Family Medicine San Diego Medical Center - Curriculum

Curriculum Goals and Objectives:

The goal of our curriculum is to develop well-trained, well-rounded compassionate physicians. We expect that graduates of our program will be prepared to succeed in practicing medicine in almost any setting.  We hope that our graduates will share our appreciation of the importance of psychosocial factors and continuity of care in a successful practice.

Formal Educational Experience

Every Friday afternoon is dedicated to resident didactic sessions where all residents will have protected education time regardless of their rotation.

Formal instruction is an important part of each clinical rotation in addition to our weekly resident educational conferences.

Scholarly Activity

Each resident is required to complete a scholarly project during their residency.  Our faculty has been involved in many research projects and will provide guidance and support to help make each project a valuable experience. Kaiser Permanente, as an organization, has a rich network of research opportunities including its own clinical journal.  Kaiser Permanente San Diego has its own research committee and internal review board.  We have regional support of statisticians.  Our electronic medical record and extensive patient databases allow a unique opportunity to complete patient-oriented research projects.

Clinical Experiences for Residents:

We are committed to providing high quality personalized care for patients in all phases of life.

Our medical offices are organized into health care teams to optimize patient care and to foster a supportive environment for all team members.  Our teams work together on measurement and improvement of quality and service.

All residents are assigned their own panel of patients in the Family Medicine Center to allow patient-physician bonding and continuity of care.

All first-year residents have their continuity clinic together in the Family Medicine Center on Wednesday afternoons.

Each resident has a dedicated Pediatric Clinic in the Family Medicine Center one-half day per month during most rotations throughout the three years of training.

We also have dedicated time for Gynecology Clinic, Minor Surgery Clinic, Behavioral Medicine Clinic and Geriatric Assessment Clinic.

Adult Medicine

There are two inpatient adult medicine teams. Each resident has the opportunity to work with Family Medicine and hospitalist attending physicians. Call is no more than every four days, with experience covering hospital admissions, consultations, and cross-covering residency patients.  There is always a faculty physician or hospital medicine specialist in-house for teaching and back-up if needed. Morning report, integrated radiology rounds, and teaching conferences add to the academic experience. Residents are exposed to a wide spectrum of disease in our high-volume medical center.  Emphasis is placed not only on the pathophysiology, but also the bio-psychosocial aspects of the medical issues for the patient and their family.   Senior level residents have the opportunity to supervise and teach medical student sub-interns on the service as well.

Intensive Care

In the second year and third year residents spend a total of four weeks in the medical and cardiac intensive care units and work one-on-one directly with an attending critical care specialist.  Residents round daily on high acuity patients with the opportunity to formulate management plans, participate in family discussions, and learn the indications and skills related to various procedures in intensive care.   Residents have the opportunity to admit patients to the ICU/CCU under the supervision of a hospitalist or intensivist attending.   They also follow their patients on the resident services that are transferred to the intensive care units.

Pediatrics

The pediatrics curriculum is highlighted by a strong outpatient experience with ten weeks of outpatient pediatric rotations including two weeks in pediatric subspecialties.  In addition to the Pediatric Clinic in the Family Medicine Center, residents have a longitudinal experience seeing children as part of their patient panel and in the community clinics.

Each resident spends four weeks during each of the first and second years on Inpatient Pediatrics. Residents are exposed to the full spectrum of hospital care including providing care for oncological and surgical patients.  Residents work one-to-one with faculty physicians.   Residents take call every fourth night only during the inpatient rotations.  Residents also have experience providing pediatric emergency and urgent care.

There is a two-week Nursery rotation in the first year.  Residents perform newborn admissions and discharges and participate in neonatal resuscitation with our neonatologists and pediatricians.

Formal teaching rounds are held on a regular schedule.  Residents are also invited to attend the Pediatrics Department’s lecture series.

Obstetrics and Gynecology

Residents have six weeks of Obstetrics and Gynecology in the first year and seven weeks in the second year of training. In Labor and Delivery, residents work closely with Obstetricians, Nurse Midwives and Family Medicine Residency Faculty who are excellent clinicians and teachers. These excellent clinicians are committed to providing a great learning experience for each resident. At the end of these rotations, each resident is expected to have delivered a minimum of thirty babies and follow at least five pregnant women throughout their pregnancy to delivery.  There are many more deliveries available if interested.

The Gynecology experience emphasizes ambulatory gynecological problems, which are typically seen in an office practice. Colposcopy, IUD placement, subdermal implantable contraceptives and endometrial biopsies are taught using state of the art equipment with closely provided supervision and instruction in the Family Medicine Center.

High-Risk Obstetrics and Gynecology electives are available in the third year for those seeking a more expanded experience.

Surgery

Throughout the three years, residents have exposure to the surgical specialties. In the first year, residents rotate for three weeks on the inpatient general surgery service working one-on-one with staff surgeons. The resident is a part of the surgical team, assisting in operative cases and rounding on patients. In the second year, the surgical experience continues with four weeks in the General Surgery Outpatient Clinic completing consultations, pre-operative and post-operative evaluations.  Second and third year residents participate in the Minor Surgery Clinic in the Family Medicine Center to increase their experience in common office procedures. In the third year, residents spend six weeks in Surgical Subspecialty Clinics spending two weeks in ENT, Urology, and Ophthalmology.  Within these subspecialty clinics, residents work closely with staff surgeons seeing commonly encountered problems in Family Medicine.

