2009 Program Directors' Workshop

Ron, Dr. Triana and I enjoyed a great PDW the last few days. We'll be coming home with some new ideas, some renewed and some new connections with our colleagues across the country and with renewed energy.

I especially enjoyed the opening plenary by our STFM president, Terry Steyer. It included a quote from President Obama that went in part like this... "we are the change we seek." That charge came through in many of the sessions I attended and particularly resonated with me because of our ongoing recovery efforts post hurricane Ike. If we don't take advantage of the opportunity within this challenge, we will have done ourselves and our program a great disservice.

This is an exciting time for Family Medicine nationally and that topic was central to the conference this year. It has been a long time since I've seen such energy and enthusiasm about the future of Family Medicine. The upcoming years are really going to be exciting times to be part of the Family Medicine family.

Other highlights from the conference for me...

A couple of great sessions on Leadership and a poster that inspired some thoughts the Residency leadership team will be discussing and implementing in the coming weeks and months. I'm also thinking about developing a FM Leadership/Advocacy elective to offer for our residents. That could also easily be an Area of Concentration, but I'll start with the elective as a good first step! Email me if that interests you.

PGY1 --> PGY2 promotion - saw a great example of some evaluation tools and a formal specifically targeted process for assessing readiness to promote. We will be doing something with a version of this modified for our program as well.

Electives: we need an elective database that includes info on electives that our residents have done. No need to completely re-invent the wheel every time and we could simplify the "who to contact to begin the process" part with a database. Also, Dr. Triana and I attended a curriculum session that included as one part an innovation that has a lot of potential for our program, so be looking forward to upcoming discussions about this. The innovation was moving all six electives to the second half of PGY3. I can think of many potential advantages and a few challenges we would have to work through to make it work. But there are enough advantages that we're at least going to seriously consider it. (Except for our DO residents, because the AOA requires one elective in PGY1, so the DO PGY3 residents would have a 5 block stretch of electives.)

Another curriculum innovation by this program is to structure the second month of emergency medicine longitudinally in PGY2 and PGY3, requiring 6 shifts in each year, done on Friday nights on rotations where the duty hours will allow. This frees up a whole additional rotation block for some other content.

From the ABFM... the ITE will be offered as a computer based exam ONLY by 2013.

From the RRC... a major revision of the program requirements is about to commence. This is especially exciting because required rotations will be critically evaluated and I believe the opportunity for restructuring our required experiences is truly coming. Dr. Ed Bope suggested his version during his plenary... there were a total of SIX program requirements (!!! for reference, I think the current program requirements are about 35 - 45 pages!) and I'll look up his slides to post these later!

One plenary session was devoted to the Patient Centered Medical Home. I learned that "cycle time" (when the patient walks in the door to when the patient walks out the door) is good proxy for practice organization and should be <60 href="http://www.aafp.org">AAFP just posted a PCMH checklist. I plan to use this checklist as a survey for our residents and faculty and use it as information and evidence for obtaining the resources we need in our clinic. Go ahead and print it off, fill it out and drop by my office if you'd like. Please put your name on it, only so I can keep track of who has done it and who hasn't. You won't hurt my feelings with your answers!

I attended a great session on the PD-Program Coordinator team and relationship. I think Linda and I are generally doing pretty well with this, but I will review the content with her and check my own perceptions to be sure she feels the same way. There are a few things from that session that we can work on too.

One session I attended was about Leadership and Life Balance. The speaker (Lee Lipsenthal) is really great and gave us a CD that I believe contains one of his talks. Residents can look forward to hearing this at an upcoming didactic session.

Overall, this year's PDW was very beneficial and we'll be bringing home some exciting ideas!

2009-2010 Curriculum

Integrative Medicine in Residency - FYI

Integrative Medicine in Residency (IMR) is a 200-hour curriculum development project of the Arizona Center for Integrative Medicine, University of Arizona, that is creating and delivering competency-based online integrative medical training to residents. IMR is a required component of the eight residency programs listed below, and is incorporated over the three years of your residency. Learning is accomplished through a combination of: web-based curriculum, program-specific experiential exercises, and group process-oriented activities.

