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 get 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.

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 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 and community partners FQHC Petaluma Health 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 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 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.

• 3-week block in the second year and 4-week block 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
  • Sonoma Health Action Together

• 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.

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
• Lactation
• Gynecology
• Point of Care Ultrasound
• Integrative Medicine & Lifestyle Medicine
• Sports Medicine
• Global Health
• Health Policy
• LGBTQ Care
• Community Medicine
• Geriatrics and Palliative Care

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.

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 Ambulatory Care Chief 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.

You will have two Gynecology blocks in your first year. The first will be 3 weeks long, followed by a 1-week vacation in the first half of the year. Your second block will be in the final 6 months of your first year, and will be 4 weeks long, including a 2-week vacation. You will have a 2-week GYN block in your second year, and the opportunity for GYN elective time.

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.

We are privileged to formally affiliate with the University of Arizona Integrative Medicine for Residents curriculum (UAzIMR). 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.

• 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.

• 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, 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.

• 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
• 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 rotating through pediatric outpatient clinics, 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.
• 4 weeks of inpatient pediatrics, newborn resuscitation and ED at the Kaiser Medical Center in Walnut Creek as a member of the inpatient pediatric service.
• 6 weeks of combined additional outpatient pediatrics in the second and third years, including urgent care.
• Residents have the option of doing a maternal/child or urgent care “track” in the 3rd year, whereby they spend 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 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.

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. Throughout the three years of training, our residents have scheduled 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.

Each resident will be loaned their own handheld ultrasound to use during their 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 both General Surgery as well the surgical subspecialties. First 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. Second 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.