In January 2016, our program launched its new model for learning in our Thursday afternoon protected half-day for residents. It has been a great success!
Most residency lectures focus on teaching facts and medical knowledge. Often, this takes the form of a Power Point presentation. And while there are effective ways to use Power Point, most of the time they are as effective for learning as a textbook and a couple of Xanax. Medical knowledge is obviously important, but traditional lectures fall short in helping residents learn the process of actual clinical reasoning. They also ignore our most current understanding of how the adult brain best learns and remembers. Case-based learning has become more common in medical schools and residencies, but is frequently just a different vehicle for transmitting factual information instead of a method to help teach thought process.
Our new case-based learning format has small groups of residents working together under faculty guidance to diagnose and treat different clinical scenarios. Small groups gradually learn more information about the case from their own workups, with attention to the financial cost of any testing they order. From a master topic list to cover the core content in family medicine, faculty instructors use real patients from their own clinical practices. This allows them to teach more than the usual biomedical aspects of a particular situation. They have firsthand knowledge of the psychosocial impact of the illness, cultural issues related to the illness or treatment, and often the long-term impact on a particular patient or their family.
Each case is presented in multiple different formats over a two-week period. This maximizes the opportunity for residents to have exposure to at least part of a particular subject, and is consistent with the science of how repetition helps reinforce learning. It incorporates multiple different formats including case-based clinical reasoning, resident-to-resident peer teaching, and interactive discussion.
In addition to the new Mystery Case format, we have preserved monthly Teaching Afternoons, which are devoted to hands-on procedural skill workshops, Preventive Medicine and Chronic Disease Management topics, Global Health teaching, and Residency Retreats.
Psychosocial Medicine Core Curriculum
A 12-month program of seminars held every 4 weeks for PGY-1 residents. The first half of the curriculum focuses on unique aspects of the patient's story at different times in their family life-cycle-infancy and childhood, adolescence, coupling, parenthood, middle age, and older age. The second half of the curriculum develops Advanced Interviewing skills including: agenda setting, active listening and empathy, and negotiating a treatment plan.
This seminar series occurs throughout the third year of residency, every other Friday morning from 9 a.m. to 12 noon. The first part of the year focuses on the practical aspects of finding the job that is right for you:
- Different career options within family medicine
- CV and cover letter preparation
- Licensure and credentialing
- Understanding the components of physician contracts and effective contract negotiation skills
This is followed by a series of sessions on the financial aspects of healthcare, starting with an intense billing and coding boot camp for the individual practitioner before moving up to the practice level and then the regional or national health system level. There are also sessions on personal financial planning. The remainder of the curriculum covers a variety of other important topics including:
- Development of leadership skills
- Medico-legal and risk management aspects of medicine
- Media relations skills for physicians
- Physician-patient electronic communication
- Medical ethics
All of the rotations for the third year are scheduled in such a way as to allow PGY-3 residents to attend every seminar throughout the year, even on inpatient hospital rotations.
Science of Family Medicine (EBM)
The "Science of Family Medicine" is our evidence-based medicine curriculum, designed to give you the skills required to practice information mastery over the course of your professional life. We are inspired by the idea that "We do not have to know everything, but we have to know how to find it!" SOFM enjoys an inter-professional teaching team: Dr. Celeste Song, faculty physician with the Department of Family Medicine, Ms. Lorraine Porcello, Branch Librarian at Highland Hospital, and Dr. Brooke Levandowski, epidemiologist with the Department of Obstetrics and Gynecology. We bring EBM to life! (Okay, the food helps, too.) This is a resident-driven curriculum, occurring cyclically over the course of the third year. As a participant, you will serve as a leader of one of twelve EBM cycles. Each leader proposes a clinical question, generated by their own practice. Over the course of the next four weeks, the R3 group collaborates to survey the secondary literature, and select and analyze a primary paper that best answers the question. The leader then prepares a summary presentation, given during our Thursday teaching afternoons, tying together the clinical scenario, point-of-care literature, the chosen piece of primary literature, and an "EBM Pearl". They then relate it back to clinical care, and ask the group to reflect on how (or if) to utilize the results of the primary paper. Far from a dry academic exercise, each session helps us become better clinician-educators, for each other and for our patients.
The Departments of Family Medicine and Internal Medicine sponsor a weekly Primary Care Grand Rounds for residents, faculty, community attendings and specialists. Our department chair, Dr. Colleen Fogarty, co-coordinates this series of presentations by local and national experts on a wide range of primary care related topics. Recent topics include the following:
- Updates from the US Preventive Services Task Force
- Health Care Reform: Implications for Highland Hospital
- Hot Topics in Depression.
Medicine Noon Conferences
Noon conferences are held five days a week at Highland Hospital in conjunction with the internal medicine residency program. The conference series includes the following core topics:
- Inpatient medicine
- Geriatric medicine
- Bedside rounds for interesting physical exam findings
- EKG interpretation
Lunch is provided. An added feature of noon conferences at Highland is a monthly hospital-to-home case conference that aims to improve continuity of care, particularly in the geriatric population. This is led by a PhD Marriage and Family Therapy fellow and the Geriatrics Department.