Eight family medicine residencies nationwide are participating in the pilot phase of this program:
· Beth Israel Family Medicine
· Carolinas Medical Center
· Hennepin County Medical Center
· Maine Medical Center – Portland
· Maine Dartmouth – Augusta
· University of Arizona
· University of Connecticut
· University of Texas Medical Branch

Year 1 Content
Introduction to Integrative Medicine
Prevention and Wellness: US Preventive Services, Nutrition and Diet, Supplements for Prevention, Physical Activity, Sleep, Stress and Mind-Body Medicine, Spirituality
Tools in Integrative Medicine : Motivational Interviewing for Behavioral Change

Year 2 Content
Pediatric Topics: ADD/ADHD, Chronic Pain Syndrome, Asthma and Allergies
Women's Health Topics: Menopause, Fibromyalgia, Osteoporosis, Depression, Eating Disorders, PMS, prenatal care and lactation
Acute Care Topics: Back Pain, Urinary Tract Infection, Gastroenteritis, Otitis media,Vaginitis, Chest Pain/GERD, Upper Respiratory Infection
Tools in Integrative Medicine: Integrative Medicine Intake Process, Botanicals, Mind-Body Medicine

Year 3 Content
Chronic Illness: Cardiovascular Disease (hypertension, hyperlipidemia, coronary artery disease), Diabetes Mellitus II, Osteoarthritis, Rheumatoid Arthritis, Obesity, Irritable Bowel Syndrome, Chronic Back Pain
Special Topics: HIV, Cancer Survivorship
Tools in Integrative Medicine: Integrative Medicine Care Plan Process, Manual Medicine, Energy Medicine, Whole Systems, Practice Management

All courses have an interactive core content and contain case studies allowing you to apply the new knowledge to patients encountered in family medicine. Content includes evidence-based Conventional and Complementary approaches to the management of the medical problems presented.

Throughout the curriculum we will emphasize well-being and balance for physicians – this interactive and experiential part of the curriculum will encourage residents to work on an individual plan to maintain their well-being and balance while in residency.

For more information on the IMR program at the University of Texas Medical Branch Family Medicine Residency, please contact: Victor Sierpina, MD, 409-772-1847, vssierpi@utmb.edu

2008 ALSO Course

As usual, I had a blast at our annual multi-residency ALSO Course, held in Baytown last week. I enjoyed working with both our residents and the others and working with my FMOB faculty colleagues from across the region.

I think the residents had fun too, or at least if anyone didn't, they didn't tell me! Several of you commented to me that you learned a lot and had a good time. And now you all have the basic tools you need for managing urgent and emergent situations in L&D. You just need some experience putting them into practice.

Click on the photo to access the photo set.

Play-Doh Workshop

We recently had our Circumcision workshop for the interns during Orientation. They were all quite excited about getting to play with Play-Doh during this experience. Unfortunately, we had a few untoward outcomes with detachment of certain important anatomic structures, but in the end it was a successful activity. And a good time was had by all, including me! What a great group of interns!

new curriculum

In response to campus and rotation changes, RRC revisions and input from our current residents, the following block curriculum revision has been submitted to the RRC-FM and will be in place for our incoming class this year:

Post-Graduate Year 1
Essential Skills in Family Medicine
Family Medicine Hospital Service 1
Family Medicine Hospital Service 2
Family Medicine Hospital Service 3
MICU
Surgery 1
Obstetrics 1
Obstetrics 2
Adult Emergency Medicine
Pediatric Emergency Medicine
Newborn Nursery
Ambulatory Pediatrics 1
Principles of Family Medicine

Post-graduate Year 2
Community Medicine 1
Community Medicine 2
Pediatric Inpatient
Gyn/Colpo
Collaborative Health Care
FM Procedures
Orthopedics 1
Family Medicine Hospital Service 4
Family Medicine Hospital Service 5
Family Medicine Hospital Service 6
CCU
Elective 1
Elective 2

Post-Graduate Year 3
Surgical Sub-specialties
Neurology
Ortho 2 / Sports Medicine
Ambulatory Family Medicine
Surgery 2
Ambulatory Pediatrics 2
Family Medicine Hospital Service 7
Family Medicine Hospital Service 8
Adult Medicine Sub-specialty
Elective 3
Elective 4
Elective 5
Elective 6