Family Medicine Continuity and Community Engagement
The management of continuity patients with a broad spectrum of age, disease processes and complexity remain an essential part of the primary role of family physicians. TheFamily Medicine Continuity and Community Engagement at Shannon Medical Center is a collaborative longitudinal curriculum that trains the residents to manage acute and chronic medical conditions and to optimize the care of patients for all ages, their families, and communities. Residents will learn to identify and minimize health care disparities. Residents will learn how healthcare intersects with other community programs and recognize the importance of community leadership. Residents will learn primarily under the supervision of their core family medicine faculty physicians and will gain valuable insight through required community engagement activities.
Adult Inpatient Medicine Curriculum
The management of hospitalized patients remains an essential part of the primary role of family physicians. The inpatient Family Medicine Service at Shannon Medical Center is a four-week block rotation that provides residents and students an exposure to most common problems of hospitalized adult patients, and it provides an opportunity for residents to refine their skills in history gathering and physical examination, selection and interpretation of diagnostic tests, and therapeutic prescribing during the initial and follow-up management of a variety of common diseases as well as complex and uncommon medical problems. PGY1 residents learn under the supervision of their attending family medicine faculty physicians, hospitalist specialists, as well as various specialty consultants. PGY3 on Family Medicine Inpatient will be primarily responsible for the ICU patients admitted from the Family Medicine Service. They are also responsible for supervising and teaching the junior residents and medical students.
Adult Night Float Curriculum
The inpatient Family Medicine Residency Night Float at Shannon Medical Center is a two week block rotation that provides residents an exposure to most common problems of hospitalized adult patients, and it provides an opportunity for residents to refine their skills in history gathering and physical examination, selection and interpretation of diagnostic tests, and therapeutic prescribing during the initial and follow-up management of a variety of common diseases as well as complex and uncommon medical problems.
Night Float covers Shannon Inpatient Residency Team Sunday through Friday. Your primary duties in the hospital will be to admit continuity Family Medicine Residency patients from the ER to the Family Medicine Residency adult inpatient medicine service and to gain extensive hands-on experience diagnosing and managing acutely ill patients in the inpatient setting as well as being a valued part of the rapid response team.
Obstetrical Curriculum
The management of obstetrical (OB) patients remains an essential part of the primary role of family physicians. Family physicians provide high-quality, evidence-based, consistent care to women throughout their lifetimes, including during pregnancy, and this continues to be an important objective of residency training. Maternity care experience varies widely among training programs, but acquiring a core set of knowledge and skills is required by accreditation council. TheObstetrical Block at Shannon Medical Center is a four-week block rotation that provides residents and students an exposure to the management of the antepartum, intrapartum and postpartum care for all hospitalized OB patients. Residents learn primarily under the supervision of their attending OB/GYN staff physicians. Residents are responsible for management of hospitalized OB patients and assigned admissions from the emergency room or outpatient clinics. Residents may see prenatal, antenatal and postpartum patients in outpatient clinics as directed by supervising OB/GYN faculty.
Gynecology/Women’s Health Curriculum
The management of gynecology patients remains an essential part of the primary role of family physicians. TheGynecology/Women’s Health rotation Shannon Medical Center is a four-week block rotation that provides residents and students an exposure to the management of the common gynecological complaint and complains common to women. Residents learn primarily under the supervision of their attending OB/GYN staff physicians. Residents are responsible for diagnosis and management of patients who present to the outpatient clinic with gynecologic and women’s health issues.
Intensive Care Unit/Procedures Medicine Curriculum
The Intensive Care Unit Rotation, ICU, at Shannon Medical Center is a four-week block rotation that provides residents and students an exposure to critical care hospitalized adult patients, and it provides an opportunity for residents to refine their skills in history gathering and physical examination, selection and interpretation of diagnostic tests, and therapeutic prescribing during the initial and follow-up management of a variety of common critical care medical problems and allows PGY3 Family Medicine residents to gain proficiency in all aspects of critical care medicine. The resident will develop and refine advanced knowledge and skills necessary for the provision of pharmaceutical care to critically ill patients with an emphasis on the medical ICU population.
