Curriculum
The Group Health Family Medicine Residency is a pioneer in the implementation of the patient-centered medical home during residency training.
The clinic uses world-class information systems and electronic medical records with outstanding educational resources. Residents have excellent support in the provision of team-based care (registered nurses, licensed practical nurses, medical assistants, pharmacists, social workers, behavioral scientists, and their faculty colleagues).
Residents learn to provide care via electronic, phone, or in-clinic encounters. Residents provide comprehensive care at each visit and, with the use of registries, reach out prospectively to their patients for both preventive and chronic disease care.
Our curriculum consists of a strong core of required rotations over a period of 34 blocks of four weeks each. This leaves sufficient time for 20 weeks of elective rotations. Our program reviews and updates its curriculum annually with input from residents, faculty, and preceptors.
About a third of each resident's time is devoted to supervised family medicine in the outpatient clinic. The remainder is spent learning from primary care and specialty practitioners in both inpatient and outpatient settings.
The Capitol Hill Medical Center is the site of the Family Medicine Residency clinic and most outpatient rotations. Group Health and Virginia Mason medical centers share inpatient facilities in Seattle. Inpatient medicine and surgery experiences occur at Virginia Mason, with obstetric experiences at the Group Health Family Beginnings Birth Unit.
Outside sites include inpatient and emergency room pediatrics at Seattle Children's hospital, and general emergency department experience at the University of Washington Medical Center.
Didactics and Conferences
Didactics are scheduled weekly. The first day of each four-week block is a full day. Didactics vary from formal presentations to informal case based discussions. Residents rotate in giving presentations as well as leading our monthly journal club. One afternoon a month focuses on incorporation of evidence-based guidelines and point-of-care tools in providing care for patients with a chronic disease, with time then set aside for each resident to review his or her own patients and provide outreach as indicated. The residency also supports reflection time for residents, and this includes Balint sessions as a group, as well as separate class check-in time.
First-Year Curriculum
Clinic 2 half-days per week.
Read a detailed description of first-year core rotations.
| Rotation | Duration |
|---|---|
| Inpatient Medicine | 12 weeks |
| Inpatient Pediatrics | 4 weeks |
| Obstetrics/Gynecology/Newborn | 12 weeks |
| Surgery | 8 weeks |
| Emergency Medicine | 4 weeks |
| Outpatient Pediatrics | 4 weeks |
| Pediatric Urgent Care | 2 weeks |
| Orthopedics | 2 weeks |
| Art of Family Medicine | 4 weeks |
Second-Year Curriculum
Clinic 2 to 3 half-days per week.
Read a detailed description of second- and third-year core rotations.
| Rotation | Duration |
|---|---|
| Inpatient Medicine | 4 weeks |
| Intensive Care Unit | 4 weeks |
| Obstetrics/Newborn | 8 weeks |
| Chemical Dependency/Psychiatry | 4 weeks |
| Podiatry/Sports Medicine | 4 weeks |
| Orthopedics | 4 weeks |
| Early Abortion/Reproductive Health | 4 weeks |
| Pediatrics Outpatient | 2 weeks |
| Pediatrics Emergency Room | 2 weeks |
| Practice Management/Leadership | 4 weeks |
| Away/International Elective | 4 weeks |
| Elective Rotations | 4 weeks |
| Gynecology/Urology | 4 weeks |
Third-Year Curriculum
Clinic 3 to 5 half-days per week.
| Rotation | Duration |
|---|---|
| Inpatient Medicine | 4 weeks |
| Skilled Nursing Facility | 4 weeks |
| Community Medicine/Clinical Leadership/Occupational Medicine | 8 weeks |
| Pediatrics Outpatient | 2 weeks |
| Pediatrics Emergency Room | 2 weeks |
| Geriatrics | 4 weeks |
| Neurology | 4 weeks |
| Dermatology | 4 weeks |
| Primary Care Clinic Away | 4 weeks |
| Allergy/Otolaryngology | 4 weeks |
| Electives | 12 weeks |
Elective Rotations
| Adolescent Medicine Anesthesiology Cardiology Endocrinology Gastroenterology Health Informatics Hematology/Oncology HIV Infectious Disease |
Nephrology Palliative Care/Hospice Pregnancy Termination Pulmonary Radiology Rheumatology Sports Medicine Urgent Care |
First-Year Core Rotations
Emergency medicine: The first-year resident (R1) works directly with the University of Washington Emergency Department physicians and staff to develop the skills necessary to evaluate and manage a patient in the emergency room.
Inpatient medicine: For the first two months, the R1 is part of a team of two R1s, senior family medicine residents, and an attending internist. The number of patients varies, averaging four to six per R1. The intern is the primary MD, with supervised responsibility and ample opportunity to develop expertise. For the third month, the R1 is paired one-on-one with the attending physician for two weeks, and spends the other two weeks doing night float, admitting and cross-covering patients with the night shift attending physician.
