Training Family Medicine Residency The Training You'll Receive Our three-year residency program is fully accredited by the Accreditation Council for Graduate Medical Education and designed to prepare physicians for board certification, excellence in Family Medicine and leadership in the profession. We emphasize active participation, personal autonomy and responsibility, organized support, and one-on-one learning with Family Medicine attendings and specialists. Our Family Medicine attendings are enthusiastic about their specialty and St. Elizabeth Healthcare is extremely supportive of our residents. The result is an ideal environment for residents to gain exemplary skills and confidence. The training program progresses continually throughout the three-year duration. Residents begin with a largely inpatient, rotation-based first year. They progress to a longitudinal specialty-focused second year before concluding in a third year that is designed to simulate that of a practicing, full-service family physician. Throughout this time, resident work-hours guidelines are taken seriously, and hours are kept well-within national recommendations. Family Medicine Residency Training The First Year We instituted a new call schedule that eliminates call for first-year residents in our program. As a result, first-year residents work in the hospital up to twice weekly until 10 p.m., but they have no overnight, in-house call. All rotations for first-year residents occur at St. Elizabeth Edgewood. There are 13 four-week block rotations annually. The first block in July is a four-week orientation rotation, where residents spend one week each with a core hospital team, like pediatrics or obstetrics, and one week in the Family Medicine Center. Senior residents run these core teams while orienting first-year residents to each team’s responsibilities. In each of the twelve remaining blocks, first-year residents are assigned to either inpatient medicine, ED and radiology experiences, or obstetrics, pediatrics and general surgery. Weekly schedules may vary in these blocks, but the total yearly experience is the same for all first-year residents. When a first-year resident is on inpatient medicine, the team is comprised of a family medicine attending, a third-year Resident ("the Chief"), and two to three first-year residents. The residents manage patients in all areas of the hospital, including intensive and transitional care units, medical/surgery floors and behavioral health (inpatient psychiatry). First-year residents are given primary responsibilities for their patients, generally managing five to eight inpatients at a time. The senior resident and attending hold morning rounds with the first-year residents and are always available to help teach and guide them. The inpatient medicine team leads all hospital codes and performs urgent intubations, central line placements and emergent care for hospitalized patients needing those services. Other rotations include time in the ED and radiology departments at St. Elizabeth Edgewood. In the ED, residents gain important triage and medical management skills while being supervised by board-certified emergency medicine physicians. They also help expedite admissions to the inpatient medicine team. In Radiology, residents work with board-certified Radiologists to learn how to interpret common radiographic tests, helping to prepare them to provide initial reading of films taken in the hospital during on-call hours. Rotations provide educational experiences in obstetrics, pediatrics and inpatient surgery. When working in obstetrics, the first-year resident works at the award-winning Family Birth Center. Residents work alongside very experienced nurses, an excellent team of obstetricians, nurse practitioners and Family Medicine Obstetrics Fellow. Residents admit and manage all aspects of laboring patients, including phone management, triage, and evaluation of pregnant patients with medical problems. Residents also perform circumcisions and serve as first assistant at C-sections. An obstetrician is in-house at all times to answer questions and attend deliveries. But, residents gain hands-on, uncontested experience. This serves them well in caring for their Family Medicine Center patients. Currently, three graduates of our OB fellowship work part-time at the Family Medicine Center and deliver their patients at the Family Birth Center. While working in pediatrics, residents manage patients in the Level III newborn intensive care unit, as well as those on the 33-bed general pediatric floor, and newborns on the OB floor. Residents attend all high risk vaginal and C-section deliveries. Residents become highly proficient in neonatal resuscitation and become certified by the American Heart Association in pediatric advanced life support (PALS) and neonatal resuscitation (NALS). One of several neonatologists from Children’s Hospital Medical Center (CHMC) of Cincinnati serves as co-attending on newborn patients. The daily close interaction with the attendings makes for active learning and lively discussions in a collegial atmosphere. Weekly teleconference grand rounds air from CHMC. During the pediatric rotations, residents gain excellent experience and knowledge in the initial management for newborn care and for common pediatric medical problems. While working in surgery, the first-year resident works directly with one of several area surgeons. Residents gain experience and skills in the diagnosis and initial management of common surgical disorders. Residents also have an opportunity to work with anesthesia, if they choose to hone their deep line and intubation skills. Finally, first-year residents spend a half day each week at the Family Medicine Center seeing their continuity patients. A second half-day each week is spent attending FOCUS. First-year residents are expected to take the USMLE, Step-III, during their first year and to acquire Kentucky state medical licensure prior to progressing to their second year. The Second Year During the second year of our program, we emphasize gaining experience in medical, surgical, and pediatric specialties. Every day, residents interact closely with outstanding