Swedish Family Medicine Residency Curriculum
Rotation Descriptions and Learning Requirements
The longitudinal curriculum at Swedish Family Medicine Residency allows PGYI and PGYII residents during most rotations to spend three to four half-days per week seeing patients at the Swedish Family Medicine Center (except for away rotations and call months). PGYIII residents see patients four to five half-days per week. Residents are required to see a minimum of 1750 patients in the SFMR office during their training.
The Inpatient Service (IPS) at Swedish Medical Center (SMC) consists of two first-year residents and four upper-level residents. Adult medicine, pediatrics, surgery, gynecology, newborn and obstetrics patients are admitted to the IPS by our residents and faculty. The multi-faceted nature of the IPS provides a challenge to residents while allowing them to continue to build the full range of inpatient clinical skills required of a family physician. Interdisciplinary teaching is provided by residency faculty, private physicians, and our behavioral scientist. Overnight call is q4 days for upper-level residents on IPS; interns work day or night shifts while on IPS.
Alternative Medicine/Ambulatory Surgery
Many people use complementary and alternative modalities like acupuncture, chiropractic, herbs, nutritional supplements, and homeopathy. Swedish Family Medicine residents spend two weeks (four-five half-days per week) during the second year learning about and reviewing the evidence for these topics. Residents also work with community general surgeons for two weeks in the outpatient setting during this rotation improving their surgical skills.
This outstanding rotation teaches the knowledge and skills needed to manage common dermatological disorders during a busy and varied clinical rotation at Denver Health Medical Center (a busy county hospital). Small group teaching sessions occur during this rotation, specifically geared toward primary care residents. The rotation also includes time spent on the Swedish campus working with a private practice dermatology group, which provides useful exposure to different dermatologic patient population.
These rotations, which occur in the first and third years, teach the knowledge base and skills required to diagnose, stabilize, and initiate treatment of the emergent, critically ill or injured patient. Residents work in the Emergency Department at Swedish Medical Center, which is a Level 1 Trauma Center, as well as at the Swedish Southwest Emergency Room, which is an affiliated, free-standing emergency setting in the local community, and where residents work one-on-one with emergency medicine-trained attending physicians. In addition, training in trauma in the emergency department occurs in the third year during the surgery rotation under the direction of Swedish’s trauma surgeons.
Residents may use up to five months for elective rotations. Common electives include obstetrics, cardiology, pulmonology, nephrology, outpatient pediatrics, alternative medicine, and procedures. Residents are encouraged to explore new elective experiences. Many residents arrange international elective rotations.
The general surgical experience is taught throughout the IPS and includes ward, operating room and emergency room experience. The general surgery/trauma month-long rotation in the third year is supplemented with ambulatory surgery experience. SMC is a Level 1 Trauma Center and during this rotation residents gain experience in the operating room, the emergency department, the hospital multi-trauma unit for inpatients and in the Surgical Critical Care Unit, supervised by the hospital’s trauma surgery team.
Swedish Medical Center is a certified Stroke Center, so residents work with the Colorado Neurological Institute (CNI) at SMC for a one month rotation. This rotation also includes a structured experience in practice management at Swedish Family Medicine.
Residents learn to manage prenatal, labor, delivery and postpartum care of the uncomplicated obstetrical patient, and are trained to recognize and manage abnormal situations. Two months of OB are required during the first year of training, one at Denver Health Medical Center (high-risk), the second at Swedish Medical Center. The PGYII rotation also occurs at SMC. Continuity obstetrical care is taught by family medicine faculty at the Swedish Family Medicine Center. A perinatologist at SMC provides obstetrical backup, if needed, to SFMR’s patients during daytime hours, and an obstetrician “deck doc” provides backup when needed at night.
Since rheumatologic and orthopedic complaints often present to the family practitioner in similar fashion, a combined ortho/rheum specialty exposure is provided during a six week longitudinal period in the first year.
Orthopedics Away (Breckenridge/Gunnison/Crested Butte)
This concentrated exposure to the management of major orthopedic and sports medicine problems, with an emphasis on outpatient evaluation, trauma and emergency care. This rotation occurs during the third year at a mountain ski town, and lodging is provided.
