Family Medicine Santa Rosa - Curriculum

• Team of two PGY-1s, one PGY-2, one PGY-3, and 1-2 medical students, supervised by family medicine and hospitalist attending physicians
• 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

Residents at our program have a comprehensive longitudinal experience in patient care as well as space for personal development and self-reflection, in large part facilitated by our on-site faculty psychologist and psychiatrist who are enthusiastically dedicated to resident learning and wellness. The brain behavioral medicine residency curriculum is woven into all aspects of outpatient and inpatient care.

• 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 typically seen in continuity clinic and on other rotations.
• Residents learn hands on patient evaluations with our psychiatrist or psychologist throughout the three years to develop skills in diagnosis and treatment including psychopharmacology, motivational interviewing, and behavioral interventions. In addition, residents learn about available KP mental health services.

We have designed an innovative set of immersive learning experiences for 4 weeks during each year of residency to catalyze each class’s learning as they move from one level of training to the next.

• R1: Clinic Immersion: The first-year curriculum immerses interns in our Family Medicine Center . Begin and end your R1 year with a focus on clinical skill building and community medicine.
• R2: Advanced Clinical Skills: Expand your skills with leadership training and advocacy work. Engage in advanced clinical training to set you up for success as you transition to second and third year senior resident duties inside and outside the hospital. Continue to engage in community work by spending time in the garden and kitchen at Ceres Community Project.
• R3: Leadership and Professional Development: Third year residents broaden their expertise as teachers and practice leaders with a primary care leadership curriculum that prepare you to be a superb clinician-leader in any community setting around the world.

Our program engages residents in community health 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 regularly 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. Our goal is that graduates humbly listen to the community and lead sustainable change to improve health equity.

• 2 weeks in the first year, 4 weeks in the second year and  4 weeks in the third year that is integrated with Integrative and Lifestyle Medicine
• Residents interact with our most vulnerable community members and explore 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): 
  • KP ACCESS (Access to Community-Centered Specialty Services)
  • Jewish Community Free Clinic
  • Hearts of Sonoma County
  • West County Health Center Gender Expansive Services Clinic
  • Ceres Community Project
• Didactic curriculum in community medicine, population health, public health, structural competency, health equity, and advocacy for justice in healthcare

Skin assessment and disease management is a critical element of family medicine. First year is focused on skin lesion assessment, teledermatology, and biopsy. Teledermatology, magnified digital photographs using a dermatoscope, allows for our patients to receive a virtual dermatology consult within 24 hours. Our dermatology preceptors will teach the residents features of normal and abnormal skin lesions and biopsy type and procedural skills. Second year focuses on the core primary care dermatologic needs, such as acne, dermatitis, skin manifestations in systemic disease, pigment disorders, and alopecia to name a few. At the end of three years of training, residents will be skilled and able to provide systematic skin screening exams, assessment of skin lesions, and adept at outpatient skin biopsy. 

New this academic year! Residents have the opportunity to pursue a distinction in an area of interest. This is voluntary and resident-driven. We structure requirements in three areas, designed to support rigor and meaning while maximizing flexibility and customizability to resident goals. Residents pursuing distinctions work with mentors and program leadership to design a program that utilizes a portion of their elective time to accomplish the following: 

1) Concentrated Experience – defined as 100 hours beyond the program requirements in an area of interest

2) Deeper Education – defined as 20 hours CME (via conference of self-study) or an equivalent course of study beyond required residency learning/didactics, in the relevant area of interest. If  an area has a certification or board (for example, integrative or lifestyle medicine) this is used to meet the requirement. 

3) Scholarship  – defined as one didactic presentation to the residency cohort AND two outputs to a wider audience. This could include conference or grand rounds presentations, publications in medical literature or for patient education or the public, presentation of a QI project, a case report, or many other avenues of showcasing a project in the distinction area. 

