- Graduate practices
- Curriculum changes
- Emphasis on MCH
- Leadership changes
- Accreditation status
- Strengths and weaknesses of program
- Innovation and national leadership
- Call intensity
- FP residents & other departments
- Laptops & PIM's for residents
- Educational Allowance and salary
- Opportunities to teach medical students
- Where residents work
- Critical Appraisal Rounds
- Faculty research
- Fellowships available
- How the selection process works
- Program performance in the Match
- Opportunities for spouse in Triangle
The 2012 graduates’ career paths showcased the broad-spectrum care we teach. Three residents are working at an Indian Reservation in Arizona providing full-spectrum care to the population. Two are continuing at UNC as fellows in the Women’s Health fellowship. One is returning to her hometown in western North Carolina joining a private practice, while another is staying local at a community health practice. Another is in Seattle working at a local community health practice.
Over the years about 60-65% of our graduates have stayed in North Carolina to practice medicine, and that trend seems to be increasing, with some recent years in which 100% of our graduates stayed in North Carolina. We have about 10-15% of our graduates who choose academic careers. The scope of practice varies, but those who do obstetrics tend also to include inpatient care. Others include inpatient medicine, but choose not to do obstetrics. Our goal is to train residents so that they can leave this program feeling competent to provide full-scope FP (delivering babies, inpatient care, procedures, ambulatory & ED care) if they choose. Lifestyle factors play a big part in graduates' choices about practice.
Our overall approach to change is that we continue to build on what we believe to be a sound basic rotation curriculum with a continued mix of community and university hospital experiences and we continue to tweak our systems in ways in which we believe will serve to improve the quality of residents' experience here.
1. With the new ACGME work hour requirements, we have shifted our inpatient service to incorporate a hybrid night-float, 30 hour call system. With a tremendous amount of resident input, we decided to proactively transition to a night float system for the upper levels which allows for continuity of care for the patients as well as learning for the interns. We transitioned to a night float system for the interns last year which was met with a warm response. First year residents now do a full month of day shifts, starting at 6am and ending at 6pm. Additionally, the first year residents cover two separate 2 week blocks of night shifts, both of which allow for conference attendance on Wednesday morning and once weekly continuity clinic. The second year residents now have two weeks of nights incorporated into their FMIS months. To preserve the learning in a long-call night, we have four 30 hr calls built into the schedule. There is a small amount of cross-cover for residents not on inpatient months allowing for preservation of continuity of care. Third year residents serve as the FMIS team leader, modeling the lifestyle of an attending physician by working six of seven days of the week from 6am-6pm. Third year residents do not take overnight call while on inpatient.
2. We are excited to be able to continue six-week blocks of what we are calling Quality Improvement in Practice into both the R2 and R3 years. This rotation, originally funded by a Title VII Residency Training Grant, has now become a permanent part of our curriculum and allows us to combine a wide variety of experiences that focus on enhancing residents' outpatient training. There is work at a site with low-income patient populations, there is dedicated time to devote to CQI projects, an opportunity to lead Patient Safety conferences, there is a large portion of our practice management curriculum embedded within these blocks. The process is highlighted in the third year and there is a senior scholarly project designed to develop skills in chronic disease models of practice management and improvement of patient outcomes.
3. We continue to improve our rural community month at a rural hospital in Chatham county. In 2009, we changed our 3rd year rural community month experience to be exclusively devoted to work in a rural Emergency Department (Chatham Hospital) primarily staffed my family medicine physicians. In 2012, we are incorporating home-call on the hospitalist service to this rotation.
One of the many strengths of our program is our Maternal Child Health curriculum. Our program has been reported in the literature (Fam Med, 2003; 35:174-80) as a unique blend of education and patient care that combines the viewpoints and philosophies of family physicians and midwives. The RRC requires 3 months of OB/GYN -- we have 6 weeks of OB with obstetricians in a large community hospital and then 4.5 months of maternal child health with the FP faculty. Of those 4.5 months in the 2nd and 3rd year, only 1.5 months of that time is spent in "obstetrics", with the remainder being inclusive of care for newborns, young children, adolescents, sexual health, family planning, and STI treatment.