Emergency Medicine

Seven weeks in the second year are devoted to Emergency Medicine.  During this rotation, residents will treat both adult and pediatric patients in our busy emergency department. This experience also includes participation in resuscitations, minor procedures, and triage.

Behavioral Medicine

We recognize the importance of psychological well-being in optimal health. Throughout the three years of training, residents interact closely with a behavioral specialist in the Family Medicine Center.    Residents also care for patients in the Behavioral Medicine Clinic at our Family Medicine Center. 

Residents spend two weeks on a Behavioral Medicine rotation in the third year.  This experience emphasizes experience in providing outpatient care for patients both in Psychiatry and Addiction Medicine. 

The Resident Support Group meets monthly and offers a structured forum to promote the developing resident’s well-being and an opportunity to explore emotions provoked by challenging cases, the doctor-patient relationship, and the role of the physician. 

Community Medicine

Residents provide medical care in diverse practice settings throughout their three years of training. Residents also spend two weeks on their Community Medicine rotation during their second year.  Rotation sites include: La Maestra, Vista, North County Health Services and Neighborhood Health Clinic.  Residents participate in school clinics and STD Clinics at the Department of Health. They learn about social services provided by Kaiser Permanente and our community and have exposure to occupational health and domestic violence prevention programs. In addition, during the Family Medicine rotations in the first and third years, residents spend half days in the community clinics.

Orthopedics/Sports Medicine

Residents’ complete rotations in Orthopedics and Sports Medicine during both the first and third years of training. The rotations are designed to provide insight and knowledge of these two overlapping but distinct specialties.
Orthopedics:  The emphasis of these rotations is the outpatient evaluation and management of acute and chronic Orthopedic illnesses.  There is some time dedicated to hospital care and the operating room including arthroscopy and joint replacement.  Residents also have the opportunity to work with Podiatrists, Pain Management and Physical Therapists.
Sports Medicine:  Residents work one-on-one with Sports Medicine fellowship trained Family Physicians in the Primary Care Sports Medicine Clinic.  Residents focus on the evaluation of athletic/sports related issues, illnesses, and injuries.  In addition to treatment of sports/athletic related injuries, emphasis is placed on injury prevention and safety during exercise.  Residents are taught how to determine appropriate radiological imaging and interpretation.  Experience is provided in monitoring the patient’s rehabilitation as it pertains to the casual as well as the professional athlete.  Specific attention is focused on nutrition; supplement use and providing an exercise prescription.

Special Orthopedic and Sports Medicine workshops include musculoskeletal examination, casting and splinting, joint aspirations, and injections.

Our residents also have opportunities to volunteer to provide medical care at numerous athletic events, including the San Diego Rock and Roll Marathon.

Medicine Subspecialties

Residents complete a four-week rotation in Cardiology during the third year of training.  Residents learn how to select appropriate cardiac studies and treatment used in the management of these diseases.

There is another four-week rotation in the third year where residents select from several medical subspecialties including Neurology, Nephrology, Pulmonary Medicine, Gastroenterology, Allergy, and Pain Medicine to work one on one with specialists in the outpatient setting.

Geriatrics

During the second and third years of training, residents provide longitudinal care to nursing home patients working directly one to one with a faculty geriatrician.  Residents also participate in a Geriatric Assessment Clinic and home visits.

There is a two-week block rotation in Geriatric Medicine during the second year. Each resident participates as a member of our multidisciplinary geriatric consultation team evaluating and treating patients in nursing homes, in the hospital with the palliative care team and with a hospice physician.

This experience is supplemented with didactics from the Geriatric and Family Medicine Residency faculty starting in the first year of residency.

Family Medicine Center

The ambulatory experience is the cornerstone of all Family Medicine Residency programs.  Our residents see first-hand that our department practices what it teaches and teaches what it practices.

Residents have seven weeks in the first year and six weeks in the third year dedicated to working closely with the core faculty in the Family Medicine Center.  The first-year residents focus on becoming comfortable in caring for patients in the outpatient setting, with an emphasis on developing strong communication skills and solidifying their skills in preventive care.

An important aspect of the experience for the third-year residents is to teach medical students and fellow residents. Another focus of this experience is to treat patients in the community clinics and to work on their scholarly project.

Dermatology

Residents spend two weeks in the first year working one-on-one with Dermatologists to improve their diagnostic and dermatologic procedural skills.  Residents are encouraged to perform minor surgical procedures on their continuity patients in the Family Medicine Center throughout their training and receive additional experience in the Minor Surgery Clinic. 

Electives

Resident’s special interests are cultivated in our program with dedicated elective time to allow flexibility for each resident to chart their own course in Family Medicine including opportunities for international electives.

Curriculum at a Glance (subject to change)