (SLCH), spends one afternoon a week at Esse Health Pediatrics in suburban Crestwood, Mo., as part of the COPE program. His preceptor is Peter Putnam, MD, who completed his residency at SLCH in 2001.
Julian says his time in a primary care office provides a nice balance to hospital-based medicine. “I do a lot of developmental questioning in COPE that comes in handy when someone I admit to the hospital is not developmentally appropriate,” he says. “Along with that, I know what “normal” is, which makes picking up on abnormal much easier.”
Of the five to seven patient encounters in the typical afternoon, Julian might have one or two well-child exams with the remainder of patients presenting with conditions such as otitis, strep throat, or bumps and bruises. A more unusual case might crop up once a week.
When selecting a COPE site, Julian weighed several criteria: location, group practice, use of digital charts, and the preceptor’s personality. He also thought it might be important to be paired with a male pediatrician.
Putnam, who has been a preceptor for four years, enjoys teaching and felt it was important to give back to a program that he remembers as an “oasis” from the rigors of the hospital. He enjoys the camaraderie with his residents and maintaining a connection to SLCH. “Residents teach me how certain situations are cared for as well as discussing difficult or unusual hospital cases,” he says.
“COPE gives residents the big picture of pediatrics — keeping kids healthy as they grow and develop,” Putnam adds. “It’s encouraging to see the growth in knowledge and confidence from month to month and year to year as a resident becomes a pediatrician.”