HOW MUCH DIDACTIC TIME IS THERE? ARE RESIDENTS PROTECTED FROM OTHER OBLIGATIONS DURING SCHEDULED TEACHING SESSIONS?
Our Didactic Curriculum has been overhauled over the past few years. To protect educational time and enhance our residents' learning, we transitioned to a weekly 2.5 hour block didactic series on Wednesday afternoons, for which all of our residents are excused from their other clinical duties to attend and which showcases some of the most innovative teaching methods in residency education, such as our interactive "Wednesday Mystery Cases" (modeled after the Tulane Friday School Curriculum). In addition, during noontime on the other days of the week, residents participate in hospital Grand Rounds, shorter teaching sessions (such as senior resident-led "Chalk Talks"), committee meetings, Balint group, res-fac meetings, intern support group, and our Behavioral Science didactic series. Didactic and interactive sessions are taught by our Family Medicine faculty and by visiting subspecialists. Journal clubs and morbidity and mortality (M&M) conferences occur monthly. Residents are not scheduled for work responsibilities during these educational sessions and are expected to attend unless they are attending to an urgent patient care need such as a code or delivery. In addition, throughout the year, residents are relieved from work responsibilities to attend a series of class-specific small group Behavioral Science workshops covering various topics.
WHAT TYPES OF LEARNING ARE AT THE PROGRAM?
Our curriculum is designed to address the needs of our urban, underinsured, multicultural and medically underserved community. Different educational modalities used in our residency program include the following: 1) traditional clinical experiences in the hospital and outpatient settings; 2) experiential learning in chronic illness care (through facilitation of group visits, planned visits, and panel management), 3) self-directed learning via electronic educational resources available through the O'Connor and Stanford Medical Libraries, 4) use of models for procedural training, 5) simulation-based learning (i.e, mock codes), 6) traditional didactic lectures, small-group seminars and workshops incorporating Active Learning Methods, 7) direct observation and feedback of clinical encounters by medical and behavioral science faculty, and 8) a structured quality improvement curriculum that exposes residents to core concepts of continuous quality improvement and population management.
This year we are piloting an exciting addition to our didactic curriculum during our 2.5 hour block didactics. Designed to model Problem-Based Learning in medical schools and the Tulane Internal Medicine Residency Program “Friday School,” our Mystery Cases encourage team teaching, case-based learning, cost-conscious health care, and self-directed learning. Here's how it works:
At 1 pm, each resident clinic team receives key information for the Mystery Case of the week. As team members work together to come up with a differential diagnosis and initial plan of care, the Faculty leader (Dr. Yu) walks around to ask questions and facilitate discussion among residents. Each team also has access to a laptop with a pre-loaded Order Genie, which team members use to “order” laboratory and diagnostic imaging needed to solve the case and which also provides an ongoing tally of dollars spent, thereby introducing the concept of cost-conscious health care to the discussion. In addition to solving the case, each team works through a set of clinical questions designed to highlight the salient points of the case.
At 2 pm, Dr. Yu leads the group through the case, encouraging team members to share their clinical reasoning and describing how a seasoned physician might have approached the case. Clinical pearls and practical advice are shared by team members during this group session. From 2:30-2:55, resident teaching begins. Each team member identifies one topic that s/he will research and share with team members at the following session. Following the assignment of learning topics, team members then teach each other the topics they selected at the previous Mystery Case Session. This Self-Directed Learning & Teaching format allows residents to truly master a topic, as it's one thing to learn something but quite another to understand it well enough to teach it. Each Mystery Case is also linked to the preceding one during the initial half hour of the session, when Dr. Yu reviews the key learning points from the previous session's clinical case.
Initial feedback from residents regarding this new curricular format has been extremely positive, and we plan to continuously refine and improve upon the method, with ongoing feedback from our learners.
What sort of elective opportunities will I have?
The elective options are wide open. Residents have two months of electives, one of which can be anywhere in the world.
Recent elective choices included working with a local midwife/obestrician group, dermatology in Hawaii, medical volunteer work in Vietnam, office-based procedures with our attendings, and Sports Medicine ultrasound in Colorado. In addition to the elective months, residents can choose a “selective” in the second year which allows for additional time rotating in subject matter that the resident chooses (such as Cardiology, Pediatrics, Dermatology etc). Finally, our faculty are involved in a wide variety of clinical activities such as teaching, volunteering in local free clinics, and staffing sports events and frequently invite residents to join them.
Are there opportunities for international health rotations?
Residents have the opportunity to do a one month away elective which can be done internationally. Our program has an association with a free clinic based in Roatan, Honduras (coincidentally also a gorgeous beach, snorkeling, diving destination) that several of our residents and faculty have rotated through. Other overseas elective opportunities are also available and residents are free to set up their own rotation for their away elective month. We are exploring the option of creating a formal global health track within our residency program, as part of the Stanford/Yale Johnson & Johnson Global Health Scholars Program.
Will I have the opportunity to do scholarly activity like research or writing journal articles?
Our program does not have a research or publication requirement but there are several opportunities for scholarly activities for those who are interested. All residents develop projects as part of their Family and Community Medicine month. These have the potential to be presented as poster presentations at national conferences. Faculty have co-presented with residents at national Family Medicine conferences and have collaborated with residents on articles for the Family Medicine journals and textbooks. Residents with a particular interest in academic Family Medicine may participate in the OSLER program during their training.
HOW MUCH OB DO YOU DO?
Our residents far exceed the number of deliveries required for family medicine residency graduates. The average number of deliveries completed by our last two graduating classes was 90. Residents also get experience with the full spectrum of labor management, vacuum assisted deliveries, and assisting with Cesarean sections. Residents do 1.5 high volume months of obstetrics training at Valley Medical Center, the local county hospital. Three of our core family medicine faculty have active maternity care practices. Two of our family medicine faculty perform C-sections as primary surgeon.
Do residents rotate AT HOSPITALS OTHER THAN O’CONNOR HOSPITAL?
Fortunately, the majority of the residency training is based at our home institution. This allows our residents to work in a familiar environment and to participate in regularly scheduled didactic sessions. There are a handful of rotations that are based outside of O’Connor Hospital in order to supplement the training available at our host institution. First year residents do two months away: a month of intense labor and delivery at Valley Medical Center, the local county hospital, and one month of inpatient pediatrics at Kaiser Santa Clara. Second year residents spend one month away doing outpatient gynecology and building their obstetrics experience by taking L&D call at Valley Medical Center.
ARE THERE ANY OTHER RESIDENCY PROGRAMS AT O'CONNOR HOSPITAL?
There are no other residency programs at O’Connor Hospital – it’s “unopposed.” Being an “unopposed “ program means our residents get exposure to the full scope of interesting clinical cases and procedures. There is no competition with other programs for certain patients or procedures. Similarly, at O’Connor Hospital you won’t be the low man on the totem pole while rotating onto another specialty’s team.