Family Medicine Residency Curriculum

The patient-physician relationship developed in the Family Medicine Residency Clinic (FMRC) is at the heart of teaching and learning family medicine. Education about the patient experience, the pathophysiology of serious illnesses requiring inpatient care, disease evaluation and management across specialties, and a holistic understanding of human health, including behavioral, familial, social and spiritual factors, come together in this model family medicine office. Residents will form and continue to build relationships with their patients in their continuity clinics during nearly all their rotations and be able to have dedicated outpatient clinic blocks.

We offer individualized tracks during PGY2 and PGY3 to allow each resident to further hone evaluation, management and procedural skills they intend to practice consistent with their future goals. Current tracks include maternity care, hybrid or adult inpatient care, rural practice and underserved practice.

This is a dedicated block separate from clinical responsibilities in which all family medicine resident physicians gather for didactics on Wednesday afternoons. The comprehensive 18-month didactic curriculum covers the breadth of family medicine, interactive workshops, simulation, resident-directed didactics and wellness retreats.

This program is designed to provide every resident physician the opportunity to succeed in developing scholarly activity. Our research initiative starts before you begin your residency, with orientation activities that will include completing training modules for ethical research. With the additional support of the Parkview Mirro Center for Research and Innovation, the program will provide you the education, mentorship and resources to complete at least one research initiative, as well as a required quality improvement project. Parkview hosts a yearly research symposium with the opportunity to submit to a regional or national meeting.

The FRMC is the foundation of our “clinic first” approach. Both weekly continuity clinic and dedicated clinic blocks provide structured experience in the management of outpatients in our newly designed clinic. Resident physicians will be given the tools to develop therapeutic relationships with patients and to accurately evaluate and treat patients of all ages across a spectrum of social and cultural backgrounds. This curriculum will also develop the skills necessary to collaborate with healthcare co-workers (e.g. attending physicians, nursing staff, therapists and ancillary staff), family members and the community. Resident physicians will develop communication skills and skills in efficiently coordinating and overseeing the holistic care of patients by working with experts in behavioral health, population and community health and health system management during their FMRC rotations. All resident physicians will develop progressive independence in the care of their patients under the supervision of outstanding ambulatory preceptors.

Training in behavioral health is essential to providing holistic care to patients of all ages. This training will begin during orientation with an introduction to the Integrated Behavioral Health (IBH) model within the FMRC and training on topics including Trauma Informed Care, Motivational Interviewing and Stages of Change among others. Integrated behavior health training during dedicated FRMC blocks and throughout the outpatient clinic experience will be developed and overseen by a psychologist educator. Resident physicians will collaborate closely with IBH providers in the primary care setting to learn to effectively identify and address patients’ physical and mental/behavioral health needs. Collaboration with psychiatry will occur during didactics and while working within the FMRC where a psychiatrist will provide psychiatric consults on a scheduled basis to improve access, reduce stigma, provide resident education and enhance opportunities for co-management of patients with more significant psychiatric disorders requiring more specialized psychopharmacology.

Given the substantial impact that social determinants of health have on medical and personal outcomes, training in population and community health is integral to providing holistic care. Beginning in orientation through three years of dedicated FRMC blocks, resident physicians will be introduced to ‘obstacles to thriving’ members of our local communities face; and individuals, groups and agencies who are available to help in a variety of patient age groups and clinical situations. You will learn how to follow-up patient challenges, to identify and remedy common obstacles, be introduced to Community Oriented Primary Care, provide care for the underserved in a variety of settings and learn how to become a helpful resource in a new community.

The complexity of the health system for patients makes it essential for a family physician to know how the system operates, how to help patients navigate it and how to provide leadership to multidisciplinary teams working within it to provide efficient and effective patient care. The structured and graduated “Pathway to Practice” curriculum is integrated within dedicated FMRC blocks, focused PGY-specific didactics and other didactics and designed to prepare graduates for successful practice in whatever setting they choose.

