Family Medicine ResidencyProgram CurriculumEisenhower Medical Center’s Family Medicine ResidencyProgram is a unique program that will provide the foundation for your professional career as a family physician. Founded in 2011, our Family Medicine Residency Program is designed with a mission to trainexceptional future family physicians in a vibrant learningenvironment, while learning and providing Health CareAs It Should Be. Our goal is to train residents with thebroad spectrum of skills required of a family physician,but more importantly, residents will achieve the ability to become expert self-learners as they develop theirbreadth as family physicians in the changing health system.

Family Medicine is constantly evolving and complex. Ourmission, however, is simple. We provide the best learningenvironment to maximize the residents’ opportunity toachieve their full potential in practicing the highest quality,comprehensive family medicine in caring for our patients– one patient, one family at a time.

Adult Inpatient Medicine

PGY1, 17 weeks; PGY2 and PGY3, 12 weeks each year

• Large community hospital providing a high level ofcare to the community with multiple subspecialtiesincluding neurosurgery, cardiothoracic surgery,interventional cardiology performing TAVR

procedures, major stroke center, and multiple othersubspecialties

• General Inpatient Medicine service is supervised by the Internal Medicine hospitalist – two blocks infirst year and one block in second year

• Family Medicine Inpatient Service is run by theFamily Medicine attendings with a focus oncontinuity of care for patients from the familymedicine clinic – one block in the first year, oneblock in the second year with an additional twoweeks while on a night service, and one block inthe third year

• Teams are made up of three residents and anattending – GIM has two first year residents and asenior resident; the family medicine service typicallyhas one first year resident, one second year residentand a third year resident

• First year focus is primarily direct patient care.Second year focus is acting as senior and juniorfaculty, managing the team

• One block of ICU in the first year – the team isusually made up of three or four first year residentsand a senior resident

• Night Service – one week in the first year, twoweeks in the second year, and four longitudinalweeks in the third year. Main responsibilities arerapid response, code team, and admissions

• Electives – there are many opportunities forsubspecialty rotations along with procedure-focused electives

• Pulmonology consult service – work one-on-onewith the pulmonary attending. This is a one blockrotation as a third year resident

• Full responsibility for patient care with open ICUproviding a broad scope of comprehensive adultcare; ability to perform many standard inpatientprocedures from paracentesis to intubation

• Excellent didactics with morning report and noonconference lectures. Grand rounds are held once aweek along with monthly M&M

E I S E N H O W E R M E D I C A L C E N T E R

Family Medicine Residency Program760-773-4504 • www.emc.org/gme

Care of Children

PGY1 and PGY2, four weeks inpatient each year (eight weeks total)PGY1 and PGY2, four weeks outpatient each year(eight weeks total)PGY3, four weeks Pediatric Emergency Medicine

• Additional longitudinal pediatric outpatientexperience at the Center for Family Medicinecontinuity clinic

• Pediatric emergency experience during generalEmergency Department rotation at EisenhowerMedical Center

• Typical schedule in the inpatient rotation is 12hours/six days a week per block

• Hospital team will be under general pediatricsteam in PGY1 and specialty team in PGY2

• Outpatient schedule is usually from 8 a.m. to 5 p.m.

• Morning report and noon conferences daily duringinpatient rotation

• Supervision will be by pediatric staff in bothinpatient and outpatient pediatrics block rotation;Family Medicine attending faculty supervise in theFamily Medicine continuity clinics and theEmergency Department attending physician in theEmergency Department

• Learning in outpatient rotations and continuityclinic include well-child visits from newborn toadolescence, age-appropriate anticipatoryguidance, common pediatric conditions, jaundicein the newborn, normal and abnormal growth anddevelopment, routine and catch-up immunizations,medication dosing for the pediatric age group;additional acute care experience during urgentcare rotation in PGY3

• Procedures such as lumbar puncture, removal offoreign bodies in ears/nose, and possibly intubationon a case-to-case basis; circumcision is learnedduring OB rotation

• Responsible for pre-rounding in the morning forpatients assigned during inpatient rotation andpresentation to the attending during rounds;morning report presentation

Maternity Care

The goal of the maternity care curriculum is to train allresidents in management of normal, low-risk vaginaldelivery and in the care of the pregnant woman andnormal newborn. Residents who wish additional experience may arrange electives.

