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Curriculum

We do more than train physicians. We train healthcare leaders.

We have designed our curriculum to offer superior clinical training, with comprehensive, evidence-based education in all of the core Family Medicine rotations and strong longitudinal experiences in Community Medicine, Integrative Medicine, Leadership, and Research & Scholarly Activity. Our innovative curriculum and schedule maximizes learning on every rotation. Didactics are a strong component of the curriculum, and we utilize simulation, mobile technology (such as “Telederm”), and other innovative tools to continuously learn, teach, and provide the best care.

Curriculum

Inpatient Adult Medicine

  • Team of two PGY-1s, one PGY-2, one PGY-3* (starting July 2020), and 1-2 medical students, supervised by family medicine and hospitalist faculty
  • 24/7 access to specialists help develop competency and skill while providing the highest quality, equitable care to all of our patients regardless of insurance type
  • Care for medically complex patients drawn from a large catchment area, including uninsured, housing insecure, and underserved
  • Opportunity for many procedures, including formal training in Point Of Care Ultrasound (POCUS) for inpatient medicine
  • Morning rounds, formal didactics during and off rotation, and simulation training

Pediatrics

Residents receive repetition and robust volume in pediatrics by rotating through pediatric outpatient clinics, as well as inpatient pediatric care, newborn rounding, care in the Intermediate Care Nursery, and dedicated pediatric time in the Emergency Department. Residents train with both family medicine faculty and pediatricians at our Santa Rosa and Walnut Creek facilities. The curriculum consists of:

  • 8 weeks in the first year of combined inpatient/outpatient shifts – round on inpatient in the morning (including newborns and intermediate care nursery, addressing breast-feeding, circumcision, resuscitation and stabilization at deliveries) then outpatient pediatrics in the afternoon, to maximize learning and patient numbers
  • 4 weeks of inpatient pediatrics and ED at the Kaiser Medical Center in Walnut Creek as a member of the inpatient resident service
  • 6 weeks of combined additional outpatient pediatrics in the second and third years, including urgent care
  • Caring for pediatric patients from birth to adolescence in the resident continuity clinic, where residents average >25% pediatric visits per clinic and have 10-25% pediatrics on their patient panels
  • There will also be opportunities to provide teen education at teen parent groups, teen mentorship at Ceres Community Project, and to conduct pre-participation physicals at high schools around Sonoma County.

Obstetrics and Gynecology

Residents work 1:1 with nurse midwives, family doctors, and obstetricians as they learn skills and become increasingly competent and independent in obstetrics and gynecology, both in our own family medicine center, in the gynecology clinic, and on Labor and Delivery. Upon graduation, all residents will be well-prepared to provide general primary care gynecology and low-risk obstetrics including prenatal care and postpartum care. For residents desiring additional obstetrics training or preparing to go to OB fellowship after residency, electives in high-risk obstetrics are available.

  • 16 weeks combined in the first and second years on Labor and Delivery caring for and delivering patients admitted for labor under the supervision of family medicine faculty, obstetricians, and certified nurse midwives. High volume department averages >150 deliveries per month
  • Additional L&D shifts scheduled across the third year to maintain skills, along with workflows to encourage residents getting continuity deliveries
  • 5 weeks in the first year and 4 weeks in the third year in both the family medicine gynecology/procedures clinic and upstairs in the Gynecology department dedicated Procedure Clinics, General Gynecology Clinic, Infertility Clinic, and comprehensive Family Planning Training
  • Attention to gender expansive language and workflows to ensure equity and inclusion of our nonbinary/transgender patients
  • Caring for prenatal patients in the resident’s own continuity clinic in the family medicine center
  • Procedural training ensures residents will feel comfortable independently performing common GYN procedures such as Pap smears, colposcopy, endometrial biopsy, IUD placement and removal, Nexplanon implants and removal, and wet mounts
  • Comprehensive Family Planning Training including miscarriage management, medical abortions, D&Cs, and opportunities for advanced training

Behavioral Medicine

Residents at our program get a comprehensive longitudinal experience in patient care as well as space for personal development and self-reflection, in large part facilitated by our faculty behaviorist and psychiatrist who are enthusiastically dedicated to resident learning and wellness. The behavioral health residency curriculum is incorporated into all aspects of outpatient and inpatient care, beginning with a longitudinal curriculum woven into every rotation of the first year.

