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Curriculum

The University of Colorado Family Medicine Residency at Rose Medical Center is a fully ACGME-approved three-year training program committed to excellence in teaching and practicing family medicine in both hospital and office settings. We accept six residents into the first year of training. The curriculum incorporates all requirements of the American Board of Family Medicine while retaining five months of elective time. This is done, in part, by incorporating longitudinal curriculum. The curriculum is subject to continuing review and modification. Suggestions from residents, faculty, changes in the health care environment, and the changing requirements of the Residency Review Committee for Family Medicine have led to and will continue to produce constructive changes.

Year One

• Family Medicine Service (FMS) 4 months
• The Basics of Family Medicine/Behavioral Science 1 month
• ICU 1 month
• Obstetrics 1 month
• Emergency Room  1 month
• Nursery 1 month 
• Pediatrics Inpatient 1 month 
• Pediatrics Outpatient 1 month
• Sports Medicine 2 weeks
• Three weeks of vacation, plus 1 unpaid week off at the end of June

SAMPLE First-Year Schedule:

Year Two

• Family Medicine Service (FMS) 2 months 
• Gynecology 1 month 
• Rural 1 month
• Advanced Obstetrics 1 month
• Surgical Subspecialties 2 (Ophthalmology/Podiatry) 2 weeks
• The Basics of Family Medicine/Behavioral Science 1 week
• Surgery 1 month
• Pediatric Emergency Room 1 month 
• Cardiology 2 weeks
• Rheumatology 2 weeks
• Electives 2 months
• Three weeks of vacation and one week of educational leave

SAMPLE SECOND-YEAR Schedule:

Year Three

• Family Medicine Service (FMS) 2 months
• Dermatology 1 month 
• Geriatrics 2 weeks
• Surgical Subspecialties 1 (Urology/ENT) 2 weeks
• Surgery II 1 month
• Practice Management 1 month 
• Outpatient Family Medicine Clinic 1 month
• Orthopedics 1 month
• Electives 3 months
• The Basics of Family Medicine/Behavioral Science 1 week
• Three weeks of vacation and one week of educational leave

SAMPLE THIRD-YEAR Schedule:

Longitudinal Curriculum

Most of what we learn as physicians is not learned through the artificial environment of residency, and for this reason we encourage lifelong learning by exposing residents to many of our learning requirements in a longitudinal fashion. Residents are required to self-monitor and complete certain learning activities as they progress through residency. Examples include cultural competency training during PGY-1, advanced fetal monitoring by PGY-2, chronic pain management by PGY-3, community medicine and scholarly pursuits.

Behavioral Science

Behavioral Science teaching occurs longitudinally throughout the three year curriculum as well as during focused time each year with the Director of Behavioral Sciences. In the second year, there is time dedicated towards preparation for the third year and learning the necessary teaching and leadership skills to be an effective SAR (senior admitting resident). Longitudinally, faculty are available for consultation for the common psychosocial problems seen in the family medicine center. For more complex cases, co-consults, where the resident will see a patient with the director of behavioral sciences, are available to residents. Audiovisual observations are regularly utilized. In addition, didactic and small group discussion sessions run throughout the academic year.

Chronic Pain Management

Chronic pain has evolved into one of the most common reasons that a patient seeks out care, and the Rose Family Medicine Residency is one of only a few family medicine residencies in the country that offers extensive training in safe and effective chronic pain care. We teach care that is evidence based and patient focused and we teach how to properly document this care so that you are protected from medico-legal risk.

Community Medicine

The curriculum in community medicine and health promotion integrates into family medicine training topics such as health risk appraisal, health education, nutrition, fitness and exercise prescriptions, stress management, environmental health, occupational and school health. We also offer electives in these areas. Theory and practical experience of the integration between family physicians and the communities they work with are taught during the rural rotation.

Conferences

The Rose Residency has weekly conferences addressing problems frequently seen in family practice. An 18 month schedule covers core topics, which are primarily ambulatory and taught by family physicians. Daily clinic case conferences occur prior to resident continuity clinics and are frequently led by residents. Residents also have the opportunity to attend conferences when assigned to specialty rotations.

Cultural Competency

Under the leadership of The Colorado Health Foundation, Rose Family Medicine is implementing a cultural competency program, providing education to faculty and residents in culturally competent communication, clinical care, and professional development. Recognizing the importance of rich cultural competence to the experience of patients and learners within a residency program, Rose Family Medicine is implementing a cultural competence advisor committee and planning standardized patients and teaching vignettes along with didactics, to be taught by leaders in the field of diversity and cultural competence. This experience will take place over the 3 years of residency training and will expand the ability of residents to communicate with patients from all backgrounds, will provide instruction in patient-centered care, and will enhance the learning experience of residents through team-building and targeted training.

