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 share our appreciation of the importance of psychosocial factors addressing social determinants of health and continuity of care in a successful practice.

Formal Educational Experience

Every Friday afternoon is dedicated to resident didactic sessions, where all the residents have protected education time, regardless of rotation.  Formal instruction is also 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 are involved in several 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 at least one-half day per month throughout the three years of training.  We also have dedicated time for Gynecology Clinic, Minor Surgery Clinic, Behavioral Medicine Clinic, Dermatology Clinic, home visits and nursing home care.

Adult Medicine

There are two inpatient adult medicine teams. Each resident works with clinic-based Family Medicine and Hospitalist attending physicians. Each resident has “long call” no more than every 7 days, with experience not only with hospital admissions and consultations, but also managing and covering the teaching services. There is always a faculty physician or hospital medicine specialist in-house for teaching and back-up if needed. Case presentations, scheduled didactics, and multi-disciplinary conferences, including Radiology and EKG rounds, 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.

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, as well as 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.  Residents work one-to-one with faculty attending physicians.  First year residents take call until 10 pm, only during the inpatient rotations.  Second year residents have overnight call during Inpatient Pediatrics.  Residents also have dedicated experiences providing pediatric emergency and urgent care.   There is a two-week NICU/Nursery rotation in the first year.  Residents perform newborn exams and become skilled at answering parents’ questions and addressing common medical concerns.  Formal teaching rounds are held on a regular schedule.  Residents also attend the Pediatric department’s lecture series.

Obstetrics and Gynecology

The Obstetrics/Gynecology rotation is a total of 12 weeks during first and second year of residency. 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 twenty babies and additionally follow at least 5 pregnant women through their pregnancy to delivery.  There are many more deliveries available if interested.

The Gynecology experience includes ambulatory gynecological problems, which are typically seen in an office practice. All our residents graduate competent at performing placement and removal of subdermal implantable contraceptives, IUD insertions and removals plus endometrial biopsies. Residents 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. Our residents have a longitudinal obstetrics experience called OB Centering, where the residents lead OB group appointments and then deliver those babies.

Surgery

Throughout the three years, residents have exposure to the surgical specialties. In the first year, residents rotate for two weeks on the inpatient General Surgery service working one-on-one with staff surgeons. The resident is 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.  Residents participate in the Minor Surgery Clinic in the Family Medicine Center throughout the three years of training to increase their experience in common office procedures including skin biopsies and removal of cysts and lipomas. 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 conditions commonly encountered in Family Medicine.

Emergency Medicine

Seven weeks in the second year is devoted to emergency medicine.  During this rotation, residents treat both adult and pediatric patients in our busy emergency department. This experience also includes participation in resuscitations, minor procedures, triaging patients, and practicing teamwork with critical cases using our state-of-art simulation laboratory.  Residents learn to triage and manage urgent and emergent medical cases.

Behavioral Medicine

We recognize the importance of psychological well-being in optimal health. Throughout the three years of training, residents treat behavioral health needs and interact closely with behavioral specialists in the 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.

Community Medicine

We provide “community-oriented” care to a diverse population in our Family Medicine Center.  Residents spend half days throughout their three years treating patients in the community health centers. Residents spend two weeks on the Community Medicine rotation during the second year.  Core rotation sites include: Neighborhood Health Clinic, La Maestra Clinic, San Diego Family Care, Vista Clinic and the San Diego County Department of Health STD clinic.  Residents participate in school-based clinics, teach educational programs, lead health fairs and provide care through our mobile clinics. Residents also learn about social services provided by Kaiser Permanente and in our community and have exposure to occupational health and domestic violence prevention programs.

Orthopedics/Sports Medicine

Residents complete a total of seven weeks of 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 conditions.  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 Primary Care Sports Medicine Clinics.  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 exam skills and 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.   Orthopedic and Sports Medicine workshops are held and include:  musculoskeletal examination, casting and splinting, joint aspirations and injections.

Medicine Subspecialties

Residents complete a two-week rotation in Cardiology during the second and third year of training.  Residents learn how to select appropriate cardiac studies and the management of cardiac diseases.   There is also 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 provider. 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.  In addition to an exceptional longitudinal experience, our 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 developing comfort 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 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)