Residency DidacticsResidency DidacticsAn Eighteen Month Rotating Didactic An Eighteen Month Rotating Didactic Lecture Curriculum in a Combined Air Lecture Curriculum in a Combined Air Force/Civilian Family Medicine ProgramForce/Civilian Family Medicine Program

Michael Nash, M.D., Capt, USAF, MCMichael Nash, M.D., Capt, USAF, MC

Knowledge is PowerKnowledge is Power Great CME past few days in ChicagoGreat CME past few days in Chicago In GME, didactics not limited to In GME, didactics not limited to

conferences and medical journals…conferences and medical journals…

The MissionThe Mission No organized system or curriculum for No organized system or curriculum for

scheduling didactic lectures…scheduling didactic lectures…

The MissionThe Mission

……Bring structure and accountability to Bring structure and accountability to the didactic lecture seriesthe didactic lecture series

Courtesy photo U.S. Air ForceCourtesy photo U.S. Air Force

OverviewOverview BackgroundBackground Nuts and boltsNuts and bolts How are we How are we

doing?doing? Future Future

challengeschallenges

Our Residency Our Residency ProgramProgram Four “Partners”Four “Partners”

– 375375thth Medical Medical GroupGroup

– SLU Med SchoolSLU Med School– St. Elizabeth St. Elizabeth

Hospital Hospital (Belleville)(Belleville)

– Southern Illinois Southern Illinois Health FoundationHealth Foundation

Our ProgramOur Program 40 Residents40 Residents

– 8 ADAF, 6 Civilian 8 ADAF, 6 Civilian per PGYper PGY

15 Military and 15 Military and Civilian Full Time Civilian Full Time FacultyFaculty

Numerous Numerous “Volunteer “Volunteer Faculty”Faculty”

BackgroundBackground Wednesday afternoons 1200-Wednesday afternoons 1200-

17001700– Dedicated didactic lecture timeDedicated didactic lecture time

Chief Resident schedules Chief Resident schedules lectures/enforces attendancelectures/enforces attendance

Existing Daily “Morning Report” Existing Daily “Morning Report” for Inpatient Teamsfor Inpatient Teams

Issues to OvercomeIssues to Overcome We did not have…We did not have…

– A pre-determined lecture curriculumA pre-determined lecture curriculum– A method to track topics coveredA method to track topics covered– A military-unique didactic curriculumA military-unique didactic curriculum– Consistent resident attendanceConsistent resident attendance

Issues to OvercomeIssues to Overcome Guest topics Guest topics

often low-yieldoften low-yield Enormous Enormous

breadth of topics breadth of topics in Family in Family MedicineMedicine

Residents want Residents want time well spenttime well spent

More on the MissionMore on the Mission Vision of LtCol Amyot (PD) and LtCol Vision of LtCol Amyot (PD) and LtCol

Goodemote Goodemote – 18-Month Rotating Curriculum18-Month Rotating Curriculum– Faculty accountability for subject areasFaculty accountability for subject areas– Chief Residents still oversee scheduling/enforcementChief Residents still oversee scheduling/enforcement

Making it HappenMaking it Happen Guidelines from Guidelines from

AAFP, ABFM, RRCAAFP, ABFM, RRC Tap into strengths Tap into strengths

of full-time facultyof full-time faculty Emphasis on Emphasis on

outpatient clinical outpatient clinical knowledge and knowledge and board preparationboard preparation

Nuts and BoltsNuts and Bolts Approximately 270 hours over 18 monthsApproximately 270 hours over 18 months

7272 Internal MedInternal Med 3434 OB/GYNOB/GYN2424 PedsPeds 2424 Ortho/Sports Ortho/Sports 2222 Behav HealthBehav Health 1818 Comm Comm MedicineMedicine18 Prac Mngt18 Prac Mngt 1818 EBMEBM1818 SurgerySurgery 1818 Military MedMilitary Med1212 GeriatricsGeriatrics

