PGY3 Family Medicine Center
I. Rationale
The Family Medicine Center is an ambulatory outpatient experience in a diverse, multicultural setting. The Family Medicine Center is a rotation where third year residents are expected to hone their skills in providing disease treatment and prevention as well as health maintenance and promotion.
Health promotion can be described as the application of methods that foster physical and emotional wellbeing and that increases length and quality of life. The concept of optimal health reflects not merely the absence of disease, but also a high level of vitality. Disease prevention refers to activities focused on health risk profiling of asymptomatic persons and appropriate use of screening tests for early detection of disease, followed by patient education and therapeutic intervention when indicated. Principles of disease prevention are applied to individual patients, based on scientific evidence from population studies. Screening protocols should be age, sex, and risk specific and dynamic, with regular reevaluation based on scientific evidence.
Health promotion and disease prevention is an implicit responsibility of the family physician. By offering continuous comprehensive care, family physicians can be catalysts for health promotion and prevention. The family unit is a natural setting in which to focus on health promotion and disease prevention, because the dynamics among family members are critical in supporting an individual member's health.
The family physician must develop knowledge and skills appropriate to manage the medical, physical, social and emotional problems of patients of all ages. Family physicians have the unique opportunity to treat all members of a family and an opportunity to appreciate the influences of family and siblings on the individual infant, child, or adult. The physician has a responsibility to monitor the health of each family, to help realize the full potential of each family, and to improve the health of children and families in the community in a proactive and responsive manner.
II. Competencies
Residents will be evaluated on the following six competencies, eventually achieving the expected level of a board certified family physician. Achievement of satisfactory performance levels for all six competencies will be necessary for successful completion of the rotation.
Medical Knowledge/Patient Care
Goals: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
Objectives:
A. An orientation toward optimizing health in addition to the traditional concept of diagnosis and treatment of disease.
B. Awareness of the importance of a physician's own health behavior in fostering quality in their own personal life and enabling the physician to function as a positive role model.
C. Recognition of the importance of both physician and patient working together as partners in
promoting optimal health.
D. Empowering the patient's awareness of selfdetermination in obtaining optimal health for
themselves.
E. Recognition of the importance of family structure and support systems in health behavior.
F. An understanding of and ability to work with the patient's level of readiness to change and
the problem of recidivism.
G. An emphasis on assessment of risks for preventable disease in each patient.
H. Recognition of the importance of updating practice behavior based on continuing review of the
medical literature.
I. The empathic concern for the health of the family in the context of the family and their culture.
J. The importance of continuity of and, access to care for prevention of illness.
K. The promotion of healthy lifestyles in children and families.
L. The awareness of the unique vulnerabilities of the very young, the very old and the disabled
that may require special attention, consultation and/or referral.
M. The importance of educating the public about environmental factors that can adversely affect
children and development of community programs that promote health and well being.
N. Understand the categories of prevention.
1. Primary prevention: immunization, fluoridation, health promotion
2. Secondary prevention: early diagnosis and treatment, such as Pap test, breast examination, blood pressure checkups
3. Tertiary: rehabilitation, such as post-stroke physical therapy
O. Develop a working understanding of nutrition concepts, dietary counseling and knowledge of the WIC
program.
1. Fat/cholesterol, caloric balance, fiber
2. Folate, iron in pregnancy and young children
3. Food Triangle: especially “Five daily fruit and vegetable servings”
4. Food fads
5. Obesity, underweight and identifying eating disorders
6. Vitamins, minerals, antioxidants
P. Understand the importance of exercise and how to advocate and counsel for it.
1. Types of exercise (Aerobic verses anaerobic) and (Isometric, isotonic, isokinetic)
2. Caloric expenditures per activity (Metabolic energy equivalents (METS)
3. Benefits of injury prevention (Warmup and cooldown, conditioning , balance of strength and flexibility)
Q. Develop an understanding of the importance of psychosocial wellbeing and the ability to identify and
counsel issues concerning:
1. Internal perceptions, Life goals, Spiritual beliefs
2. Selfesteem and efficacy, External relationships
3. Stress Recognition & Management
4. Life adjustment periods, Significant life events (e.g., bereavement, divorce, illness)
5. Life transitions (i.e., parenting, adolescence, early adulthood, midlife, aging)
R. Become aware of importance and counseling required for Injury prevention.
1. Motor vehicle accidents
2. Household injury
3. Recreational injuries, including protective equipment
4. Domestic violence
S. Understand importance and skills required for the prevention of STD’s & unintended pregnancy.
1. Sexual practices
2. Life goals
T. Become knowledgeable and proactive Re immunization & chemoprophylaxis.
1. Aspirin
2. Vitamin E, Folic acid, Calcium, Flouride
3. Hormone replacement therapy (Risks vs Benefits)
4. Sunscreens
Last Updated April 19, 2013
5. Immunizations
U. Develop an appreciation for environmental heath.
1. Occupational safety and health
2. Housing and sanitation
3. Food borne illness
4. Lead exposure
5. Toxic exposures such as air, water, waste sites
6. Secondhand smoke
V. Understand individual and population characteristics for risk assessment.
1. Age and sex
2. Family history including genetic, ethnic and behavioral
3. Geographic and environmental factors
4. Socioeconomic status
5. Lifestyle characteristics
W. Understand the criteria for use of screening tests.
1. Incidence, prevalence and natural history of disease
2. Treatment effectiveness
3. Sensitivity and Specificity
4. Predictive value
5. Patient acceptability
6. Simplicity
7. Cost effectiveness
X. Learn the periodic health examination recommendations, particularly those of the AAFP and the U.S.
Preventive Services Task Force.