  • Longitudinal curriculum throughout the three years including integrated presence of our faculty psychiatrist and psychologist in the family medicine center
  • Formal didactics throughout the three years including opportunities for 1:1 learning about relevant psychiatric conditions/concerns on inpatient medicine, obstetrics, musculoskeletal, and other rotations.
  • Dedicated chronic pain and addiction medicine rotation with time in the Chemical Dependency Recovery Program (CDRP) and the opportunity to learn about buprenorphine prescribing. Residents learn, in a compassionate and holistic way, the evaluation and treatment of patients with chemical dependency. In small group settings, residents will do cultural self-exploration assignments to encourage recognition of their own potential bias and stereotyping. Residents will also explore how historical, political, environmental, and institutional factors (including racism and discrimination) impact health and underlie health care disparities.
  • Training in mind-body techniques such as motivational interviewing, HeartMath, mindfulness-based stress reduction, and other evidence-based modalities for mental health and wellness

Community Medicine

Our program engages residents in community health from day one, primarily through longitudinal curricular experiences with our affiliated partner, Petaluma Health Center, a federally qualified health center (FQHC) which includes a high performing wellness and prevention-minded community health center, a homeless clinic, school-based clinics, and other safety net programs. All residents see patients at PHC once every 4-6 weeks throughout their entire three years, precepted by our Community Medicine Fellow. Our curriculum encompasses population health, public health, leadership, and advocacy for justice in healthcare and other social determinants of health. Graduates will have the knowledge and skills to lead sustainable community change.

  • 3 week block in the second year and 2 week block in the third year further explore the concept of “The Community as a Unit of Health”, both in addressing our most vulnerable community members as well as exploring the population-based and structural supports that help maximize the total health of all members of a diverse community.
  • Experiences during community medicine rotations include (but not limited to):
    • Jewish Community Free Clinic (https://www.jewishfreeclinic.org/)
    • Graton Day Labor Center (https://www.gratondaylabor.org/)
    • VOICES (https://www.voicesyouthcenter.org/)
    • Sonoma Health Action (http://sonomahealthaction.org/Home/)

Didactic curriculum in community medicine, population health, public health, structural compentancy, health equity, and advocacy for justice in healthcare and other social determinants of health provide the knowledge and skills for graduates to lead sustainable positive community change.

Musculoskeletal and Sports Medicine

Caring for musculoskeletal injuries and conditions is one of the most important skills a Family Physician may develop. Residents rotate through Sports Medicine, Orthopedics, Physical Medicine and Rehabilitation, Podiatry, Rheumatology, Radiology/Interventional Radiology, and the Chronic Pain Program.

  • 4 weeks in the first year and 4 weeks in the second year, with repetition and further skill development seeing patients in continuity clinic
  • Didactics, seminars, and opportunities for training room, team sport, and mass event coverage. Residents will learn to care for uncomplicated fractures, consult with orthopedic colleagues, master physical diagnosis, and aspirate/inject joints and soft tissues.
  • Formal and informal training in musculoskeletal ultrasound with opportunities for more advanced training in point of care ultrasound (POCUS).

Simulation and POCUS Training

Each class participates in a state-of-the art simulation lab with our high-fidelity mannequins and trainers. We teach hands-on skills for common procedures and emergency situations, including lumbar puncture, obstetrical emergencies, laceration repair, intubation, point of care ultrasound, and joint injections. Every six months, our residents also have the opportunity to do resident-specific OSCEs utilizing our skilled cast of standardized patients; these cases focus on common diagnoses and clinical management, interpersonal communication skills, and ethical conundrums. Sessions conclude with a video review and facilitated debriefing to get supported coaching on clinical management and team-building skills.

Family Medicine Practice

Continuity clinic is the cornerstone of all Family Medicine residency programs. We are committed to providing high quality personalized care for a diverse population of patients in all phases of life. All residents and faculty practice full-scope outpatient family medicine in our Family Medicine Center, including gynecologic, dermatologic, and musculoskeletal procedures, pediatrics from newborn to adolescence, and prenatal care.

  • All residents are assigned their own panel of patients (starting with 100 patients and growing to a maximum of about 400-500 patients by graduation) to maximize patient-physician bonding and continuity of care.
  • Each resident team has a dedicated medical assistant to ensure patient continuity. Residents will spend an increasing number of half days per week in the FMC as they progress from first year (average 1-3 half days per week) to third year (average 3-5 half days per week).
  • R3s will have the unique opportunity to transition from resident learner to clinical teacher and leader through our Ambulatory Care Chief Curriculum. This curriculum includes opportunities to precept medical students and fellow residents, leadership training in practice management and team facilitation, and guidance in developing a quality or performance improvement project.