Pediatrics: For inpatient pediatrics, first-year residents spend four weeks at Seattle Children's hospital. They work primarily with pediatricians (attending physicians, senior residents, and interns) and family medicine interns. Cases range from bread-and-butter to very unusual. One week is spent on night float. For outpatient pediatrics, the R1 spends four weeks at a busy outpatient practice working one-on-one with a seasoned pediatrician. One of those weeks includes rounding on all newborns in the morning. Two weeks of pediatric urgent care at the end of the year round out the pediatric training.
Obstetrics and newborn: Residents work with obstetricians, family physicians from both Group Health and community health centers, and midwives during their rotation. Specialties and staff work collegially in a state-of-the-art unit with 24-hour in-house obstetric, anesthesiology, and pediatric coverage. The R1 has primary responsibility for the triage or evaluation room, and is involved not only with labor and deliveries but also with antepartum testing, newborn care, and prenatal care.
Orthopedics: A popular rotation where full days are spent in a busy outpatient clinic evaluating operable and nonoperable orthopedic problems. Joint aspirations and injections may be performed.
Surgery: While on surgery, the R1 works directly with attending surgeons, spending eight weeks with those who have a particular interest in teaching. The resident participates in pre- and post-operative care, as well as assist in the OR. Other opportunities in the clinic setting include in-office procedures for removal of common lumps and bumps, and post-operative wound care.
The Art of Family Medicine: The last four weeks of the first year, all R1s participate in The Art of Family Medicine, a time allowing for reflection on the experience of the first year and at preparation for the assumption of a more intense role in the clinic and as a supervising resident. Points of emphasis include family assessment, common outpatient problems and procedures, team building, and doctor-patient relationships. Evidence-based care and population management are also introduced.
Second- and Third-Year Core Rotations
During the second and third years, residents have additional time in their own continuity clinics. They also participate in longitudinal and multidisciplinary clinics, where the emphasis is on outpatient service. They continue with some hospital-based rotations, taking on more decision making and serving a teaching role for new residents and students.
Teen Pregnancy and Parenting Clinic: This clinic, which meets twice a week, is staffed by a family practice attending physician, a resident, an RN, a social worker, a dietician, and a patient educator. Second- and third-year residents provide the longitudinal primary care and are responsible for deliveries and postpartum care for the teens, thus expanding their outpatient continuity for obstetrical experience and exposing them to the multitude of complicating factors often associated with teen pregnancy. Twice monthly well-child clinics allow for further continuity and parenting guidance, demonstrating the value of a family physician throughout the course of pregnancy and child rearing.
Skilled nursing facility: This rotation takes place at Stafford Healthcare. These subacutely ill patients — needing skilled care for conditions such as stroke, hip fracture, respiratory illness, and other debilitating conditions — used to be cared for in a hospital setting. Throughout the United States, such patients are cared for in facilities emphasizing rehabilitation, where the skills of a family physician as team leader are paramount. The resident manages 8 to 12 patients at a time under the guidance of a geriatrician.
Abortion training: This training is incorporated into the curriculum throughout the three years of training. In the first year, residents participate in didactic workshops. In the second year, residents work at Planned Parenthood and a small independent clinic counseling, doing dating ultrasounds, and performing surgical and medical abortions. Residents can choose to opt-out of the termination procedures if they so choose. Additional medical and surgical abortion training is then available both at Group Health and at other clinics, and is scheduled throughout the second and third year.
Community medicine: This two-month community medicine rotation allows each third-year resident to work in various community settings, including community health centers, the public health department, county jail, needle exchange programs, sexually transmitted diseases clinic, and so on. Residents learn about community resources outside of the Group Health system and some of the difficulties patients face when their access to medical care may be limited by financial or psychosocial barriers.
Behavioral science: Behavioral health is an integral part of the educational experience. We highly value the biopsychosocial perspective, with the goal of residents becoming knowledgeable and skilled in this approach to family medicine. Learning experiences include one-on-one teaching with the behavioral scientists, videotaping, co-therapy opportunities, and behavioral science didactics, as well as rotations in psychiatry and chemical dependency. Primary care counseling by residents is emphasized.
Primary care clinic away: An outpatient clinical experience at a non-residency Group Health clinic. A rural rotation can be arranged as an alternative, depending on career plans.
Integrated group practice: Practical, daily experience with managed health care is a fundamental part of residency experience at Group Health Cooperative. We view managed care as a method of improving coordination and quality of care. Residents have ample opportunity to participate in cooperative-wide groups with those goals.
Additional training opportunities: Several opportunities for developing procedural skills are also incorporated into the second and third years. In the minor operating room (MOR) clinic, under the supervision of a family medicine physician in the general surgery clinic, residents gain experience with common outpatient procedures such as excision of large lipomas and sebaceous cysts. A colposcopy clinic occurs twice a month, and a circumcision clinic is scheduled once a week.