Family Medicine Curriculum - PIH Health

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Curriculum and Rotations

During the first year, residents are based at PIH Health in Whittier with pediatric rotations at LAC+USC Medical Center in Los Angeles. The rotations blend the large university county hospital experience with the private community hospital setting. The focus is on gaining independence and confidence while still in a closely supervised environment. Throughout the year, interns maintain office hours one half-day session a week at the Family Medicine Residency Center and establish a primary care provider relationship with a panel of continuity patients.

Family Medicine Orientation (4 weeks)

During the first month of the year, new interns acclimatize to life as a resident and bond with their class. The orientation month includes a busy schedule of didactic lectures covering basic principles of disease, physical diagnosis, administrative policies, and interviewing skills. Interns also gain an introduction to the Family Practice Inpatient Service rotation through a weeklong stint with the inpatient team. First year residents are also introduced to patient care in the office setting and begin developing their office-based practices. New interns receive certification in Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Neonatal Resuscitation Program (NRP), and Advanced Life Support for Obstetrics (ALSO).

Family Medicine Inpatient Service (16 weeks)

Residents spend four months working as part of a family medicine team to admit and manage hospitalized patients. The team manages a wide array of pathology from bread-and-butter medicine to rare and complex diagnoses. The inpatient team consists of two senior residents and two interns with a family practice faculty attending. Residents are directly responsible for patient care including regular hospital floor and intensive care unit patients. Residents learn critical thinking with regards to the hospitalized patient and become proficient at various procedures, surgical assisting, and medical management. We take care to build each intern’s capacity to manage multiple patients while pushing them to improve their efficiency and management skills. Interns are not asked to take overnight call during their first year, allowing them to focus entirely on developing patient care skills and increasing their knowledge.The rotation involves daily morning report with teaching by a panel of family medicine, internal medicine, critical care, surgery and pediatric attendings, as well as weekly grand rounds and noon-time visiting lecturers.

Behavioral Health (4 weeks)

Emphasis is on improving doctor-patient interaction in the office and hospital settings. During the four-week rotation, residents will also receive didactic instruction and clinical exposure to psychiatric illness. While on service, the resident will work one on one with the Behavioral Medicine Coordinator, Beth Silvey, LCSW, ACHP-SW, to learn valuable skills in tackling difficult-to-manage problems. Residents gain valuable insight into patient, family, and physician attitudes and perceptions when treating acute and chronic diseases and dealing with end of life issues. Residents are in the family practice office setting three to four half days a week where they are given constructive feedback and training while seeing patients.

Women’s Health (8 weeks)

During two month-long rotations, residents learn to manage pregnant patients in PIH’s beautiful Ruth B. Shannon Maternity Care Center. During the rotation, interns become comfortable handling uncomplicated obstetric deliveries and performing first assist on C-section deliveries. With progressive experience, residents learn to identify and manage ante- and post-partum complications in the pregnant patient. Weekly one-on-one teaching sessions are conducted with OB/GYN attendings. Residents see female patients with a variety of health concerns both acute and chronic during the Women’s Health Clinic time at the Family Medicine Residency Center. Common problems, such as prenatal evaluation, management of abnormal PAP smears, problems with menstruation, contraception, menopause, and breast disease, are just a few of the conditions seen. Residents gain additional experience in performing well-woman examinations and such office procedures as colposcopy, cryotherapy, endometrial biopsy, and IUD insertion. Given the unopposed nature of the program, residents rarely if ever have difficulty meeting ACGME requirements for OB experiences.

Pediatric Wards (4 weeks)

Residents rotate onto the very busy Pediatric Inpatient Service at LAC+USC Hospital. PIH Family Practice residents work side by side with USC pediatric residents and attendings while they are assigned to one of the four pediatric inpatient teams. A wide spectrum of complicated and uncomplicated pediatric illnesses are admitted and co-managed by the intern and senior pediatric resident.The intern works one week of nights with the team, otherwise the team is on long call every 4th night. Additional responsibilities include daily presentations at attending rounds and attendance at grand rounds. On average, interns will admit one to three patients per day.

Newborn Nursery (4 weeks)

Residents spend four weeks in the Newborn Nursery at LAC+USC, where they work with the mid-level providers and attendings to become experts at the newborn exam. They learn to counsel expectant and new mothers in anticipatory care and troubleshoot breastfeeding difficulties. Residents get one weekend day off per week. Newborn nursery provides endless opportunities to conduct newborn examinations and identify common exam findings as well as potential high risk infants.

Pediatric Acute Care/Peds Clinics (4 weeks)

Residents rotate through Pediatrics Emergency Room at LAC+USC, evaluating and treating acutely ill pediatric patients. They also spend time at various pediatric subspecialty clinics throughout the hospital (Surgery, Cardiology, HIV, TB). Excellent didactic teaching is provided through attendance of pediatric grand rounds, problem rounds, and morbidity and mortality review. This rotation allows residents to have weekends free.

Surgery (2 weeks)

Residents work one on one with private surgical attendings and serve as first surgical assistants on the majority of operations performed during the month-long rotations.. The surgery rotation includes inpatient and office-based practice with the majority of time spent learning about the diagnosis of common surgical conditions and techniques of surgical assisting. Hours are traditionally long but residents take no in-house surgery call.