Emergency Medicine

Our Emergency Department services a diverse patient population, which includes pediatric to geriatric cases and patients of all insurance statuses. Residents are the only learners in the Emergency Department, providing an optimal learning environment. Residents have a dedicated Emergency Medicine rotation, but also care for patients in the ED while on other inpatient and subspecialty services. The Simulation Lab is utilized for specific scenarios and complements the rotational experience.

Surgery

Residents will have rotations in both General Surgery as well the surgical subspecialties. Residents are assigned to a surgical attending for a one-on-one teaching experience, always acting as first assist in the operating room. Our goal in the OR is to teach basic scrub technique, preoperative assessment, and post-operative management and care.

Capstone

We have designed an innovative set of non-hospital based immersive learning experiences at the beginning and end of each residency year to catalyze each class’s learning as they move from one level of training to the next.

  • R1: Clinic Immersion and Community Medicine: The first-year curriculum immerses interns in our Family Medicine Center and community partners FQHC Petaluma Health Center and Ceres Community Project. Begin and end your R1 year with a focus on clinical skill building and community medicine.
  • R2: Advanced Clinical Skills and Global Medicine: Expand your skills with leadership training and advocacy work, including a class trip to an underserved community outside our own. Engage in advanced clinical training, including simulation and POCUS (point of care ultrasound) training to set you up for success as you transition to second and third year senior resident duties inside and outside the hospital.
  • Leadership and Professional Development: Third years will broaden their expertise as teachers and practice leaders with an ambulatory care chief curriculum that will prepare you to be a superb clinician-leader in any community setting around the world. Residents will have funded support and guidance in both global health opportunities and QI/PI research projects

Emergency Medicine

Our Emergency Department services a diverse patient population, which includes pediatric to geriatric cases and patients of all insurance statuses. Residents are the only learners in the Emergency Department, providing an optimal learning environment. Residents have a dedicated Emergency Medicine rotation, but also care for patients in the ED while on other inpatient and subspecialty services. The Simulation Lab is utilized for specific scenarios and complements the rotational experience.

Scholarly Activity and Research

Kaiser Permanente has the second-largest patient database in the country (second only to the VA Medical system) and a regional Kaiser Permanente Division of Research; these are incredible resources that help us conduct patient-centered, clinically relevant, community-minded research. We are also thrilled to have a full-time research project manager on-site to support all faculty and residents in scholarly activity. All residents will complete a collaborative scholarly activity project and a QI/PI project during residency and will get faculty support and advising for this requirement. Residents and faculty will pitch their research and QI/PI projects each year at an annual “Research Shark Tank” event; faculty-resident teams will then work together to develop their projects, which may include retrospective data analysis, curriculum design, or writing for publication. Second and third-year residents will then collaborate with our Quality Team and FMC leaders to develop and implement a patient-centered practice improvement project. We financially support our residents presenting at conferences.

Integrative Medicine

We are privileged to formally affiliate with the UAzIMR, the University of Arizona Integrative Medicine for Residents curriculum. This is a three-year longitudinal curriculum designed to be interwoven into the 36 months of clinical rotations. UAzIMR is committed to developing physicians who model the healthy lifestyle they learn about, have a positive sense of well-being, and are relationship-centered in their approach to medical care. This philosophy is incorporated into the curriculum, reflective exercises, and collaboration with faculty and peers. All residents have access to the online curriculum when they start residency, and dedicated time and formal didactics for a portion of the curriculum. Those who are interested may use elective time to complete the whole 200-hour curriculum and receive a certificate of completion upon graduation.

Physical Health and Wellness

Our program values wellness and a healthy work/life balance. We believe that doctors who take care of themselves take better care of their patients. With a humane schedule (no overnight shifts in the first year and no 24-hour call at all!), strict adherence to ACGME Resident Work Hours requirements, and supportive faculty, we ensure that our residents “thrive.” Our faculty model healthy, balanced lifestyles.

Formal residency wellness practice includes:
Resident Balint Group: Balint is a small-group method of discussing and reflecting on the doctor-patient relationship. The purpose of the Balint Group Session is to build empathy for the patient and to explore creatively the unique bond between doctor and patient.
Personal & Professional Development (P&PD) Groups: Regularly scheduled with protected time, weekly Personal and Professional Development (P&PD) sessions are facilitated by a skilled behaviorist to foster support and community during this dramatic time of growth and experience.
Our Integrative Medicine Curriculum includes time for self-reflection, personal health goal setting, and respect for the body, mind, and spiritual aspects of the resident experience. Residents will participate in HeartMath training and mind-body techniques such as guided visualization, meditation, and yoga. A spirituality in medicine and narrative medicine curriculum is in development.