Outpatient Pediatric Curriculum
The management of the newborn and outpatient pediatric patients remains an essential part of the primary role of family physicians. TheOutpatient and Newborn Pediatric Rotation at Shannon Medical Center is two four-week block rotations (during the PGY-1 and PGY-2 years) that provide residents and students an exposure to newborn assessments and recognition of common newborn conditions, well child visits, normal anticipatory guidance recommendations and to the most common medical problems of pediatric patients. The pediatric rotation will prepare Family Medicine residents to care for a broad spectrum of pediatric patients, including neonates, children, and adolescents in the outpatient setting. This rotation provides an opportunity for residents to refine their skills in history gathering and physical examination, selection and interpretation of diagnostic tests, and therapeutic prescribing during the initial and follow-up management of a variety of common diseases. PGY1 and PGY2 residents learn primarily under the supervision of their attending pediatric faculty physicians. PGY1 and PGY2 residents are responsible for rounding on assigned newborn children in labor and delivery. Residents will be assigned Mount Sinai Parenting Modules on teaching strong parent child relationships and early social emotional cognitive development that must be completed, and all test passed by the end of first pediatric block rotation. https://parenting.mountsinai.org/providers/course-category/keystone-curriculum/
Pediatric Inpatient/ER Medicine Curriculum
The management of acutely ill and hospitalized pediatric patients remains an essential part of the primary role of family physicians. TheInpatient/ER Pediatric an exposure to most common problems of hospitalized and acutely ill pediatric patients, and it provides an opportunity for residents to refine their skills in history gathering and physical examination, selection and interpretation of diagnostic tests, and therapeutic prescribing during the initial and follow-up management of a variety of common diseases as well as complex and uncommon medical problems. PGY3 residents learn primarily under the supervision of their attending pediatric and Emergency Room faculty physicians. PGY3 residents are responsible for management of hospitalized pediatric patients and assigned admissions from the emergency room or pediatric clinics. PGY3 will be assigned Emergency Room duties during this rotation to include initial evaluation, diagnosis and treatment as well as history and physicals for children requiring hospital admission and arranging transfers to another facility if necessary. ACGME requirements include of caring for acutely ill children and should include 50 inpatient encounters and 50 emergency room pediatric encounters.
Geriatric/Neurology and Palliative Care Curriculum
Geriatric care in large part includes neurologic and palliative care. Neurologic conditions account for 10-15% of family medicine office visits. Family medicine residents must learn to identify common neurologic conditions and those common in the aging population. Taking a neurological history and performing a comprehensive neurological examination are essential skills for all family physicians. Emphasis on good diagnostic and therapeutic skills and appropriate consideration of biopsychosocial and cultural factors must be included in the curriculum. Neurological diseases can carry a significant social stigma, and family physicians must address both the medical and often severe psychosocial stress that each disorder can cause in the patient and his or her family. Through the three years in the family medicine residency a longitudinal curriculum will occur as part of the family medicine continuity clinic, nursing home rounds, core didactics and inpatient service.
Caring for dying patients is as much a part of family medicine as are efforts to improve patients’ lives. As patients live longer, more people live with chronic health conditions, and the aging and terminally ill populations continue to grow. It is vital to ensure family physicians are appropriately trained to provide high-quality palliative and end-of-life care.
One important element of palliative and end-of-life care is allowing terminally ill patients to die with as much dignity, comfort, and control as possible. Palliative medicine is focused on improving quality of life for patients for whom a cure is not possible, available, or the primary goal. Palliative medicine is focused on improving quality of life for patients for whom a cure is not possible, available, or the primary goal. Many of the tenets intrinsic to the specialty of family medicine are important in the care of individuals at the end of life. A holistic approach to each patient’s physical and psychosocial well-being, a focus on the family, continuity of care, and an emphasis on quality of life are four important principles that make the family physician uniquely suited to care for people who have terminal illnesses.
The end of life is a critical time in the physician-patient relationship. Palliative medicine may be combined with other treatments or modalities with a therapeutic goal, or it may be the complete focus, as in hospice care. A family physician providing and coordinating hospice or other team care for a dying patient can ease physical symptoms and provide social, emotional, and spiritual support to the patient and their loved ones.
PGY-2 residents will be exposed to intensive geriatric/neurology and palliative care curriculum during a 4-week block.
Musculoskeletal/Sports Med Curriculum
Family Physicians are often the first health care provider of contact after an injury. Identifying and management of acute musculoskeletal and sports related injuries are an integral part of training. Orthopedics and Sports Medicine training is addressed during a 4-week block rotation during the PGY-1 year as well as a longitudinal experience during the resident’s continuity clinics and didactic and skill training. Residents are required to attend at least one local sporting event annually. Residents may be asked to participate in preparticipation physicals when not on the Sports Medicine rotation. The rotation provides residents and students an exposure to most common musculoskeletal and sport injury problems as well as the skills necessary for sports participation examinations. It provides an opportunity for residents to refine their skills in physical examination, selection and interpretation of diagnostic tests, and therapeutic prescribing. These rotations involved seeing patients with specialists in Sports Medicine, Orthopedics and Rheumatology in the outpatient clinic setting and participating in procedure clinics.