The 'C' of MCH is also a strength of our program--newborn care, FMC children's acute care clinic, pediatric care at a health department, urban and rural pediatric settings are all part of residents' experience during MCH months. The residents also have 3 months of pediatrics with the Pediatrics services at Wake and at UNC Hospitals.
This past year Dr. Cristy Page, who has served as assistant program director since 2007 has taken over the role of Program Director. Cristy did a fantastic job in her first year with a successful match and leading the residency to a five-year ACGME residency accreditation.
The residency program continues to achieve full accreditation with every site visit. We are very excited to have earned a five-year accreditation in January 2012. We would love to thank all of the faculty, residents and clinical staff who helped us earn this outstanding honor!
Since this is such a common filler question during interviews, we are probably making it difficult for candidates by answering it here. On the other hand, for those who are creative they will be grateful for the opportunity to explore the question in depth using the list below as jump-off points or examine other avenues of inquiry entirely.
- Broad scope family medicine training including MCH, inpatient care, and the full spectrum of outpatient office practice throughout all three years of residency, all taught by Family Physicians
- Broad procedural experience taught by Family Physicians: colposcopy, vasectomy, circumcisions, exercise testing, dermatologic procedures, acupuncture
- Midwife on faculty
- Strong diabetes experience with special emphasis on behavioral change components--as you know diabetes is becoming a national epidemic
- Blend of community hospital, outpatient experience and tertiary care experience--best of all worlds
- Exposure to diverse group of talented faculty clinicians, teachers, researchers--strong identity as an academic department
- Diversity of resident physicians--we attract a unique group of residents who enrich our program with their individual interests and strengths.
- The state of NC is beautiful! And this part of North Carolina provides particularly nice lifestyle options.
- Intensity of program. This program is intended for candidates who are interested in being trained for the broadest scope of family medicine. It takes commitment to this concept. Candidates who are looking for intensity of the program to significantly decrease after internship might find our program too demanding for their style. Our second and third year residents have increasing leadership responsibilities in patient care and teaching of other residents and medical students.
- Driving. Several of our rotations involve some commuting (the rotations at Wake Medical Center in Raleigh are most notable in this regard). All the residents say these rotations are 'worth the drive.' However, for those who do not like driving or commuting this could be a turn-off.
With what innovations and leadership has the program and UNC Department of Family Medicine distinguished itself?
We believe that one of the most important things a university-based program can offer is opportunity to engage in innovative change and advancement of the knowledge within the discipline. We can point to a significant list of ways that our faculty has worked to achieve distinction within the UNC University and Hospitals sytems as well as nationally. You will find here examples of exellence and achievement in:
We follow the ACGME guidelines for frequency and duration of call and no more than 80 hours per week on average for any month. First years on FMIS service will have one month of days (6a-6p) and two 2-week blocks of nights (6p-6a). On other services, day shifts and night shifts vary in duration and schedule. Second year residents on FMIS are now on a night float system working (6p-6a) during half of their inpatient month. There are 2-3 30-hr calls on the inpatient service for second year every 7 days. Cross-covering, or taking call on FMIS during a different rotation, is rare and only occurs 2-3 times a year with our new schedule. Third year residents work from 6a-6p six days of a week while on inpatient (six separate times throughout the year). MCH in both the second and third year is a q3 call on average (q2-a5), but this is call from home, so when there are no active labor patients, residents do not stay in the hospital. To maintain continuity to our laboring patients, the residents strongly advocated to maintain the call schedule during MCH.
This is a common question we receive from candidates who are concerned about the way FM residents are treated in academic medical centers. It is our feeling that the high quality of our residents over the years has built a strong reputation among their colleagues in the institutions where we work, and that there is an expectation for strong clinical skills in the FM residents. Accordingly, we feel that the other departments treat their off-service FM residents as equal members of whatever team they are on.
