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Zen Garden
Transcript
Longitudinal
Curriculum
Kate Estlin, MD
Family Medicine Residency Faculty
St Joseph Hospital
Redwood Memorial Hospital
Open Door Community Health Center
Why
More Clinic
More Access
Bigger Panels
More Continuity
Integrate specialist learning into their FP practice from the first year
Better Residents
More skilled
and competent at inpatient care
Happier Residents
- Learn like family doctors practice, be a family doctor from the beginning
- Think about wellness like a graduate
- Experience continuity, which is WHY students choose FM
Additional Benefits May Include:
Additional Benefits
- Residents more likely to stay local
- Quality follows continuity
Welcome to the Jungle
Old
Learning in Bursts
... and then forget about that specialty for a year.
No Patient Continuity
- Intern clinic 4 hrs/wk
- Many blocks NO clinic
- Panel sizes <100
- Very poor continuity
No Patient Continuity
Residents not able to be effective PCPs
Integration of learning across subspecialites
No Integration
delayed until 3rd year or after graduation
Tradition!
"That's how we did it..."
New
New
Clinic
Clinic often enough to be an effect PCP from the beginning
Full Spectrum Skills
are the Stones
Full Spectrum Skills
spaced evenly throughout
residency
Home
Home Visits
Inpatient
Inpatient
SNF
SNF
Urgent Care
Labor and Delivery
Labor &
Delivery
Specialty Skills & Experiences
- Cardiology
- General Surgery
- Orthopedics
- Dermatology
- ENT
fill in the gaps and are integrated into practice
Speciality skills an FP should at least observe
Observe
- Cardiac catheterization
- Laparotomy
- Cholecystectomy -- open and laproscopic
- Appendectomy
- Colectomy
- Total knee and hip replacements
- Spinal fusion
- Endoscopy
- C-section
- Forcepts Delivery
- Colpoplexy
- etc
Skills an FP resident should learn to do,
Do
- Skin biopsies and excisions
- Electrodessication and curettage
- Skin injections (keloids, cysts)
- MSK injections (joints, bursas, etc)
- Vaginal deliveries
- Vacuum-assisted deliveries
- etc
for which specialist teaching is beneficial
Focused Experience Months
- Inpatient Peds
- Pediatric ER
- Away Electives
Focused Experience Months
Exceptions to a
longitudinal integration schedule
How
Continuity
Is The "Secret Sauce"
Clinic Panels
Panels
- Goal of 250 paneled patients on day one of residency (.2 clinic FTE)
- Residents paired with the same clinic MA and RN throughout residency
- Panels transferred intact from graduating R3 to new R1
~16 clinic
appts per week
Clinics
takes an R1 more time
than an R3
Schedules
Sample Month
Choose a template
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