Surgical Curriculum
Family Medicine physicians often make the decision to refer patients for elective and emergent surgery. Family medicine physicians are uniquely qualified to evaluate patients with a preoperative risk assessment, assessment for frailty and eliciting patients; goals and priorities in context of their overall health. Family physicians can and often serve as surgical assistants and serve as the patient advocate. Core medical knowledge and skills will be obtained through 2-week block rotation during PGY1 and additional surgical experience throughout the three years of experience in their continuity family medicine practice, on their family medicine inpatient service, during emergency medicine rotations, and through elective experiences.
Dermatology Curriculum
Dermatology and skin complaints account for 5% of family medicine office visits. Family medicine residents must learn to identify dermatologic conditions common in the outpatient setting. Although a longitudinal dermatology exposure will occur as part of the family medicine continuity clinic, PGY-1 Residents will be exposed to intensive dermatology curriculum during a two-week block with an attending dermatology. Basic Dermatology Curriculum will include online modules provided through the American Academy of Dermatology.
Surgical Subspecialty Curriculum
Family Medicine physicians often make the decision to refer patients for elective and emergent surgery. Family medicine physicians are uniquely qualified to evaluate patients with a possible surgical specialty need. These elective rotations will include urology, neurosurgery, ENT, plastics, oral maxillofacial, vascular surgery, cardiothoracic surgery, and podiatry. Family physicians can and often serve as surgical assistants and serve as the patient advocate.
Emergency Medicine Curriculum
Family medicine physicians provide emergency care to patients in a variety of settings, including ERs, acutely ill patients in clinic, and in global health work. All Shannon Family Medicine Residents should demonstrate competency assessing, diagnosing, and managing emergent conditions upon completion of their residency. The Emergency Room Block is an excellent opportunity to hone those skills. Emergency Room Shifts will be scheduled for you by Emergency Room coordinator. Your continuity clinic will include a minimum of 4 full days or 8 ½ days in clinic will be scheduled to permit you to participate in full shifts in the ER as a critical member of the emergency care team.
Cardiology Curriculum
Cardiovascular disease is a major cause of morbidity and mortality in our society. The family physician is the most broadly trained health care professional and should be proficient in the diagnosis and management of a variety of cardiovascular disorders. In addition, family physicians are uniquely equipped to provide comprehensive and continuing care to individuals and families, with particular attention to behavioral and lifestyle factors and social determinants of health. Although a longitudinal cardiology exposure will occur as part of the family medicine continuity clinic and inpatient rotations over three years, PGY-1 will be exposed to cardiovascular medicine during a two-week block with an attending cardiology physician.
Gastroenterology Curriculum
Gastrointestinal complaints are common in primary care practices. Family medicine residents must learn to identify gastrointestinal conditions common in the outpatient setting. Although a longitudinal gastrointestinal disease exposure will occur as part of the family medicine continuity clinic, inpatient clinical rotations, emergency room rotation and part of didactic lecture series. PGY-1 Residents will be exposed to intensive gastroenterology curriculum during a two-week block with an attending gastroenterologist.
Ophthalmology Curriculum
Ocular dysfunction presents unique challenges to patients and is a common presentation in primary care offices. Family medicine residents must learn to maximize visual function through the control of environmental factors, the management of disease, and preventative care. Deterioration of ocular function can be minimized through initiation of appropriate treatment, including rapid referral when necessary. The family medicine resident must also learn when social and/or psychological intervention is appropriate in patients who have ocular dysfunction. Although a longitudinal ophthalmology exposure will occur as part of the family medicine continuity clinic over three years, PGY-2 will be exposed to ophthalmology during a two-week block with an attending ophthalmology physician during a block rotation.
Pain Management Curriculum
Family medicine physicians provide care to patients in a variety of settings. All Shannon Family Medicine Residents should demonstrate competency assessing, diagnosing, and managing acute and chronic pain conditions upon completion of their residency. The Pain Management Block is an excellent opportunity to hone those skills. The pain management block is a 2-week rotation where residents will have intentional time working with pain management specialists. The longitudinal curriculum will include chronic pain management in family medicine continuity clinic, management of acute pain the hospital and emergency room settings as well as comprehensive didactic curriculum. Patient suffering can evoke empathy and compassion in health care professionals. However, complex psychosocial factors and learned behavior influence how individuals experience pain and interact with the health care system in patients who have chronic pain. These factors can impair the physician-patient relationship. Family physicians are challenged to use new toolkits in their approach to chronic pain and to find new ways of communicating care goals that will engage and activate their patients.