The opioid epidemic prompted research into successful models of treatment for opioid use disorder and the high prevalence of substance use disorders. A working knowledge of the identification, evaluation and treatment of patients with substance use disorders is an essential skill for family physicians. Working with a board-certified addictionologist with family medicine training, resident physicians will be trained in weekly half-day Addiction Medicine clinics during their dedicated FMRC blocks.

Residents are provided opportunities to explore family medicine practices in rural, suburban, or underserved settings while working alongside family physicians eager to share their experiences and serve as mentors

Resident physicians can choose to pursue additional experience during residency to support planned practice after graduation. At the beginning of their training each resident physician will meet with an advisor to help develop their own individualized learning plan. That plan might include a track of increased expertise from the beginning, or an interest may develop over time. While these two blocks support gaining that additional experience, most tracks will require additional experience during some of the elective months. Current tracks include maternity care, hybrid or adult inpatient care, rural practice and underserved practice.

Adult inpatient medicine is an important rotation for resident physicians to become competent, compassionate and well-rounded family physicians. Caring for patients in the hospital enables a deeper understanding of the pathophysiology of common diseases, greater insight into avoidable hospitalization and an understanding of the experiences patients and their families. On the medical wards, resident physicians will build their medical knowledge through exposure to different pathologies and management of hospitalized patients, develop excellent communication and interpersonal skills with patients and medical staff and learn the complex relationship between health status and social determinants of health. Morning report, interdisciplinary meetings and transition rounds, as well as teaching and bedside rounds, are just a few of the methods in which a resident physician will learn a team-based, patient-centered approach to care.

A fundamental knowledge of critical care medicine is essential for providing care to severely ill patients and recognizing the experiences of these patients and families. This rotation will provide resident physicians with rigorous experience in the assessment and care of critically ill medical patients. Parkview Health provides a unique environment of diverse pathophysiology as well as patients from diverse communities, socioeconomic and cultural backgrounds. Resident physicians will manage patients in a tertiary care ICU setting as part of a multidisciplinary team under the direct supervision of attending physicians with expertise in critical care medicine.

Adult inpatient medicine night float rotation is a valuable experience for resident physicians to learn skills such as: assessing patient’s initial presentation through admissions, addressing acute conditions of floor patients, forming differential diagnosis, attending rapid responses/code blues and planning the patient’s work-up. Resident physicians will build their medical knowledge through exposure to different pathologies and acute management of patients and will improve upon their communication and interpersonal skills with patients, families, subspecialists and medical staff. All resident physicians on this rotation are expected to be able to provide the same level of patient care and communication to patients and families as those on day inpatient teams. Mastery of handover is an essential element of the night float rotation. Night float will be divided into two-week blocks so that resident physicians will not have four consecutive weeks of night float.

Cardiovascular disease is the leading cause of death in the U.S., and family physicians are on the forefront of preventing and treating heart disease across the age spectrum. Resident physicians will learn to stabilize, evaluate and treat patients who present with a variety of symptoms from underlying cardiac disease including ischemic heart disease, valvular heart disease, electrical heart rhythm disorders and heart failure in both inpatient and office settings.

Obstetrics provides an amazing mix of collaborative care for our residents to work with patients from diverse backgrounds and settings. Residents will deliver babies in our state-of-the-art hospitals, Parkview Regional Medical Center and Parkview Hospital Randallia, and work with a collaborative team of teaching faculty, OB/GYN hospitalists and nurse midwives. They will manage prenatal care in our own residency clinic. The residents will learn expectant management of prenatal care, including working knowledge of routine labs, milestones, doppler checks, maternal and fetal development, non-stress test and heart rate tracings and common complications and their management. All residents will also be certified in Advanced Life Support in Obstetrics (ALSO). This foundational rotation will help resident physicians decide if they want to pursue a higher-track OB course.