Outpatient pediatrics is taught in two settings. The residency outpatient office provides quality training in well child care, the care of sick children and in adolescent care. A new second year ambulatory pediatric rotation will begin in 2014-15 at the Rocky Mountain Hospital for Children’s affiliated pediatric specialty practices. A pediatric selective also occurs during the third year, where residents work in pediatric urgent care or outpatient office settings of their choice. Interns rotate at Childrens Hospital of Colorado providing care for hospitalized children as part of a team supervised by pediatricians.
A longitudinal experience in population health and a one month block rotation are currently in development to improve residents’ experiences in managing chronic disease, in addressing disparities in health care, and in providing care within the PCMH setting.
During the rural rotation, residents spend three weeks functioning as a member of a community-based practice seeing ambulatory patients, making hospital rounds, seeing patient in the emergency department and taking overnight call. This rotation provides the second year resident with the opportunity to experience the role of a rural family physician. There are eight approved rural sites for this rotation across the state.
All residents work at Englewood High School in a school-based health clinic on a recurring basis throughout their three years of training. A faculty member accompanies one resident two afternoons each week, which provides an excellent adolescent medicine experience. Our program also provides team physician coverage for Englewood High School’s football team. Many residency staff, residents and faculty also participate in periodic volunteer activities in the community, including working with the Food Bank of the Rockies. Interns learn about community resources during a week-long rotation in their first year and gain exposure to the Public Health Department. Residents may participate in other community medicine activities with approval.
The residency provides a rich and varied menu of continuing medical education conferences every Thursday afternoon during dedicated didactic sessions. The hospital’s Family Medicine Department also presents educational conferences twice per month, and hospital Grand Rounds occur monthly. Resident Forum, a time for the residents to meet together to discuss programmatic issues among themselves, occurs twice monthly as well.
Health Promotion/Disease Prevention (HPDP)
This curriculum integrates such topics as health risk appraisal, health education, nutrition, fitness and exercise prescriptions, stress management, smoking cessation, weight-loss, environmental health, and occupational and school health. Electives are also available in these areas. Interns meet in small group sessions throughout their first year to learn about these health maintenance topics.
As a Level 3 PCMH, SFMR is very focused on team-based care. In addition to physician faculty, our program utilizes behavioral scientists, pharmacists, a care manager/nutritionist and a social worker to help care for patients and to help teach residents in the clinic setting. Team-based care also involves physicians working closely with medical assistants, nurses, and other office staff to improve patient care and office efficiency. Each resident is assigned to a team throughout their three years and works alongside faculty members and staff members as well as their own resident partners to help maximize care for their patients.
Behavioral science teaching occurs throughout the three year curriculum, led by Laurie Ivey, Psy.D. Other faculty are available for consultation for the common psychosocial problems seen in ambulatory patients. The faculty encourages direct supervision through co-therapy consults. Didactic and small group discussion including Balint sessions, also occur on a regular basis. SFMR also has a psychology fellow who helps the residency’s patients. The behavioral science curriculum provides training in management of common mental health issues, motivational interviewing, behavior change, and includes video precepting encounters for each resident on a recurring basis.
Each resident completes a scholarly activity project. Possible topics include designing a community outreach program, drafting patient education materials, implementing a continuing education program or a curricular addition. Residents may conduct original research, write a review article or produce other published educational materials, or present an educational poster at a regional conference. A case report utilizing a review of the literature can also be conducted, with approval. Faculty are eager to assist residents with such activities.
All residents complete at least one Quality Improvement project utilizing the American Academy of Family Physicians’ Measuring, Evaluating and Transforming Research into Care (METRIC) process, which provides Part IV Maintenance of Certification credit for the American Board of Family Medicine. Residents also participate in a QI project with their team as part of the clinic’s PCMH process
All residents participate in a longitudinal patient safety experience that includes training in the fundamentals of patient safety, an adverse event reporting system, patient safety conferences to discuss adverse event reports, participation in hospital root cause analyses of adverse events, and an objective simulated clinical examination (OSCE) focused on error disclosure.