Nuts and BoltsNuts and Bolts Internal Med breakdownsInternal Med breakdowns

1212 CardiologyCardiology 8 8 EndocrinologyEndocrinology

88 DermatologyDermatology 8 Infect Disease8 Infect Disease88 GastroGastro 6 Health Promo6 Health Promo44 NeurologyNeurology 4 Pain Mngt4 Pain Mngt4 Pulmonary4 Pulmonary 2 Rheumatology2 Rheumatology22 Heme/OncHeme/Onc

Nuts and BoltsNuts and Bolts SurgerySurgery

6 General6 General44 ENTENT44 UrologyUrology44 Ophthalmology Ophthalmology

Other InnovationsOther Innovations ““Workshop” FormatWorkshop” Format

– Sports Medicine, Cervical Dysplasia, Sports Medicine, Cervical Dysplasia, Diabetes MellitusDiabetes Mellitus

Snappy TitlesSnappy Titles– ““Skeeters With Kueter: Why Malaria Skeeters With Kueter: Why Malaria

Should Scare You”Should Scare You”– ““Dishonorable Discharge: Evaluation Dishonorable Discharge: Evaluation

and Management of Vaginitis and and Management of Vaginitis and STD’s”STD’s”

Other InnovationsOther Innovations Faculty attendanceFaculty attendance

– 2 or more per week 2 or more per week blocked out of clinicblocked out of clinic

Meaningful Meaningful Evaluation ProcessEvaluation Process– Detailed weekly Detailed weekly

evaluationsevaluations– 3-4 random 3-4 random

residents/facultyresidents/faculty

Curriculum GoalsCurriculum Goals A more balanced curriculumA more balanced curriculum Increased faculty lecture Increased faculty lecture

involvementinvolvement Increased resident attendance & Increased resident attendance &

satisfactionsatisfaction

How are we doing?How are we doing?

I .M.SurgPsychOrthoOB/ GYNPedsCommPrac Mgt

How are we doing?How are we doing? 75 hours by full-75 hours by full-

time facultytime faculty 20 hours by 20 hours by

volunteer facultyvolunteer faculty 15 hours by 15 hours by

senior residentssenior residents

Full-timeVol.

Res.

How are we doing?How are we doing? High-yield, High-yield,

applicable topicsapplicable topics– Sinusitis & coughSinusitis & cough– HyperlipidemiaHyperlipidemia– Migraine Migraine

headachesheadaches– Cervical dysplasiaCervical dysplasia– Hip, knee, and Hip, knee, and

back painback pain

How are we doing?How are we doing? The Ultimate…Resident AttendanceThe Ultimate…Resident Attendance

– First quarterFirst quarter On average 30/40 residents are expectedOn average 30/40 residents are expected Presently 29/40 residents attend weeklyPresently 29/40 residents attend weekly

– Second quarterSecond quarter On average 30/40 residents are expectedOn average 30/40 residents are expected Presently 29.5/40 residents attend weeklyPresently 29.5/40 residents attend weekly

How are we doing?How are we doing? Resident satisfactionResident satisfaction

– Over 95% of residents “Agree” or Over 95% of residents “Agree” or “Strongly Agree” lectures will be “Strongly Agree” lectures will be usefuluseful During residencyDuring residency To pass boardsTo pass boards In future practiceIn future practice

Don’t forget the RRC!Don’t forget the RRC! RRC has guidelines RRC has guidelines

for didacticsfor didactics Also guidelines for # Also guidelines for #

of hours devoted to of hours devoted to certain areas (e.g. certain areas (e.g. Practice Mgt)Practice Mgt)

Will be Will be easyeasy for RRC for RRC Review next yearReview next year

Challenges for the Challenges for the FutureFuture Everyone wants a piece…Everyone wants a piece… When 18 months is up…When 18 months is up… Flexibility is key…Flexibility is key… Faculty turnover…Faculty turnover…

Courtesy photo U.S. Air ForceCourtesy photo U.S. Air Force