Electives

Residents have a total of 12 weeks of elective time (4 weeks in the second year, 8 weeks the third year) to pursue training and experiences in areas of special interest. During the third year, 4 of the 8 weeks of elective time may be spent away with no required on-campus clinical duties. Residents can create their own elective experiences, or they may elect to participate in our formalized elective rotations, including (but not limited to):

  • Advanced Obstetrics
  • Integrative Medicine & Lifestyle Medicine
  • Sports Medicine
  • Global Health
  • LGBTQ Care
  • Community Medicine
  • Geriatrics

Residents have access to all Global Health rotations through Kaiser Permanente California. Our partnerships with nonprofit global health organizations help foster global citizenship amongst our physicians. Residents make critical connections between global social and healthcare issues and their local communities. Residents explore the health effects of poverty, migration, climate change, emerging infectious disease, and access to healthcare. These experiences add depth and breadth to the clinical capacity of our physicians, and in the process, improve the care they provide to our local and global communities. Additional funding is available to offset the costs of travel through the Reginal GME Department.

Geriatrics

Sonoma County is a wonderful place to retire, hence many seniors reside here. Residents will participate in both a longitudinal and focused curriculum geared toward providing high-quality care across the geriatric timeline. Residents are assigned to an extended care facility where they learn the art of managing patients in a non-hospital setting. This includes geriatrics, home care, hospice care, and other community-related experiences. Didactic seminars, geriatric assessment scales, and ethical decision making are all part of the overall experience. Throughout residency, we teach geriatric clinical skills through a Family Medicine lens. At least six home visits are made to complete the scope of caring for the elderly as a family physician.

Rotation Schedule

Capstone 1A: Clinic Immersion, Community Medicine 2 weeks
Capstone 1B: Ceres Community Project, Advanced Clinical Skills 2 weeks
Family Medicine Practice Continuity Clinic 1-2 half days per week
Petaluma Health Center (on outpatient months) 1-2 half days per week
Inpatient Adult Medicine (6am – 6pm) 16 weeks
Maternity Care (Obstetrics 6am – 6pm) 8 weeks
Women’s Health (Gynecology) 5 weeks
Inpatient/Outpatient Pediatrics (combined, with Newborns & Emergency Medicine) 8 weeks
Emergency Medicine 4 weeks
Musculoskeletal / Sports Medicine 4 weeks
Vacation + CME 4 weeks
Capstone 2A: Advanced Clinical Skills 2 weeks
Capstone 2B: Community & Global Health 2 weeks
Family Medicine Practice Continuity Clinic 2 – 4 half days per week
Petaluma Health Center (on outpatient months) 2 – 4 half days per week
Adult Inpatient Medicine 8 weeks
Maternity Care (Obstetrics, Swing Shift) 8 weeks
Pediatrics Inpatient (Walnut Creek) 4 weeks
Pediatrics Outpatient 2 weeks
Musculoskeletal/Sports Medicine 4 weeks
Behavioral Medicine/Geriatrics 2 weeks
Community Medicine 3 weeks
Surgery & Dermatology 4 weeks
Emergency Medicine 2 weeks
ICU 2 weeks
LTC/SNF Rounds 1 half day per month
Elective 4 weeks
Vacation + CME 4 weeks
Capstone 3A: Scholarly Activity & QI/PI 2 weeks
Capstone 3B: Health Systems Managementand Leadership 2 weeks
Family Medicine Practice Continuity Clinic 3-5 half days per week
Petaluma Health Center 3-4 half days per month
Adult Inpatient Medicine Chief 8 weeks
Pediatrics (Outpatient) & Newborns 4 weeks
Women’s Health (Gynecology) 4 weeks
Maternity Care Shifts (on outpatient rotations) 1-2 shifts per month
Medical Subspecialties 3 weeks
Surgical Subspecialties 2 weeks
Pain Management & Addiction 2 weeks
Intensive Care Unit 2 weeks
Emergency Medicine 2 weeks
Surgery 2 weeks
Dermatology & Procedures 2 weeks
Community Medicine 2 weeks
Integrative & Lifestyle Medicine 2 weeks
LTC/SNF Rounds 1 half day per month
Scholarly Activity 2 weeks
Electives 8 weeks (4 away)
Electives (including up to 4 weeks away/Global Health elective) 8 Weeks
Vacation + CME 4 weeks
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