Curriculum

One half-day per week in the Family Medicine Center
2 months Family Medicine Service
1 month Cardiology/CCU
1 month Gastroenterology
1½ months Pediatrics Inpatient
1½ months Obstetrics
1½ months Night Float
1 month Surgery
1 month Emergency Medicine
½ month Pediatric Emergency Medicine
1 month Introduction to Family Medicine in the Family Medicine Center which includes:

• Evidence Based Medicine
• Point-of-care Ultrasound
• Practice Management
• Radiology
• Laboratory Medicine
• Interviewing Skills
• Cultural competence and oral health
• Osteopathic Manipulative Treatment (OMT) Clinic

The first year of the Family Medicine Residency Program focuses on inpatient care and introducing residents to the concept of a Patient-centered Medical Home. The inpatient component consists of experiences in Family Medicine, cardiology, gastroenterology, pediatrics, obstetrics, emergency medicine, and intensive care medicine. First year residents begin seeing patients in the Family Medicine Center 1-2 sessions per week and build a panel of patients that they will follow throughout their three years of residency.

The Patient-Centered Medical Home (PCMH) is taught in our Family Medicine Center/Longitudinal curriculum. First year residents spend one month in the Family Medicine Center as an introduction to the PCMH, in addition to their sessions in the Family Medicine Center that occur throughout the first year. The month takes place during the beginning of the residency to help orient residents to the PCMH early in their training. During this rotation, residents have the opportunity to work closely with faculty and senior residents in the office. One-to-one precepting sessions with faculty allow for personalized teaching and time to become comfortable with our electronic medical record. Residents also work with our Behavioral Scientist on interviewing skills during this time. Sessions are devoted to evidence based medicine, performance improvement, disease management, practice management, and radiology and laboratory skills. Time is also available to start independent work on computer-based courses as well as on long range research, practice management, and community medicine projects.

The inpatient rotations consist of two months on the Family Medicine Service, one month of pediatrics, two months of obstetrics, and one month each of cardiology (CCU), gastroenterology, surgery and emergency medicine. On the Family Medicine Service, residents care for patients admitted from our Family Medicine Center, including general medicine, pediatrics, gynecology, and intensive care unit patients. This rotation stresses the diagnosis and treatment of common medical problems using a team approach, with a senior resident and Family Medicine faculty following the patient through all degrees of illness. During the Cardiology/CCU rotation, residents learn how to care for common cardiology illnesses such as congestive heart failure and coronary artery disease and follow critical care unit patients with the private cardiologists and perform procedures related to these patients. With the gastroenterologists, residents are able to learn GI procedures including flexible sigmoidoscopy. In emergency medicine, residents work with full-time Emergency Department attendings to learn how to assess and stabilize acutely ill patients in JFK’s new state of the art Emergency Department.

The pediatric experience occurs on the pediatrics floor at JFK. The resident spends six weeks working with the Pediatric faculty which includes pediatric intensivists. The residents care for pediatric patients and learn the fundamentals of inpatient pediatric care through a combination of bedside teaching and didactics. The Family Medicine resident admits and follows a caseload of patients with pediatric attendings, participates in daily rounds and attends conferences. Residents spend two weeks in the new pediatric Emergency room at JFK working with Pediatric ED attendings in assessment of the acutely ill pediatric patient.

Obstetrics training consists of a six-week block at JFK. The residents care for our Family Medicine Center obstetrical patients – managing prenatal care, labor and delivery, post-partum care and follow-up. They also follow newborns in the nursery. The residents are supervised by both Family Medicine faculty and attendings in the Family Medicine obstetrical group, who provide 24-hour coverage as well as didactic lectures to the obstetrics resident.

The surgical rotation consists of four weeks under the assignment of JFK general surgery attending physicians. The residents evaluate and diagnose surgical patients, assist the surgeon intra-operatively and post-operatively, and learn appropriate surgical referral.

First year residents do a total of six weeks of night float during the year. Two weeks are done in the first four months of the year, with another month occurring later in the year. Residents work five shifts a week at night (Friday and Saturday off) with duties including covering our Family Medicine inpatients and obstetric patients and working together with senior residents assessing and admitting patients in the emergency room.

