Residency Program | COPE

Community Outpatient Practice Experience

The Community Outpatient Practice Experience 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.

Jennifer Kelloff, M.D., PL-2, and Pat Amato, M.D., confer with office staff on the day's schedule.

The COPE program was awarded the 1996 Outstanding Teaching Award by the Ambulatory Pediatric Association based on its ability to provide strong community-based education with clear educational objectives and excellent outcome assessments. Interns are paired with preceptors by a match process after they have had an opportunity to meet four to five preceptors prior to or during orientation week. The intern will work 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 problem-solving 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.

Nearly 80 pediatricians participate in the program as COPE 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 38 miles from the hospital.

	Drs. Amato and Kelloff review a patient chart.

Modeled after similar programs at the Universities of Utah and 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 rich 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 Community Outpatient Practice Experience (COPE) 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 all aspects of 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. Some of our clinician-educator preceptors have particpated in the program since its inception and new preceptors are eager to join the program each year. Increasingly, former COPE residents who have entered community pediatrics have become preceptors themselves -- many of them have joined their former COPE preceptor's practice. 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 based upon their experience.

Pat Amato, M.D., and PL-2 Jennifer Kelloff, M.D., with a young patient.

COPE in Perspective

Pediatric resident Jennifer Kelloff, M.D., and her COPE preceptor, Pat Amato, M.D., are examples of the teamwork and apprentice-type teaching/mentoring that is the core of the COPE program. Dr. Amato's suburban pediatric practice is located in Webster Groves, Missouri, about seven miles from the hospital. She has a large, diverse patient population and keeps a busy schedule. Dr. Amato was the first preceptor recipient of the annual COPE Award, which is given each year to a resident/preceptor dyad.

Dr. Amato says, "I completed my pediatric residency training at St. Louis Children's Hospital in 1985. I had a wonderful residency there, and I am happy to be a COPE preceptor and contribute to the education of pediatric residents. I love to teach, and I love general pediatrics. The COPE program allows me to do both. I have been a COPE preceptor since the program started, and I am happy to be working with my fifth resident. Primary care pediatricians have a wealth of information to share with pediatric residents. Working in a general pediatric office allows the residents to see healthy children, screen for common illnesses, develop long term relationships with families, and understand the business aspects of staffing and running an office."

A typical afternoon in the COPE office for Dr. Kelloff would include seeing as many as 10 patients. She has some patients scheduled for her and sees others as they arrive. She has seen many patients more than once. Dr. Kelloff says, "COPE as opposed to a hospital-based continuity clinic enables residents to experience primary pediatrics in a community setting while providing a consistent environment with better continuity of care."

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