Interviewing, discussing and examining any patient must always be handled with respect, maturity and dignity. This is even more pronounced in the realm of gynecology. Our residents will not only learn by example to expertly perform delicate exams but also become proficient in conducting patient-centered and evidence-based discussion around a variety of topics including contraception; family planning; management of irregular cycles; dyspareunia; cysts and abscesses; and well woman care. Through it all, our residents will preserve the sanctity and dignity of our patients while expertly delivering the best quality care.

Family physicians skilled in caring for both well and ill children are equipped to provide families with comprehensive care. Resident physicians in inpatient pediatrics will gain skills in the evaluation and management of well newborns, newborn resuscitation, the care of acutely ill children and learn procedures like circumcision and lumbar puncture. A separate two-week rotation in PGY-2 will take place in the emergency department (ED) focused on evaluating and managing acutely ill children in that setting. As skills develop, residents will learn to care for late preterm infants, attend with NICU staff supervision higher risk newborn resuscitations and learn about common problems encountered in the neonatal period.

In addition to their own continuity clinics, resident physicians will rotate with experienced pediatricians interested in teaching the breadth of outpatient pediatric evaluation and management through supervised clinical care, case-based teaching, didactics and assigned readings and discussion. In addition, resident physicians will be exposed to pediatric specialty care including pediatric cardiology, gastroenterology and endocrinology.

Family physicians will frequently see patients with undifferentiated illnesses and acute conditions, and in rural locations, may help provide care in the ED. These rotations will provide resident physicians with skills in the acute assessment and stabilization of critically ill patients and the evaluation of patients with acute and undifferentiated illnesses across the lifespan and in multiple settings. Training will occur in suburban tertiary ED, urban ED, rural ED and pediatric-focused ED settings. In addition to the variety of ages, settings and acuity levels, this is an important rotation to learn the transitions of care patients experience from the emergency room to the hospital, home and back to the office.

Evaluating patients in need of either elective or urgent surgery, pre-operative assessment and coordinating care for patients postoperatively are common tasks for family physicians. Many family physicians and nearly all those practicing in rural or underserved areas will also perform a variety of minor procedures from skin biopsies and excisions to laceration repairs. This rotation provides resident physicians with thorough training in preoperative assessment, minor procedures and postoperative evaluation not only for their own procedures but also those of others in a supportive environment taught by general and plastic surgeons and clinicians in a comprehensive preoperative evaluation center.

Resident physicians will experience a longitudinal three-year dermatology curriculum beginning with the introduction of dermoscopy during the orientation month, regular dermatology-focused didactics, supervised evaluation of skin-related concerns during continuity clinic, a 2-week PGY-2 rotation, and a two-week rotation with an experienced dermatologist in PGY-3. During the PGY-2 rotation, skin procedures and other common procedures are introduced by didactics and simulation followed by supervised procedures in the FMRC. Resident physicians will be instructed in dermatological terminology, given opportunities to diagnose and manage skin diseases, and practice the clinical use of dermoscopy. Finally, residents will have hands-on training using a point-of-care ultrasound (POCUS).

[1] Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014 Jun;134(6):1527-1534. 

[2] Le Roux E, Edwards PJ, Sanderson E, Barnes RK, Ridd MJ. The content and conduct of GP consultations for dermatology problems: a cross-sectional study. Br J Gen Pract. 2020 Oct 1;70(699):e723-e730. 

Family physicians are on the front line of care for patients with a variety of painful conditions. Their role providing comprehensive and holistic care is summarized by the quote attributed to Hippocrates: “Cure sometimes, relieve [or treat] often and comfort always.” Fortunately, consultants in pain management have much to teach resident and practicing physicians about the promise and practice of multidisciplinary pain management. Experienced and supportive pain management faculty will teach how to provide patients with a toolbox of care options from a biopsychosocial and evidence-based approach. This includes medications and procedures to help resident physicians learn to comprehensively care for patients experiencing pain.