Two to four half-days per week in the Family Medicine Center
1 month Family Medicine Service
1 month Pediatric Emergency Medicine
2 months Geriatrics/Hospice and Palliative Care Medicine
1 month Emergency Medicine
1 month Intensive Care Medicine
1 month Musculoskeletal Medicine
1 month Night Float
2 month Electives
2 months Longitudinal Family Medicine Curriculum which includes:

• Dermatology
• Community Medicine
• Practice Management
• Point-of-care Ultrasound
• Hematology/Oncology
• Infectious Disease
• Rheumatology
• Neurology
• Nephrology
• Endocrinology
• Complex Patient Clinic
• Adolescent Clinic
• Osteopathic Manipulative Treatment (OMT) Clinic

The second year of the Family Medicine residency is as challenging as the first, but much more varied, as time is divided between inpatient work at the hospital and outpatient care in both the Family Medicine Center and other ambulatory sites.

A large part of the second-year outpatient medicine experience takes place during the Longitudinal Family Medicine Curriculum rotations. The rotations include time seeing continuity patients in the Family Medicine Center, longitudinal medical subspecialties (including endocrinology, hematology/oncology, infectious disease, nephrology, neurology and rheumatology), and dermatology spread over three one-month rotations. Also during this time, residents will continue to build their knowledge and experience in the Patient-centered Medical Home. They also spend two sessions per month in our GYN clinic learning outpatient gynecologic procedures, such as colposcopy, IUD insertions, and endometrial biopsies under the supervision of an OB/GYN preceptor in our FMC. Residents build on their pediatric knowledge by participating in the FMC Adolescent Clinic working one-on-one with our own Adolescent faculty and Behavioral scientist, focusing on the unique healthcare needs of the adolescent patient. Residents also continue to develop their skills in treating medically and psychosocially complex patients by participating in the FMC Complex Patient Clinic. Here, they work with the Behavioral Scientist, a Medical Faculty Member and a fellow resident to develop an individualized treatment plan for patients with complex needs.

Our regularly scheduled OMT clinic allows residents to treat patients for multiple conditions such as headaches, neck pain, and low back pain. This allows our patients to have access to a hands-on treatment option without the use of medications and invasive procedures. All residents, both DO and MD, have the opportunity to rotate through the clinic, giving the opportunity to have exposure to this treatment modality.

Residents spend one month as Chief of the JFK Family Medicine Service, caring for patients admitted from our Family Medicine Center. This involves daily patient management, teaching rounds, and supervising the PGY-I resident and medical student on service in conjunction with the Family Medicine faculty.

The second-year residents spend one month in the pediatric emergency room at JFK Medical Center to learn such skills as caring for the febrile child, managing acute minor illnesses and injuries, and suturing techniques. They also spend one month in the main JFK ER where they care for a wide variety of medical, surgical, and trauma conditions in adult patients.

Residents study Intensive Care Medicine working with JFK’s Intensivists. The resident participates in the daily care of ICU patients, as well as interacts with intensive medicine specialists who staff the critical care units 24 hours a day. This enables residents to learn how to evaluate and manage critical patients and to perform appropriate procedures, including arterial lines, central lines, and code management.

Other rotations include orthopedics/sports medicine, geriatrics and two elective month. Our strong geriatrics curriculum includes a concentrated eight-week rotation learning the principles of geriatric medicine and multidisciplinary geriatric assessment. Residents work directly with Dr. JoyLynne Carnes, MD, who has a Certificate of Added Qualification in Geriatric Medicine. She is also the medical director of two nursing homes where our residents rotate. Our residents also learn principles of Hospice and Palliative Care medicine. Residents start to provide longitudinal care for their own panel of patients in a long-term care facility for the latter two years of the program.

The Orthopedics and sports medicine rotation is divided between a large, local orthopedic group and our own sports medicine faculty in the Family Medicine Center. Learning opportunities include x-ray interpretation, casting and splinting, tendon and joint injections, and the potential for sporting events coverage.