motivated specialists, usually in their offices. Working directly with them helps our residents develop valuable skills they could not attain in any other way. The second year of residency includes a six-month longitudinal component, which was developed to replace the block format. This approach provides more continuity with the patients being seen in the specialist's office and offers a variety of experience throughout each week. This period includes: Thirteen weeks of mixed pediatrics and gynecology outpatient experiences. The second-year pediatric experience takes place in the world-renown Cincinnati Children's Hospital Medical Center Six weeks of mixed ENT, dermatology and ophthalmology outpatient experiences. Six weeks of orthopaedic outpatient experiences. The remaining six months of the resident’s second year includes: Three weeks of inpatient/outpatient cardiology, nephrology, rheumatology and gastroenterology. Four weeks of inpatient critical care. Three-and-a-half blocks of electives. Required electives include: Two weeks of sports medicine. Two weeks of urology. Additional electives commonly include endocrinology, ID, pulmonary, or hematology/oncology. During the second year, residents spend two to three half-days weekly seeing outpatients at the Family Medicine Center. Rounds at a nearby nursing home also begin in the second year, with residents managing up to three patients each, along with formal rounds every six weeks. Two of our Family Medicine attendings have specialty certification in geriatric care. However, all attendings emphasize geriatric care. This is an excellent learning experience, which prepares all our residents well in the management of geriatric patients after their time in our program. In the second year, residents also continue FOCUS a half-day each week. FOCUS is a relaxed, collegial and fun afternoon, where you and your fellow second-year residents come together and participate in a broad range of clinical topics. Every resident looks forward to FOCUS afternoons for camaraderie and comfortable interaction. Call occurs less than one in eight days. Residents work in teams of three upper-level residents covering the house. Moonlighting shifts – with additional compensation – also become available to qualifying second-year residents, most of whom participate. The Third Year The third year of residency includes fewer set rotations, but rather the schedule is set to mirror that of practicing Family Medicine physicians. Over the year, third-year residents spend seven-and-a-half months seeing outpatients full-time at the Family Medicine Center. The emphasis during this year is on clinical skills and practice management training, which also occurs during FOCUS sessions throughout the year. Many teaching opportunities are available to third year residents including supervising junior residents and medical students in the office, teaching the service medicine team during first year inpatient medicine rotations, and leading FOCUS sessions for the first year residents. The third year residents rotate one week at a time leading the medicine service team at St. Elizabeth Edgewood for week-long periods. Additionally, three-and-a-half months of the third year are devoted to electives, used to polish their abilities and advance areas of special interest. An additional month is spent in the Edgewood emergency department, including urgent and emergent pediatric and adult care. When the Family Medicine Center is closed, second and third-year residents take turns covering beeper calls for private patients. Two in-house calls are required per month. Additional paid moonlighting opportunities are also available to interested third-year residents. Office Components of Our Program The St. Elizabeth Family Practice Center is the base of operations for our residents. Patients at this state-of-the-art facility are assigned to residents and include a diverse mix of adults, children and obstetrics patients. This is a busy practice, which consistently gets very high marks on twice-yearly patient satisfaction surveys. Each resident receives individual patient satisfaction scores and comments from their patients from six surveys during residency. Residents also receive monthly productivity reports showing key measures of their office work – visits, show-rates, charges, wRVUs, charge/visit and academic year and program visit totals. Faculty members are always available in the office for supervision and training regarding patient conditions, diagnoses and treatment plans. Residents have the option of developing competence in office-based procedures such as skin lesion removal, colposcopy, Nasolaryngoscopy, LEEP and ultrasound. The Noon Conference Each weekday at noon at St. Elizabeth Edgewood, physicians lecture on medical topics pertinent to Family Medicine. These comprehensive lectures are organized on a three-year rotating schedule. Lecturers range from pediatric sub-specialists at Cincinnati Children’s Hospital Medical Center, to medical and surgical subspecialists, radiologists, Family Medicine staff attendings and residents. Residents will attend at least 140 hours of these presentations annually. FOCUS Family-centered Organization of Concepts for Understanding our Specialty – FOCUS – gives each residency class a chance to come together for a half-day weekly for study or another activity that’s important to their training that’s not being fully addressed elsewhere. This is a great opportunity for each class’s members to share camaraderie and learn as a team. Topics include ambulatory care, behavioral science, preventive medicine, procedures, public speaking and practice management. Nursing home rounds also occur during this time. Committees All residents serve on at least one continuing quality improvement committee, including those focusing on residency work hours, electronic medical records and others. One attending works with each committee to collect input from house staff and others in order to make and present recommendations at faculty meetings for discussion and debate. The residency program is very supportive of suggestions for improvements since proposed changes are developed through such processes.