Ophthalmology (2 weeks)

Working directly with attendings in the outpatient setting, residents become proficient in basic eye care with a focus on differentiating emergent from non-emergent situations. Residents also assist with procedures including cataract removal and pterygium removal.

Rotations - Second/Third Year Curriculum

2nd year:

Inpatient 8 weeks, 4 weeks nights

Women’s Health 4 weeks

Nephrology 2 weeks

Endocrine 2 weeks

Geriatric 4 weeks

Oncology 2 weeks

Pediatrics outpatient 4 weeks

Orthopedics 4 weeks

Cardiology 4 weeks

Electives 8 weeks

Vacation 4 weeks  

3rd year:

Inpatient 8 weeks, 4 weeks nights

Women’s Health 4 weeks

ER 4 weeks

Dermatology 4 weeks

Nephrology 2 weeks

Orthopedics 2 weeks

ENT 2 weeks

Surgery 2 weeks

Elective 16 weeks

Vacation 4 weeks

Family Medicine Inpatient Service (12 weeks total per year, including 4 weeks of night float)

As PGY-2 and -3s, residents transition to a management role, focusing more on supervising interns and coordinating the care team. Assisting with education of  junior residents and medical students is also an expectation during these blocks. Senior residents work 4 weeks of night float throughout the year spread in 1 week blocks where they cover the inpatient list and glucose management team for the hospital, admitting, and covering overnight stand-by OB deliveries, C-section assists, and surgical first assists as needed, hereby completing the full spectrum of Family Practice.

Geriatrics/Community Medicine (4 weeks)

With an ever-growing elderly population, the special needs and concerns of the geriatric patient are an important part of a family physician’s training. Residents gain valuable experience managing patients in the community’s skilled nursing facilities, assisted living centers, and the patient’s own home. The focus is on the diagnosis, intervention, and long-term care issues of the frail elderly. Combined with the rotation is a community medicine component that consists of an orientation and immersion into the process of evaluating whole communities in regard to their health issues. From County Health Department STD clinics to the Vector control Center for an overview of county efforts at stemming insect-borne maladies, we provide an understanding for the resident as to what constitutes a well community. Included in the experience is exposure to occupational/industrial and preventive medicine.

Dermatology (4 weeks)

The dermatology curriculum is both a longitudinal experience and a four-week block rotation done in the PGY-2 or PGY-3 years. In addition to weekly practical procedure clinics, residents have opportunities to participate in a dynamic curriculum, including a laser tattoo removal clinic for ex-gang members who are re-joining the workforce and a wound care specialty clinic. At the completion of their training, residents will be well-practiced in diagnosis, treatment, and management of the full-scope of dermatologic conditions.

Palliative Care (4 weeks)

The Home Care/ Palliative Care Program is a longitudinal course of study involving patient care, multidisciplinary group meetings and academic study and discussion. Residents will become comfortable in improving the lives of patients by means of treating pain and other distressing symptoms and integrating the psychological and spiritual aspects of care. Residents and students will gain experience by working in home visits, nursing homes, clinic, and hospice.

General/Orthopedic Surgery (6 weeks)

Residents work one on one with private surgical attendings. The surgery rotation includes inpatient and office-based practice with the majority of time spent learning about the diagnosis of common surgical conditions and techniques of surgical assisting. Residents serve as first surgical assistants on the majority of operations performed during the month-long rotations. Days are traditionally long, but residents take no in-house surgery call.

Emergency Medicine (4 weeks)

The Emergency Medicine rotation is based at PIH’s R.C. Baker Regional Emergency Center, which sees upwards of 40,000 visits annually. Residents see and evaluate patients under the direct close supervision of the Emergency Medicine attending. In addition to gaining valuable experience and confidence in managing patients with emergency and urgent care problems, residents have numerous opportunities for learning office and hospital-based procedures. Residents are assigned flexible weekday shift hours including some weekends.

Didactics

The PIH Family Medicine Residency has an extensive didactic lecture training series. Lectures  typically take place at lunch  Monday, Wednesday, and, and Friday.  Lectures are provided by PIH faculty and specialist attendings, as well as occasionally by visiting lecturers and clinicians from around the country. The lecture series consists of didactic and hands-on workshops taught in a small group setting, allowing for one-to-one interaction with presenters. The didactic lecture series is designed on a 2-year cycle of core topics with added miscellaneous medical and professional lecture subjects, workshops, and scholarly activities interspersed within the core curriculum.

On Tuesdays and Thursdays, the Family Medicine Residency meets for morning grand rounds. Interns and senior residents present exceptional cases with the goal of educating their peers.

Residents also regularly attend multidisciplinary conferences such as Geriatric Grand Rounds, Hospice Rounds, Tumor Board, Pediatric Grand Rounds, and Hospital CME programs. Residents also participate in the quarterly Family Medicine Department Meetings, and the quarterly General Medical Staff Meetings. At different times throughout their training, residents are responsible for giving lectures, and overseeing the Residency M and M rounds.