PGY1, four weeks at the Robert E. Bush Naval Hospital in Twentynine Palms

• Family-centered care experience with familyphysicians

• Prenatal care, triage, labor and delivery, coupletcare of post-partum mothers and babies

• Baby-friendly hospital with breastfeeding support

PGY2, four weeks at Palomar Medical Center

• Traditional obstetrics service

• Higher volume with some high-risk patients

• Electives available at several locations foradditional experience

Care of Women

PGY1 and PGY2, four weeks each year

• Teaching and clinical experience with all routinegynecological procedures and care

• IUD insertion and Nexplanon® placement taught inthe Center for Family Medicine and in communityrotations

• Community experience with both privatepractitioners and medically underserved clinics

• WIC experience on rotation to help learncommunity resources available to low incomepatients

• Breastfeeding clinic at WIC

• Weekly resident-run women’s health clinic forunderinsured/uninsured patients at the CoachellaValley Volunteers in Medicine Clinic

• Teen gynecology clinic exposure at a communityhealth center

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General Surgery

PGY1 and PGY2, four weeks each year

• Residents attend nine to 10 half days per week

• Experience outpatient surgery consults in the busypractice of a surgery group under direct supervision

• Learn to initially evaluate and manage commonsurgical problems, develop basic outpatientprocedural skills and surgical assisting skills anddevelop an appropriate evaluation and treatmentplan for a range of surgical problems

• Conduct a focused history and physical of thepresenting problem and determine need forsurgical consultation and/or intervention

• Complete an appropriate pre-operative evaluationof the patient, including the patient’s clinical status,determination of the indication for surgicalintervention

• In both inpatient and outpatient surgical settings,residents learn to perioperatively manage patientsand effectively act as first assistant intraoperatively

• Learn and demonstrate sterile technique in the ORsetting; pre-operative endotracheal intubation;basic suturing/laceration repair; incision anddrainage of abscesses and thrombosed hemorrhoids;wound debridement; wound management; andincisional, shave and excisional biopsy of masses

• Appropriately manage the post-operative care ofthe patient, including maintenance of electrolyte,acid-base and fluid balance; manage commonpost-op organ damage; identify and managesepsis; select antibiotics for infectious complicationsand prophylaxis; manage suctions and drains,implement plans for post-operative diet andactivity

• Adequate pain management, including the use ofshort-acting, parenteral narcotics, longer acting,oral or peri-rectal preparations, non-narcoticanalgesics and non-pharmacological methods

Fundamentals of Family Medicine

PGY1, four weeks

• Provides an extended orientation with education in some physical examination skills, EKG reading,ultrasound, etc.

• Introduction to community resources

• Time to complete online courses in qualityimprovement, patient-centered medical home,EKG reading and intern boot camp

• Extra time in the Center for Family Medicine tolearn electronic health record, connect with nursingstaff and begin to establish individual practice

Emergency Medicine

PGY1 and PGY2, four weeks each year

• Each week compromised of four 12-hour shifts inthe Emergency Department under directsupervision

• Competently and cost-effectively evaluate andmanage patients of all ages presenting to theEmergency Department

• Assess and appropriately triage patients, prioritizingtheir care as needed by the severity of their illnessor injury

• Recognize and manage complications seen in theemergency care setting and engage in consultationswhen appropriate

• Perform emergency procedures common in theemergency care setting such as arterial blood gascollection, airway management, lumbar punctureand laceration repair

• Learn to competently describe the pathophysiologyand clinical presentation of common emergencyconditions such as altered mental status, syncope,chest pain, respiratory failure, abdominal pain,psychiatric disorders, and drug use disorders

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Behavioral Health

Longitudinal throughout the three-year program

• An integrated behavioral health approachemphasizing the collaboration between medicalproviders and behavioral health faculty in patient care

• Didactic lectures covering major behavioral sciencetopics and medication management

• Hospital rounds including behavioral health facultyon a weekly basis

• Experience in primary care counseling of basicfamily medicine issues, such as depression, anxiety,grief, life cycle issues, etc.

• Experience training in medication managementwhen appropriate

• Taught by family physicians, psychiatrist andbehaviorists

• Monthly participation in Balint group

• Emphasis on personal wellness, mindfulness andbalance

• Training with psychiatrist on location at the BarbaraSinatra Children’s Center and community medicaland behavioral health clinics

• Active participation in hospice care with anemphasis on communication and service withterminally ill patients and their families

Orthopedics/Sports Medicine

PGY2 and PGY3, four weeks each year

• Extensive orthopedic exposure along with directsupervision by subspecialty trained orthopedists/physiatrists

• Sideline and event coverage along withparticipation in mass pre-participation examinations(PPEs) at various high schools and College of theDesert

• Orthopedic/physiatry subspecialties: spine,shoulder/elbow, hand/wrist, hip/knee, foot/anklewith either arthroscopy or total joint replacement

• Exposure to musculoskeletal ultrasound whileworking with sports medicine fellows/faculty andduring dedicated ultrasound workshop held by thesports medicine staff

Care of the Elderly

PGY2 and PGY3, four weeks each year

• Longitudinal care of institutionally bound elderlyduring PGY2 and PGY3

• Specialty sub-rotations in neurology, hematology/oncology, and hospice care

• Full responsibility for patient care with excellentfaculty backup

• Special attention to performing cognitiveassessment, functional assessment, falls, balanceand gait assessment