Y. Know how to diagnose and manage the most common conditions encountered in a family
practice setting.
1. Hypertension
2. Acute Upper Respiratory Tract Illness
3. General medical exam-prevention
4. Sinusitis
5. Acute Lower Respiratory Tract Illness
6. Otitis media
7. Depression, anxiety
8. Diabetes mellitus
9. Acute sprains, strains
10. Arthritis
11. Ischemic cardiovascular disease
12. Asthma
13. Low Back Pain
14. Lacerations, contusions
15. Fibrositis, myalgia, arthralgia
16. Nonfungal skin infection
17. Headache
18. Abdominal pain
19. Bursitis, tenosynovitis
20. Chronic rhinitis (allergic vs vasomotor)
21. Pregnancy Care
22. COPD
23. Thyroid disease
24. Urinary Tract Infection
25. Peptic Disease
Z. Become proficient in information gathering to include obtaining the Chief Complaint,
History of Present Illness, Review of Systems, Past Medical History (allergies, surgeries,
medications, hospitalizations), Social history (diet, alcohol, tobacco, drug use, exercise,
stress, sleep, family life, occupation, recreation), and Family History.
AA. In the appropriate setting, be able to discuss with patients their health beliefs, spiritual beliefs, and patient awareness.
BB. Be able to provide patients with motivation for lifestyle change, by modeling a healthy lifestyle and
selfresponsibility.
CC. Counseling skills
1. Individual/family/group/ Behavior change
2. Motivational techniques
3. Stress management techniques
4. Exercise prescription
5. Nutrition prescription
DD. Perform the physical examination appropriate to each patient’s presenting problem with particular attention paid to:
1. Vital Signs
2. HEENT
3. NECK
4. CHEST/LUNGS
5. CARDIOVASCULAR
6. ABDOMEN
7. GENITOURINARY
8. BACK/EXTREMITIES
9. NEUROLOGICAL
10. SKIN
11. MENTAL STATUS
EE. Become competent to perform the following procedural skills:
1. Flexible sigmoidoscopy
2. Exercise treadmill testing
3. Colposcopy
4. I & D Abscess
5. Endometrial biopsy
6. IUD placement/removal
7. Nasopharyngolaryngoscopy
8. Punch and excisional biopsy
9. Casting/splinting
10. Toenail excision
11. Cryosurgery
12. Circumcision
13. Vasectomy
14. Tympanometry
15. Audiometry interpretation
16. Visual Function Evaluation
17. Fine-Needle Aspiration
18. Norplant insertion/removal
19. Diaphragm fitting
20. Anoscopy
21. Joint and soft tissue aspiration and injection
22. PAP Smears/Wet Smear and KOH Preparation
23. EKG interpretation
24. Local and topical anesthesia
25. Peripheral nerve blocks
26. Radiofrequency surgery
Learning ActivitiesAttending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X
X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / X / Noon Conference (BCC) / Journal Club
X / Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / X / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
X / Program Dir
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / X / Videotape Review / X / Quarterly Review
X / Other (Monographs and SAM(Self Assessment Module)
Professionalism
Goal: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
Objectives:
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
D. Arrive at the clinic in a timely fashion.
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information about patients.
G. Assist patients and their families in planning for future care needs and care decisions based on prognosis for the disease.
H. Support the patient in their healthcare decisions.
I. Demonstrate professional, respectful demeanor when addressing team members, patients, ancillary staff, and consultants.
J. Appear professionally dressed and well groomed.
K. Completes clinic notes, referrals, lab letters, prescription refills in a timely fashion.
L. Attends required daily conferences and grand rounds.
M. Responds to pages and patient calls in a timely fashion.
Learning ActivitiesAttending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / X / Noon Conference / Journal Club
X / Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / Morning Report
X / Program Director
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / X / Videotape Review / X / Quarterly Review
Other
Interpersonal and Communication Skills
Goal: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.
Objectives:
A. A. Develop patient sensitive skills for interviewing that allow accurate, and complete collection of information regarding symptoms, the family and the community that affect the patient's health and care.
B. Develop skills in communicating results to patients, their families, other health care providers.
C. Develop skills in educating patients and their families, in dealing with sensitive issues for patients and families, and in negotiating a plan of investigation and treatment with the patient and family.
D. Develop professional relationships with co-workers, consultants, ancillary staff and other professionals to enable assembling of health care teams and mobilization of community resources to optimize care of the patient.
E. Develop an understanding of the role of the family medicine consultant, and is able to support the patient through the process of consultation, medical evaluation, treatment, rehabilitation and long-term care.
F. Use professional language and demeanor when communicating with other residents, with Family Medicine attending physicians, with physicians from other services, with non-physician clinical staff, with non-physician non-clinical staff, and with patients and their families.
G. Create and sustain a therapeutic and ethically sound relationship with patients.
H. Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills.
I. Work effectively with others as a member or leader of a health care team or other professional group.
Learning ActivitiesAttending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / X / Noon Conference / X / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / X / Directly Supervised Procedures / Morning Report
X / Program Director
Review / X / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / X / Videotape Review / X / Quarterly Review
Other
Systems-based Practice
Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
Objectives:
A. Understand how their patient care and other professional practices affect other health care professionals, the health care organization, and the larger society and how these elements of the system affect their own practice.
B. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
C. Practice cost-effective health care and resource allocation that does not compromise quality of care.