Overview:
The family medicine center curriculum of the Memorial Hospital Family Medicine Residency consists of longitudinal outpatient experiences over all three years of training. Instruction, supervision and evaluation are provided by family medicine residency faculty, community family physicians and obstetrical proctors.
Goals:
The Family Medicine Center Curriculum shall:
- Meet the diverse training needs of our residents who will enter a variety of practice settings
- Provide a structured educational experience in outpatient family medicine stressing the importance of continuity of care
- Provide a system to ensure that residents are adequately trained in outpatient family medicine and office procedures
- Provide a positive training experience that allows residents to gain experience in a group practice model
Objectives:
While caring for their panel of continuity patients in the family medicine center:
PGY-1
- Is able to perform a complete and accurate general history and physical exam (PC)
- Can present an appropriate and broad differential diagnosis for clinic patients to a supervising physician (MK)
- Can effectively manage uncomplicated patients with acute and chronic conditions in the clinic with close supervision (PC, MK)
- Accurately shares medical information with patients and families (ICS)
- Is able to provide health education and health maintenance counseling to clinic patients for the most commonly seen health issues (ICS)
- Will document at least 150 patient visits in the FMC (PC)
- Is able to accurately code and bill for each office visit with assistance (SBP)
PGY-2
- Demonstrates appropriate medical judgment to prioritize and efficiently perform a relevant and focused history and physical exam on a patient with a specific complaint (PC)
- Is able to recognize and manage less frequently encountered medical problems with supervision (MK)
- Incorporates diverse sources of information into effective communication and relationship building with patients and their families. (ICS)
- Is able to provide health education, health maintenance and prevention counseling to clinic patients for more complicated health issues (ICS)
- Is able to manage an increased number of patients in the FMC (PC)
- Is able to accurately code and bill office visits ( SBP )
PGY-3
- Demonstrates appropriate medical judgment to prioritize and efficiently perform a detailed history and physical exam on a patient with multiple complaints (PC)
- Is able to recognize and manage complex medical problems with minimal supervision (MK)
- Incorporates diverse sources of information into effective communication and relationship building with patients and their families. (ICS)
- Is able to provide health education, health maintenance and prevention counseling to clinic patients for complex health issues (ICS)
- Is able to manage an increased number of patients in the FMC, and will have at least 1650 documented patient visits (PC)
- Is able to accurately code and bill for all levels of office visits (SBP)
- Is able to provide comprehensive care for patients in relationship to their families, the community and the health care system. (SBP)
Implementation:
Educational Methods
Learning in the FMC is primarily experiential based. Residents care for patients in an outpatient setting under the supervision of board certified family physicians and obstetrician gynecologists. A supervising physician is always present and readily available when residents are seeing patients in the FMC. Informal didactic and teaching sessions occur on a regular basis as residents present and discuss care with supervising physicians. Residents are encouraged to read current medical literature that is relevant to the care delivered in the FMC to supplement the experiential learning.
Resident Responsibilities
Residents are assigned a panel of continuity patients with representation from all age groups, both sexes, and various ethnic and socioeconomic backgrounds. In collaboration with their resident colleagues, residents are expected to provide appropriate care for their patients, under supervision. Residents are expected to see patients in the clinic as scheduled and approved by the clinic director. Included in the responsibility to clinic patients is the need to be available to respond to phone messages, prescription refills and clinical results at times the resident is not scheduled to see patients in the clinic. When the resident is not available to fulfill these responsibilities, appropriate coverage must be arranged.
Resources
- Electronic medical record provided by family medicine center
- UpToDate, medical reference provided by Memorial Hospital
- Print resources in the clinic library
Methods of Evaluation:
Numerous evaluation methods are used to assess resident progress in the FMC. Immediate feedback and assessment is given after case presentations to the supervising physician at the time of patient care in the FMC. Charts are reviewed by the resident’s team leader after the visits. Feedback is given by electronic message and progress is reviewed at the periodic review scheduled with the team leader. As a part of the behavioral science curriculum, residents are observed by a member of the behavioral science staff during a patient interaction. See the behavioral science curriculum for details of this evaluation and instructional feedback. As part of the procedures curriculum, procedures performed in the clinic are evaluated by a supervising faculty and an assessment of independent competence is made for residents with advanced skills. See the procedures curriculum for details. Residents also receive feedback from patients and clinical staff on a regular basis.
10.3.3. Intensive Care Unit Management
Residents will manage their clinic patients admitted to the intensive care unit in the hospital. If indicated, the critical care physician will be consulted to assist in management of the patient. This supports our “open ICU” policy at Memorial Hospital.