We can support a wide variety of distinctions; current residents are pursuing distinctions in:

• Health IT and Artificial Intelligence
• Geriatrics
• Medical Spanish 
• Academic Medicine/Faculty Development 
• Men’s Health/Urology

Residents have a total of 24 weeks of elective time (1 week in the first year, 7 weeks in the second year, 16 weeks the third year) to pursue training and experiences in areas of special interest. During the second and third years, 4 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 
• Lactation
• Gynecology
• Point of Care Ultrasound
• Integrative Medicine & Lifestyle Medicine
• Sports Medicine
• Global Health
• Health Policy
• LGBTQ Care
• Community Medicine including Sonoma County Indian Health Project
• Geriatrics and Palliative Care

Residents have access to Global Health rotations where 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 Regional GME Department.

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. 

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. Our 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.

• 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 Personal and Professional Development Curriculum. This curriculum includes leadership training in practice management and team facilitation, and guidance in developing a quality or performance improvement project.

Telephone and video appointments are built into the residents’ continuity clinic schedules from the beginning of the first year. Faculty preceptors use split headsets to directly supervise residents during telephone visits until they demonstrate independence and confidence in safely delivering virtual care.

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. 

We believe gynecology IS family medicine, and family medicine IS gynecology. Our Family Medicine and Ob-Gyn faculty have teamed up to make this rotation full of learning experiences. Your mentors will consist of both family medicine physicians and obstetrician gynecologists and your clinics will be in both the Adult and Family Medicine and Obstetrics and Gynecology departments.

Our goal is to expose you to the broad breadth of gynecology health issues that you will encounter as a family doctor. Each topic is also within the scope of what you will also be seeing in your continuity clinics too. During this rotation, you can expect a 1:1 clinical experience with the attending in each of the following clinics:

• General Gynecology Clinic
• Procedure Clinic
• SAB and TAB Procedure Clinic
• Colposcopy Clinic

We will teach you to pay attention to gender expansive language and introduce you to workflows that ensure equity and inclusion of our nonbinary/transgender patients

General Gynecology Clinic

The unique set of patients scheduled each day will provide the backdrop for you to grasp a solid fund of gynecology knowledge. Here you will address issues ranging from vaginitis, to abnormal uterine bleeding, hormonal issues, STIs, contraception, breast problems, and cancer screening. If the menstrual cycle and the actions of the sex hormones have intimidated you in the past, don’t fear! You will become much more comfortable and fluent in this area.

Procedure Clinic

Consider this your “long-acting contraception” clinic. Here you will have ample opportunity to refine your speculum skills and find every cervix with ease! You will learn the risks/benefits of all forms of long-acting contraception and will gain the skills to counsel patients and independently perform these procedures in your future practice. You will also perform endometrial biopsies in this clinic.

SAB and TAB Procedure Clinic (opportunity to opt out)

Here you will be exposed to the management of early pregnancy loss and elective terminations. You will practice dating early pregnancies and learn about medical and procedural management, including the risks and benefits of each. If you decide that doing TABs is not for you, come speak to one of us and we will come up with an alternative educational experience.

Colposcopy Clinic

We have a brand new beautiful colposcope! Here you will gain the skill of colposcopy and an in-depth understanding of cervical cancer screening, including the management of abnormal pap smears.

In conjunction with the Andrew Weil Center for Integrative Medicine (AWCIM), our residency offers the Integrative Medicine in Residency (IMR) program, which provides a dynamic, self-paced online Integrative Medicine curriculum specifically designed for medical residents. This 100-hour competency-based CORE program aligns with ACGME guidelines and equips physicians to better address the growing prevalence of chronic illnesses and stress-related disorders. Upon completion, residents receive a Certificate of Completion and gain access to over 85 additional hours of advanced, condition-specific content. The program provides 24-hour access and blends online learning with experiential activities, ensuring flexibility for busy schedules. It also includes a Healthcare Professional Wellbeing Course and incorporates evaluation tools to monitor progress and assess knowledge acquisition.. During specific rotations, residents complete the UAZCIM curricular content that is specific to their current rotation. This includes formal didactics and guided online training. We offer an optional 200-hour certificate track to UAZCIM. 

• 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
• Learn more about spirituality in medicine with the hospital chaplain and palliative care team
• Support for reflective writing, creative arts, music, and other tools for self-inquiry and insight
• Training in mind-body techniques such as HeartMath to manage stress, revitalize energy, and restore mental and emotional balance, and resilience.