During the second year, time in the Family Medicine Center increases from one half-day per week to an average of three half-days per week. As a second-year resident’s panel of patients grows, residents become more skilled in the management of a wide variety of health problems such as hypertension, diabetes mellitus, asthma, depression and anxiety. Also at this time, second-year residents begin to care for obstetric patients whom they will follow through the full course of prenatal care, delivery and post-partum care. Second year residents also begin to participate in our Centering group visits for prenatal and diabetic patients.

Second year residents spend one month on the night float rotation, managing acute issues with inpatients on the Family Medicine service, supervising the first year resident and providing phone triage of FMC patients, with ED assessments and patient admissions as needed.

Three to five half-days per week in the Family Medicine Center
½ month Family Medicine Service
½ month Night Float
1 month Urgent Care
1 month Inpatient Hospitalist Medicine
1 month Musculoskeletal Medicine
4 month Electives
4 months Longitudinal Family Medicine Curriculum which includes:

• Practice Management
• Psychiatry/Addiction Medicine
• Community Medicine
• Complementary and Alternative Medicine
• Procedure Clinic
• Osteopathic Manipulative Treatment (OMT) Clinic
• Urology
• ENT
• Ophthalmology
• Evidence Based Medicine
• Point-of-care Ultrasound

The third year of the residency program is the final stage of training for residents preparing for their future in Family Medicine. The emphasis in the third year shifts even more towards ambulatory care, while residents continue to hone inpatient skills through on-call experiences and as chief of the Family Medicine inpatient service.

In the third year, residents spend a total of six months on the Longitudinal Family Medicine Curriculum rotations. During these rotations, the FMC functions as the residents’ “home-base”, where they refine their outpatient management skills by caring for their own panel of patients an average of four half-days per week. In the FMC, the third year resident also takes on the role of team-leader, helping to coordinate delivery of care to patients in a manner that fosters continuity and the concept of the FMC as a Patient-Centered Medical Home. Residents continue to learn principles of practice management, performance improvement and evidence based medicine. Residents have administrative time during these rotations to work on practice management, performance improvement and independent research projects. Third year residents also learn to lead group visits for patients with Diabetes, as well as prenatal groups during these months. In addition, the third year Longitudinal Family Medicine rotations include training in the surgical subspecialties of Urology, ENT and ophthalmology, psychiatry and addiction, plus exposure to various community agencies and alternative medicine. A dedicated half-day for minor surgical procedures is also incorporated into four of the six FMC rotations in the third year.

The third year resident spends a final month of inpatient training as Chief of the Family Medicine inpatient service. This position requires residents to manage the entire panel of patients, including pediatric, adult and intensive-care patients, in conjunction with the Family Medicine faculty. As Chief, the resident also learns to supervise and teach junior residents and medical students. Two weeks are spent on night shift, managing acute issues with the inpatients on the Family Medicine service, supervising the first year resident and providing phone triage of FMC patients, with ED assessments and patient admissions as needed. Night shifts are done Sunday through Thursday, giving the night shift resident weekends off.

In addition, third year residents further expand their knowledge of Orthopedic/Sports medicine with a month-long rotation. This rotation provides additional exposure to common orthopedic problems, including a half day/week working one-on-one with our own Sports Medicine faculty gaining experience in joint injections, splinting and other procedures.

Four months of elective time in the third year enable residents to individualize their curriculum, allowing them to choose additional time in the fields of special interest.

PGY-3 rotations also include Urgent Care and Hospitalist Medicine. Residents rotate in a private Urgent Care Center for a month working with on-site attendings evaluating patients who seek care for acute illness and injury, including exposure to minor procedures such as splinting and suturing. An additional month is spent rotating at JFK on an inpatient hospitalist service gaining experience in this growing field.

Throughout the third year, residents continue to provide longitudinal care to their patients in long-term care facilities, to home visit patients, and to their continuity obstetric patients, as well as to their regular panel of patients in the FMC. Residents have increasing autonomy in the care of their patients and families over the course of their three years. At the completion of the program, residents emerge confident and well equipped to handle the challenges of the independent practice of family medicine.