Resident physicians will hone their skills in diagnosing and managing common neurological illnesses while working with our incredible neurology department. Through clinical care and didactic teaching they will become proficient managing patients with headaches, neuropathy, and dementias and develop an approach to care for conditions such as multiple sclerosis, seizure, stroke and Parkinson's disease. Treatment of the disease, although a primary focus, must also come alongside understanding how the illness impacts the patient and their family, requiring an holistic approach that encourages the resident physician to consider activities of daily living, transportation, housing, medication management and caregiver support.

During this rotation, resident physicians will work with sports medicine physicians and athletic trainers in various outpatient settings to gain knowledge of and exposure to radiologic interpretation and diagnosis of common sports-related injuries, concussion management, the pre-participation sports physical, sports nutrition and injury prevention and rehabilitation, among other topics. The final week of the rotation will be spent working with a board-certified rheumatologist during which time resident physicians will refine their evaluation of rheumatic conditions, develop familiarity with x-ray and lab workups for various kinds of autoimmune conditions and common and advanced treatments for them.

Our residents will tackle the orthopedic clinic under the expert coaching of our amazing preceptors. As you might expect, back pain is the No. 1 musculoskeletal complaint in family medicine. After this rotation, residents won’t punt on back pain or other musculoskeletal needs. Residents will be scheduled with four days of clinic outside of the FMRC for a full block. With the orthopedist in their corner, the resident will enhance their skills in orthopedic history and physical examination, learn the appropriate use of radiologic tools for evaluation and diagnosis and manage common problems of the back, neck, shoulders, elbows, wrists, hips, knees and feet. Our residents will learn splinting/stabilization of joints, short casting of arms and legs, aspiration and injection of joints, taping and strapping, steroid injections of tendons and ligaments, carpal and ulnar tunnel steroid injections, trigger point injections and dry needling.

Resident physicians will train on geriatric services in a variety of settings to learn an interdisciplinary approach to caring for older adults including: diagnosing and managing medical problems, providing medical care of the older surgical patient (including pre-operative evaluation and post-operative management), performing comprehensive assessments of functional status and appropriate levels of care, mastering discharge planning to optimize use of community and outpatient services available to older adults, assessing and managing ambulatory community-based older adults, caring for institutionalized long-term care patients, learning the principles of caring for chronically ill and older patients with acute and sub-acute medical issues, caring for dying patients and their families and caring for frail patient with multiple medical, psychiatric, cognitive, socio-economic and/or functional problems. Care will also be provided in a longitudinal fashion in a comprehensive community-based geriatric care setting.

Few conditions can be as painful as a kidney stone, or as embarrassing as incontinence, or as frustrating as erectile dysfunction. These are common urological conditions our residents will learn to manage alongside our urologists while also gaining skills for diagnosing and treating overactive bladder, recurrent and complicated urinary tract infections, pelvic floor dysfunction and prostate enlargement. Residents will have exposure to and learn how to rely on current evidence-based guidelines and recommendations for screening for prostate cancer and how to best manage those at highest risk. As these concerns are often sensitive in nature, learning to make the conversation and examination comfortable and dignified for patients is one of the utmost goals of this rotation.

During the second and third years of residency, resident physicians will have opportunities to choose from several electives. These may vary in duration from two or four weeks. As part of an individualized learning plan, electives not listed here may also be explored and developed in collaboration with residency faculty and relevant disciplines. 

• Addiction medicine
• Allergy and immunology 
• Better Future Clinic
• Dermatology 
• Endocrinology 
• Gastroenterology 
• Health advocacy 
• Health system management 
• Hematology-oncology 
• Infectious disease 
• LGBTQ+-focused care 
• Maternal-fetal medicine 
• Medical ophthalmology
• Neonatal ICU
• Obesity medicine 
• Office gynecology 
• Osteopathic manipulative medicine 
• Otolaryngology 
• Pain management 
• Palliative care and hospice medicine 
• Pediatric emergency medicine 
• Pediatric subspecialties 
• Psychiatry 
• Rehabilitation medicine 
• Rural family medicine 
• Sleep medicine 
• Sports medicine and non-operative orthopedics 
• Urology 
• Wound care