• Medication management with a thoroughunderstanding of Beer’s List

• Transitions of care from hospital to skilled nursingfacility (SNF), SNF to community

• Direct care of the elderly in the SNF environment

• Assessment and treatment of pressure sores andsurgical wounds

• Biology of aging and atypical presentation ofdisease

• Adverse events and safety

• Assessment and treatments for incontinence

• Communication

• Aspects of community care

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Community Medicine

Longitudinal throughout the three-year program,includes active involvement in community-based healthclinics and street medicine outreach

PGY1, four weeks

• Community-based clinics, including Borrego Healthand Coachella Valley Volunteers in Medicine

• Eisenhower Memory Care Center – Adult DayCenter

• Emphasis on population health and street medicine

• Didactics with national experts in addiction

• Differential diagnostics and treatment approacheswith alternative health care providers

• Active participation and engagement with highschool students in a local health and nutritionalscience academy

• Elementary school health education programs

• Child Protective Services

• County Health Department, WIC (Women, Infantsand Children)

• Courtroom experience

• Eisenhower primer to volunteer services and casemanagement

• Educational and speaking engagements with localschools, senior centers and other agencies

• Home visit opportunities with support andsupervision

Practice Management Curriculum

PGY3, four weeks

The curriculum in practice management prepares theresidents to improve and manage their own practicesand to gain a wider understanding of health care systems as a whole. The overriding goal is to help theresident make wise career decisions as to what practicesettings are a good fit for them after residency. It alsoprovides a basis for the resident to step in to roles ofleadership, design and implementation of future healthsystems.

• Individual appointments with Eisenhower MedicalCenter executive leadership to better understandthe three “worlds” of an organized health system:clinical, financial and operational

• A half-day experience with reception and also withnursing in the back office of the Center for FamilyMedicine. These experiences develop understandingand empathy with the various roles in a medicaloffice

• Reading the book, What Works to Improve PrimaryCare: Effective Strategies and Case Studies, 2017by Suzanne Houck

• Discuss the book, other readings and experienceswith the Practice Management Curriculum Directorat the beginning and end of the rotation

• Independent study at other clinic locations tobetter understand their practice management.Options include the Borrego Health FQHC, anyprivate practice (including alternative practicemodels), Coachella Valley Volunteers in Medicinefree clinic, health departments and other healthagencies

Urgent Care

PGY2, four weeks

• Each week consists of five 9-hour shifts in one ofthree state-of-the-art Eisenhower Urgent Carefacilities that span the Coachella Valley, under thedirect supervision of the urgent care physician

• Assess and triage patients of all ages presenting to the urgent care; recognize and perform initialmanagement; refer patients to higher level of care when appropriate

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• Perform procedures common to the urgent caresetting such as abscess incision and drainage, localanesthesia, laceration repair, X-ray interpretationand reduction and splinting of simple fractures

• Communicate effectively with patients and familiesacross a broad range of socioeconomic andcultural backgrounds

• Communicate effectively with physicians, otherhealth professionals and health-related agencies

• Elicit a history and physical examination relative toa suspicion of child abuse, family violence or sexualassault and provide access to community resources

• Work effectively as a member or leader of a healthcare team or other professional group

Cardiology

PGY1, four weeks

• Includes management of the cardiac patients inboth inpatient and outpatient environments whileworking one-on-one with cardiologists

• One-on-one didactics with cardiologists with“capstone” presentation by the resident at noonconference

• Rotation focuses on building EKG interpretationskills, provides exposure to treadmill and nuclearstress testing as well as Holter and implantablemonitoring, provides exposure to angiography andstent placement procedures in cath lab andexposure to trans-arterial valve replacement

• Rotation provides extensive exposure to acute andchronic heart failure, myocardial infarction, arrhythmias,coronary artery disease and dyslipidemia, includingmanagement of conditions in patients with multiplecomorbidities

Introduction to Addiction Medicine

PGY1, one week

• Immersive experience in the world-famous BettyFord Center under the direct supervision of theirmedical and clinical staff

• Compassionately gather information from patientsand their families, develop effective patientmanagement plans that address their medical andemotional needs

• Learn and demonstrate effective implementation of behavioral change strategies, using principles ofmotivational interviewing

• Foster and develop provider self-awareness,empathy and well-being

• Determine the psychosocial needs of the patientswho have diverse ethnic and cultural backgrounds

• Integrate psychological and behavioral knowledgeand socio-cultural factors into the care of patientswith physical symptoms and diseases

• Integrate the principles of screening, briefintervention and referral to treatment (SBIRT) forpatients with alcohol and other substance usedisorders