Additionally, our faculty hold several of the most important positions within the UNC system. Our chair serves as the Executive Dean of the Medical School. Our clinic director now oversees all of the clinics within the UNC outpatient clinic system. We hold leadership positions in the electronic medical record system, medical school education, and residency leadership.
The use of computers is increasingly important in the practice of modern medicine. The residency program aids residents in developing personal skills with information technology in many ways. Although we do not provide Personal Data Assistants (PDA's) or SmartPhones, they have become widely used in business and medicine, and our residents can use a portion of their educational funds to purchase these devices after approval from our IT department. Our recently remodeled Resident Business Center and Central Precepting area has been widely equipped with desktop computers at each of the resident's desks, with full internet access and printing capability.
Our building has a well developed local area network, now including wireless connections, which allows access to word processing, graphics, laser printers and many other software packages, as well as direct access to the Internet. Free online computer searching of Medline is available through the UNC Medical School. Connection is possible to the network, the Internet, electronic medical records, electronic mail and radiology studies from the FMC, our hospital inpatient office and home computers.
Experience with electronic medical records is another important part of the computer curriculum. The Family Medicine Center has a computerized medical record, which has a web-based interface. WebCIS, as the system is known, is in an advanced stage of development. It is an online information system that provides access to FMC dictations, hospital discharge summaries, laboratory results, radiology and other imaging studies, patient scheduling, problem lists, medication and allergies, notes from other clinics at UNC Hospitals, and a vast array of direct entry note applications including individually customized note templates. Within recent years it has added the capability of online prescriptions and communications features for clinicians and nurses to send one another notes regarding patient care. The best part about the system is that it continues to have a development team involved and many faculty members are participating in this process.
What is the "Educational Allowance" and how can it be used? What are the annual salaries for residents?
Every incoming intern has a total of $2,000 that can be used over the three years for educational expenses, including books, subscriptions and travel to conferences. Most residents have used it for 1-2 conferences, travel to elective rotations and subscriptions.
Effective October 2, 2011, the current academic year salary scale for residents is:
* R1 - $46,986
* R2 - $48,622
* R3 - $50,203
Yes! The opportunity to teach and to recruit medical students into Family Medicine is one of the attractive features of working at UNC. The University of North Carolina Family Medicine student program is a vital part of the Department's mission in the institution. Residents' interactions with students on clinical rotations are vital to attracting medical students to family medicine. Family Medicine interns also work with third year students when rotating on Pediatrics, Medicine, Surgery and Obstetrics services; our inpatient service frequently has Acting Interns. In third year, our residents have an opportunity to precept under supervision in the FMC. All residents also help with coverage of the Student Health Action Coalition free clinic that is organized and coordinated by the medical students at UNC Medical School. The continued presence of psychiatry first-year residents on our service emphasizes the importance of gaining teaching and supervisory skills.
Our philosophy is that diversity of patients and patient-care settings is crucial for resident training. The Family Medicine Center, where residents' continuity practices are located, serves a cross section of Chapel Hill. Just over half of the patients are adults between the ages of 20 and 60, with 25% of the patients over 65, 30% black, and 20% Medicaid. Most of the hospital rotations take place at either the University of North Carolina Hospitals, a tertiary care facility with comprehensive facilities or Wake Hospital, a large community hospital about 30-40 minutes away in Raleigh. Short rotations in other settings--local practices, rural community health centers and practices, the Student Health Service--provide specific clinical experience and exposure to other kinds of clinical settings.
In addition to more traditional conferences, this residency has conferences entitled "Evidence-based Practice" What is this conference?
Evidenced based practice has been a staple of training at this residency since before its educational application was popularized. One manifestation of this is our conference series where Residents and Faculty take joint responsibility for presenting an interesting case or clinical question and an article that relates to the question. Discussion focuses on the quality of the evidence and whether it changes management of the clinical problem. The topics are diverse and timely.