Caring for musculoskeletal injuries and conditions is one of the most important skills for a family physician. Residents learn how to manage these injuries through the eyes of specialists in Sports Medicine, Orthopedic Surgery, Physical Medicine and Rehabilitation and Podiatry.

• Didactics, workshops, team sport, and mass event coverage. Residents learn to care for uncomplicated fractures, learn to recognize when a consult is necessary, master physical examinations, 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).

Residents work 1:1 with nurse midwives, family doctors, and obstetricians as they learn skills and become increasingly competent and independent in obstetrics, both in our own family medicine center, our obstetrics and

gynecology clinic, and on Labor and Delivery. Upon graduation, all residents will be well-prepared to provide 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.

– 12 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. We have a high volume department averaging >150 deliveries per month

– Additional opportunities to do L&D shifts as part of elective time, along with workflows to encourage residents getting continuity deliveries  

– Attention to gender expansive language and workflows to ensure equity and inclusion of our nonbinary/transgender patients

– Caring for prenatal patients in the residents’ own continuity clinics in the family medicine center

Residents receive repetition and robust volume in pediatrics by seeing patients together with an on-module pediatrician, inpatient pediatric care, newborn rounding, and dedicated pediatric time in the Emergency Department. Residents train with family medicine faculty, pediatricians, and Emergency Room physicians at our Santa Rosa, Walnut Creek and Antioch facilities. The curriculum consists of:

– 8 weeks in the first year of combined inpatient/outpatient shifts – round on inpatient in the morning (including pediatric and teenage patients, newborns, lactation, circumcision if desired) then outpatient pediatrics in the afternoon, to maximize learning and patient numbers.

– 2 weeks of inpatient pediatrics, newborn resuscitation and ED at the Kaiser Medical Center in Walnut Creek as a member of the inpatient pediatric service in your second year.

– 8 weeks of additional pediatrics in the second and third years, including urgent care, inpatient chief, and outpatient.

– Residents have the option of focusing on maternal/child health in the 3rd year, spending additional time either on labor and delivery and caring for newborns at deliveries or spend time doing additional pediatric and adult 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% pediatric patients 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.

– Regularly scheduled, protected Personal and Professional Development (P&PD) sessions facilitated by faculty to provide check-in and support during this dramatic time of growth and experience

– Monthly facilitated Balint group to creatively reflect on the doctor-patient relationship, to help build empathy for the patient and their experience.

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 senior 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 “Scholarly 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. Third-year residents will collaborate with leadership to develop and implement a patient-centered practice improvement project. We financially support our residents who are accepted to present at conferences. 

KP Santa Rosa has a state-of-the art simulation lab with 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. Throughout the three years of training, residents have specific OSCEs utilizing skilled 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.

Each resident will be loaned their own handheld ultrasound to use during residency. The residency also has three point of care ultrasound devices to use in both the hospital and clinic setting. In addition, you will have access to ultrasound carts for use on your other core rotations including (but not limited to) obstetrics and gynecology, the intensive care unit, and the emergency department. Point of care ultrasound training occurs across a wide range of clinical settings and will cover heart, lung, abdomen, vascular, obstetrics, musculoskeletal, bedside procedures, and others. Multiple hands-on training sessions are also built into the curriculum. Finally, there is simulation software available to provide virtual training.

Residents will have rotations in General Surgery a. Second year residents are assigned to a surgical attending for a 1:1 teaching experience, acting often as first assist in the operating room and inpatient postoperative care. Residents learn surgical sterile technique, assessment of emergent vs. elective surgical care, wound and perioperative pain management as well as perioperative complications. Third year focuses on outpatient surgical subspecialties including office based surgical procedures, wound care, ENT, breast surgery, and colorectal surgery. In addition, the resident will learn about preoperative risk assessment and testing. The goals of this curriculum are to increase procedural skills, understand perioperative assessment for emergent care, operative risk assessment, wound care, and pain management while working as an integrated multidisciplinary team.