A program which prides itself on training full scope family practice physicians, the University of North Carolina Department of Family Medicine provides both comprehensive inpatient and outpatient training. Our department runs an inpatient service at UNC for our own Family Medicine Center patients as well as other surrounding family medicine practices in the community. For eight of the ten residents in each class, outpatient continuity clinic is held just over a half mile down the hill in the William B. Aycock Family Medicine Building. The two residents who chose to pursue an underserved track will establish their continuity clinic at Piedmont Health Services.
Maternal and Child Health. The department also runs a maternal and child health service for the patients of the practice, and those who seek their prenatal care at the Orange County Health Department, Highgate Family Practice, and Chatham Primary Care. The MCH service also provides physician backup to a free standing birthing center staffed by midwives. Emphasis is on longitudinal care of both the mother and baby throughout the pregnancy and after birth. During Maternal/Child Health months on this service residents work with Family Medicine faculty with special interests in obstetrics to develop skills in continuity and family oriented obstetrics, outpatient gynecology, neonatology, developmental pediatrics, and adolescent care. One of the most rewarding experiences of this rotation is the care of the family unit from the prenatal visits to the newborn weight checks. Continuity is achieved by pairing patients with the residents who will be on service during their due date. Residents work one-on-one with attendings in an apprenticeship model of care.
Inpatient Medicine. In the first year residents gain experience with inpatient medicine in two hospitals. On a busy Family Practice Inpatient Service in the UNC Hospitals, a university hospital system located in Chapel Hill, residents take care of FPC patients and patients from community practices. Wake Medical Center, a community hospital in Raleigh, provides an excellent opportunity for residents' training in each major specialty with rotations in Intensive Care, Pediatrics, Surgery, and Obstetrics and Gynecology (To Curriculum Summary). All second and third year inpatient training is done at UNC Hospital.
Continuity Clinic. We take continuity and patient care very seriously and nothing shows this better than the clinic at the Family Medicine Center. As a level III patient centered medical home, residents throughout the years learn to work as a team while developing longitudinal relationships with patients and coworkers. The clinic is structured around four teams of clinical support staff to which residents and attending faculty are assigned. Within these teams, we strive for personal and team continuity with our patients. Our clinic is strengthened by the resources we have to share with patients. On site financial counseling, nicotine dependence programming, nutritionist, social workers, lab and x-ray services, as well as pharmacists, acupuncture, and physical therapy allow us to provide better care. Residents also have the opportunity to learn about systems based practice by attending monthly team and all clinic business meetings. During second and third years of training, our exposure to leadership within the clinic expands as we have the opportunity to be involved in the clinic supervisors meeting as well as by leading the monthly team meetings. The clinic medical directors take great pride in providing each resident a diverse patient panel that appropriately grows as the resident continues through the program. Our clinic welcomes patients of all ages, including obstetric care. Procedures are easily incorporated into clinic schedules and are encouraged.
Outpatient Rotations. Second and third year residents have a number of special outpatient rotations, including a rural rotation at Chatham County Emergency Department, two weeks devoted exclusively to improving behavioral medicine skills, and another four months of in- and out-of-town electives to develop individual skills. A six-week block in second year provides residents exposure to rural and under-served populations, geriatrics, and opportunities to learn techniques for CQI and practice management skills. Another six-week block in third year is devoted to developing an understanding of how to improve quality of care in an outpatient practice through group projects that have ranged from developing preventive care guidelines to finding ways to adapt the chronic disease model of care into this practice.
Behavioral Health. The behavioral health curriculum is longitudinal and designed for residents to be thinking and learning about behavioral health issues in an ongoing way throughout residency. Residents are in a sense always on their behavioral health rotation, encountering and managing behavioral health issues and challenges on every rotation. In addition, the curriculum includes specific behavioral health activities occurring throughout all three years of residency geared toward development of the six core competencies. The curriculum includes teaching in the inpatient and outpatient clinical settings, individual one-on-one meetings with behavioral health faculty, community visits, structured didactics, and select readings. The combination of didactic and clinical activities is designed to create an appreciation for the role of behavioral health in primary care and to provide a diverse and challenging educational experience.
Practice Management. As an ongoing part of residents' development in the Family Medicine Center practice management is incorporated into all three years of the program. Time is allocated in the second and third years to learn the principles of practice management, explore medical computer applications, visit community practices, and do career planning. Seminars, workshops and other conferences on practice management topics are a regular part of the conference curriculum.
Geriatrics and Home Visits. Geriatrics is taught by an interdisciplinary group of family physician faculty and faculty from the geriatrics fellowship program. There are longitudinal components throughout the three years that include didactic sessions during R1 and R2 family medicine months, home visits, protected time to visit with two assigned nursing home residents in the second and third years, and time spent at local CCRCs during the QIP months.
Weekly Conferences. The final major component of the curriculum is the conference schedule. Weekly departmental conferences are conducted on Wednesday mornings. The organization of the conferences in a single half-day allows the program to arrange for residents to be free of other duties in order to be able to attend the Family Medicine conferences. All residents are expected to attend. As part of their commitment to our education, faculty run the inpatient and MCH services while we attend conference.The conferences are organized around a set of themes that are pertinent to the practice of Family Medicine and teaching strategies are designed to rely on clinical cases as well as to encourage learner participation.
Electives. Four months of elective time over the last two years of residency provide individuals plenty of opportunity to tailor the program to meet their particular educational needs. Residents have used the time to round out a variety of areas of outpatient medicine, take an intensive inpatient rotation, explore international medicine, try out practices in communities they plan to work in after residency, and acquire an understanding of the value of complementary and alternative health care options that their patients often ask them about.
Faculty. Residents in the UNC FM Residency Program work with highly respected faculty, nationally and internationally, as teachers and researchers in Family Medicine. Individual faculty members with special strengths in many different areas provide a wealth of opportunity to explore a wide variety of educational topics.
Resident Lifestyle. The residency program strives to address the needs of today's residents. We recognize that physicians in training are individuals whose personal lives do not cease with residency. Ways we acknowledge this are:
- Three weeks of vacation every year
- Well-articulated maternity and paternity leave policies
- Resident support groups to help cope with normal residency stress. Interns have a support group which meets at least once monthly during conference. Second and third year residents have Finding Meaning in Medicine, a group led by several faculty members which allows residents to explore personal feelings related to patient care.
- A structured professional development curriculum across all three years of training
- Individual faculty advisors as well as senior resident 'big sibs' advisor
- Opportunity to develop personalized Areas of Concentration "AOC's" in Sports Medicine, Leadership in Family Medicine, Underserved Care, Geriatrics, and Global Health. These AOC's allow one to specifically investigate a field of interest by choosing a mentor, applying 3 of the 4 electives to exploration in the field, and publishing or presenting a poster which applies to the field.
- An annual beach retreat during which all residents are excused from clinical duties (and invited to bring their families) to come together in a relaxed, fun atmosphere with faculty to build upon and improve the residency together!
Updated August 2012