The University of North Carolina ranks fifth in the country among departments of Family Medicine in NIH funding for research. Reports of research in this department has included prevalence of Disney cartoon characters shown smoking, relationship of residency program characteristics to match outcomes, and prevalence of sexual concerns among female patients in outpatient clinics. Numerous other research projects have conducted investigation into rural health manpower, managing dizziness, nursing home effectiveness for Alzheimer patients, pap smear quality, and management of low back pain. Current research projects are exploring spirituality in medicine, effectiveness of acupuncture, and the treatment and management of osteoporosis.
A common theme of much of the research in our department is improving the effectiveness of primary care. The faculty members involved in these projects are involved in residency teaching. Our philosophy is that ongoing patient care related research enriches the learning environment. Residents are encouraged but not required to do research. However, they are required to do two projects during their residency. In Year 2 during Family Medicine Month, they do a short group project examining an aspect of preventive care. In Year 3, they do a major project over the course of the year aimed at improving some aspect of the actual practice as it is conducted in the FMC. Both projects involve a detailed examination of the questions related, thorough search and review of the literature, chart reviews of current practices, summary of findings and recommendations. Formal presentations at conference time serve to complete these projects.
The Department of Family Medicine and University of North Carolina are nationally renowned for the variety and quality of fellowship training available. Our fellows have gone on to take leadership roles in the AAFP and in departments across the country. Through our residency and fellowship training, almost 10% of all faculty in Family Medicine in the United States are graduates of the UNC Department of Family Medicine. Examples of our fellowship opportunities include:
Primary Care Sports Medicine
Career Development Fellowships , which can be tailored to your educational goals.Examples of recent fellows’ clinical foci include MCH with operative OB, MCH without operative OB, Global Health, and Hospitalist training.
Faculty Development Fellowship
Primary Care Research Fellowship
How does your selection process work? Should I expect further communication from you after the interview?
We participate in the Electronic Residency Application System, and all applicants should consult their respective medical schools to learn how to use this system. Using the information available through ERAS we screen candidates' applications and will begin inviting individuals for interviews as early as we can, usually around September. We conduct formal interviews on most Mondays and Fridays from mid-October through January. The evening before interview days, our residents meet with candidates informally over a dinner held at a resident's house. Further application information is available via this link.
At every step of the process, residents play a very active role in selecting their colleagues. In early February, we prepare a draft rank listing of all applicants based on a scoring of academic records (50%) and interviews (50%). The interview score is obtained by averaging faculty and resident evaluations, and all evaluations are counted equally. This draft match list is then modified at a combined resident-faculty meeting before being submitted to the NRMP.
We honor the spirit and the letter of the National Residency Match Program, which is designed to protect the interests of medical students. Applicants should expect to receive an acknowledgement from the program after their visit, but in no case will there be a promise of a position in advance of the match. We encourage further communication from candidates. Often there are additional questions that need to be addressed after getting back home and some people like to come back for a second look. We are perfectly amenable to that and will be happy to help anyone who wishes to do so make the necessary arrangements.
Since 1993, the program has successfully filled all its positions except one (in 1999) through the Match. That position was filled the day after with an exceptional candidate. Since 1999, we have been blessed with fantastic candidates who successfully match into our program. In fact, in 2011, we increased our program size from 8 to 10 residents per year and had no difficulty recruiting high-caliber, passionate residents to join our professional family. That being said, if you like what a program offers, it fits your career directions, and has the right combination of features to meet your personal needs, that is probably of higher significance than the program’s Match record.
What sorts of opportunities exist for my spouse, significant other or other family in the Triangle area?
The Triangle has much to recommend it as a place to live. Three outstanding institutions (UNC, Duke, NC State) offer a wide variety of graduate programs and employment, as well as an excellent variety of cultural offerings. Unemployment is low, with many industries located in the Research Triangle Park and an economy that continues to have signs of growing. Finally, the climate allows year-round outdoor recreation. Both the ocean and the mountains are within "weekend distance." The attractiveness of the area combined with a very comfortable climate throughout the year have made the triangle area a very attractive retirement community as well.
Updated: August 2012