Behavioral Health Curriculum
The management of continuity patients with a broad spectrum of age, disease processes and complexity remain an essential part of the primary role of family physicians. TheBehavioral Health Curriculum at Shannon Medical Center is a collaborative longitudinal curriculum that trains the residents to manage acute and chronic mental health conditions and to optimize the care of patients for all ages, their families, and communities. Residents work collaboratively with Behavioral Health specialist in their continuity clinics and during a dedicated block rotation during PGY-3 year. Residents will learn to identify and minimize health care disparities. Residents will learn how healthcare intersects with other community programs. Residents will learn primarily from Family medicine behavioral health faculty about human behavior, mental health disorders and the skills necessary to recognize, diagnose and treat common conditions.
Elective Rotations
Each resident has 6 elective block rotations during residency: PGY1s 1 block, PGY2s 2 blocks and PGY3s 3 blocks. These electives can be taken as 4-week block divided into 2-week electives x2 or a 4-week elective. Residents are encouraged to choose an elective from the list below but may opt to develop their own elective experience (subject to Program Director approval). The residents must obtain teaching faculty approval prior to submitting a request for elective. You also have one-half day of administrative time during your elective. You may choose which half-day to take while coordinating with the program coordinator and your supervising faculty.
PGY1&2 resident elective rotations must be at “Home” which means there are performed at a location near enough (< 1 hour drive away) for the resident to maintain continuity clinic and call requirements.
PGY-3 residents may choose to have 2 “Away” rotations which means the rotation is at a location that does not allow for continuity clinic.
2024-2027 Shannon Medical Center Residency Block Diagram
|
Block |
1* |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
|
Site |
1/2 |
1/5 |
1/2 |
2/5 |
6 |
2 |
2 |
2 |
2 |
3 |
3 |
3 |
TBD |
|
Rotation |
Clinic/ Service |
Clinic/ PainMt |
Clinic/ RAD/MK |
Cards/ Derm |
Surg/ SpMed |
INPT Wards |
INPT Wards |
INPT Wards |
INPT Wards |
Peds/ NB |
OB |
GYN |
Elective |
|
% Outpatient |
50 |
100 |
100 |
90 |
90 |
10 |
10 |
10 |
10 |
90 |
25 |
50 |
TBD |
|
% Research |
|
Block |
1* |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
|
Site |
1/2 |
1/5 |
1/5 |
5 |
2/1 |
2/1 |
2/1 |
2/1 |
3 |
2/5 |
3 |
TBD |
TBD |
|
Rotation |
Clinic/ Service |
Clinic/ GI |
Clinic/ Optho |
GERI/ Neuro |
Nights/Clinic |
Nights/Clinic |
Nights/Clinic |
Nights/Clinic |
Peds/ NB |
ER |
OB |
Elective |
Elective |
|
% Outpatient |
50 |
100 |
100 |
75 |
60 |
60 |
60 |
60 |
90 |
0 |
25 |
TBD |
TBD |
|
% Research |
|
Block |
1* |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
13 |
|
Site |
1/2 |
1 |
4 |
1/6 |
2/1 |
2/1 |
2/1 |
2/1 |
2/1 |
2 |
TBD |
TBD |
TBD |
|
Rotation |
Clinic/ Service |
HSM/ PopHth |
BH/ Psych |
Heme/ ENT |
PEDS INPT/ER |
INPT/ Clinic |
INPT/ Clinic |
INPT/ Clinic |
INPT/ Clinic |
ICU/ Proc |
Elective |
Elective |
Elective |
|
% Outpatient |
75 |
80 |
100 |
90 |
10 |
60 |
60 |
60 |
60 |
10 |
TBD |
TBD |
TBD |
|
% Research |
20 |
*Denotes 4 week BLOCK= 1 week at the beginning, 2 weeks in the middle of the year, 1 week at end of the year
Sites:
- Shannon Family Medicine Residency Clinic
- Shannon Medical Center
- Shannon Women’s and Children’s Hospital
- Shannon Behavioral Health
- Shannon South Medical Center
- Shannon Surgery Center West & Sports Medicine