• Develop skills in the physician/patient relationship,patient interviewing skills, and counseling skills,utilizing motivational interviewing as a basicconstruct for addressing lifestyle behavior changes

• Develop competence in the psychopharmacologyof commonly used medications in the managementof addictive disorders and co-morbid conditions

• Understand of the DSM-V multi-axial classificationsystem of mental disorders and approach totreatment

Dermatology

PGY3, two weeks

• Residents develop the ability to apply knowledgeof classification and terminology of skin disordersto physical findings

• The description of primary and secondary lesions isdeveloped

• The diagnosis of common dermatologic disordersbased on history, topography and morphology ispracticed

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• Office based procedures, such as the punchbiopsies, shave biopsies, excisional biopsies as wellas scrapings and microscopic examinations can bepracticed in longitudinal fashion as electives. Skinclosure techniques include: non-suturing techniques(e.g., benzoin and steri-strips, skin glues); simpleinterrupted; simple continuous; vertical andhorizontal mattress; layered closures; andsubcuticular suturing

• Use of dermoscopy to complement physicalexamination

• Principles and practice of wound care, includinguse of occlusive dressings is taught in longitudinalfashion including geriatrics, inpatient andemergency department rotations

• Counseling and anticipatory guidance fordermatologic disorders

Urology

PGY3, two weeks

• Outpatient rotation with urology group

• Work with multiple urologists and physicianassistant in a busy urology clinic

• One-on-one didactics with urologists

• Characterization and management of male andfemale uro-genital conditions including urinaryincontinence, bladder and prostate cancer, BPH,erectile dysfunction, nephrolithiasis

• Exposure to in-office procedures includingcystoscopy, UroLift®, opportunities to observehospital-based procedures as well

Ear, Nose and Throat (ENT)

PGY3, two weeks

• Work one-on-one with specialists in a busy ENTclinic environment

• Exposure to in-office ENT procedures includingfiberoptic endoscopy

• Diagnosis and treatment of sinusitis, pharyngitis,thyroid disease, GERD, vocal cord dysfunction,allergy management

Evidence-Based Medicine

Longitudinal throughout the three-year program

• Includes faculty-led journal club discussion onceeach block with different statistical teaching pointshighlighted each month

Point of Care Ultrasound (POCUS)

Longitudinal throughout the three-year program

• A two-day introductory course is offered everyother year with 24/7 online access to how-to videosfor specific equipment utilized at EisenhowerMedical Center

• Hands-on application is taught and required in the emergency department and sports medicineelective rotations and strongly encouraged in thefamily medicine clinic and ICU during hospitalrotations

• POCUS applications include FAST Exam, obstetrics/gynecology applications, limited echocardiography,screening exams for AAA, DVT, PAD, carotid arterystenosis, pulmonary ultrasound, musculoskeletalexam, hepatobiliary exams and more

• The development of hospital certification andprivileging criteria is currently underway

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Electives

Longitudinal throughout the three-year program

• We have one elective in the first year, one in thesecond year, and three in the third year. Residentsmay use this time to broaden their family medicineexperience or to focus on a particular area such asmaternity care, hospital medicine, emergencymedicine, integrative medicine, sports medicine,etc.

• Residents may choose from electives in internalmedicine subspecialties or other standard rotations.They may use electives previous residents havedeveloped such as procedural medicine. Residentsare welcome to develop their own electives, too;this requires submission of goals and objectives anda schedule for the block.

• There is the option to do one block away from theprogram in the third year if individual clinic numbersare adequate.

Integrative Medicine

• Integrative Medicine Certificate available throughArizona Center for Integrative Medicine onlinecurriculum for residents

• 200 hours of coursework and reading material thatcan be completed as a longitudinal elective

• Eisenhower is in the process of developing anintegrative medicine clinic within the residencywhere interested residents who have completedthe above coursework can have a longitudinalcontinuity integrative medicine clinic experiencewith integrative and functional medicine trainedfaculty

Osteopathic Recognition

Eisenhower recognizes the importance of the fourtenets of osteopathic philosophy which include:

1. The body is a unit; the person is a unit of the body, mind and spirit.

2. The body is capable of self-regulation, self-healing and health maintenance.

3. Structure and function are reciprocally interrelated.

4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation and the interrelationship of structure and function.

• Eisenhower has applied for osteopathic recognitionand is developing curriculum for osteopaths andnon-osteopaths wishing to acquire these skills

• Didactics are inclusive of osteopathic principlesand their applications

• Regular Osteopathic Principles and Practicessessions are conducted to develop, practice andexplore new techniques

• A monthly Manual Medicine Office day isscheduled to focus on the applications of thismode of diagnosis treatment

• Eisenhower remains closely aligned withosteopathic institutions in Southern California toaugment training and teaching opportunities

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