Educational Leave

Educational leave allows the resident time for a focused educational experience. A conference, dedicated reading time, intensive procedural time are all available during this time.

Leadership

Residents are exposed to principles of leadership and team-building during didactics, in the Basics of Family Medicine rotation, and during the "Creede" experience, which includes small group teaching and leadership challenges in a wilderness setting. Additional skill set training that residents receive throughout their PGY-2 and PGY-3 years includes professional development, medical staff training and credentialing, advocacy, public speaking and media training. Residents receive specific feedback on their performance as a leader and supervisor, and develop skills needed to incorporate these various leadership techniques as they progress through residency.

Patient Centered Medical Home

Rose Family Medicine believes in the value of an integrated medical home for its patients, and is reworking office systems to provide more experience in the concept of a PCMH. The residency is planning for the expected implementation of an EMR in 2009. Currently, a full time social worker and a behavioral psychologist, along with a psychology intern, help model the integrated home for residents in providing services to clinic patients. The residency believes in team-centered medical care to prepare physicians for practices of the future.

Scholarly Pursuits

All residents are required to pursue a scholarly project during their three years in the residency. This may be a special project such as setting up a community outreach program, drafting patient education materials, or implementing a continuing education program. Usually, residents choose to work with one of the members of the faculty in writing a review article or evidence based medicine answer for a clinical question for publication in a print or electronic format. The resident may also work with several faculty with training in research design and data collection to complete a more in-depth project. Faculty are eager to assist residents with these pursuits.

Course Descriptions

Advanced Obstetrics

We have created a one-month advanced obstetrical rotation in which our PGY II residents are expected to manage 25-30 labors resulting in 15-20 vaginal deliveries and four to eight cesarean sections in the role of first assist. Our residents also will be responsible for triage of patients presenting to the labor deck and for rounding on the newborns they have delivered, including circumcisions and managing any newborn complications such as sepsis workups, hypoglycemia, and other acute illnesses of the newborn.

The Basics of Family Medicine

First year residents spend one month together as a group in September to gain familiarity with the Family Medicine Center, its staff, faculty and resources. Development of rapport and a team atmosphere are emphasized during various outdoor recreational activities during the week away in Creede, Colorado. After returning from Creede, residents are given a series of lectures on a variety of topics, including practice management subjects such as billing and coding, as well as more “medical” subjects like the management of sepsis or a difficult obstetrical patient. Interns also recertify ACLS during this time.

Cardiology

Second-year residents spend two weeks in the cardiologist’s office learning how they work up complaints that family medicine physicians often refer to them, including palpitations, chronic heart failure, coronary disease and difficult to manage hypertension. They expand on skills learned during PGY-1, including ECG interpretation and chosing and interpreting non-interventional tests.

Dermatology

This rotation, at the Denver Health Medical Center, teaches the knowledge and skills to manage frequently seen dermatological disorders. Special small group teaching sessions for non-dermatology residents supplements a busy and varied clinical experience.

Electives

A full range of elective offerings are available. These include but are not limited to drug abuse treatment, advanced geriatric care, advanced obstetric care, child development, family and newborn development, complementary medicine, family medicine procedures, endocrinology, radiology, sports medicine, practice management, research in primary care, palliative care, hospice care, and the entire spectrum of medical and surgical subspecialties.

Emergency Medicine

During this rotation, residents learn the knowledge base and skills to diagnose, stabilize, and initiate treatment of the emergent, critically ill, or injured patient. Emergency medicine is primarily taught on the emergency services at Rose Medical Center in the first year. Exposure to trauma emergency care can occur in third year elective rotations on theSwedish Trauma Service, a regional trauma referral center. Residents on the Family Medicine Service also care for our patients in the Rose Emergency Department.

Family Medicine Service (Rose Medical Center)

The Family Medicine Service at Rose Medical Center consists of a team first, second and third year family medicine residents. The day team consists of first years supervised by an upper level senior resident and nightime coverage is provided by a second or third year resident. Diverse pediatric, adult, geriatric and OB patients create a community inpatient family medicine experience. Residency faculty, private physicians and the pharmacists provide interdisciplinary teaching. Residents learn inpatient evaluation and management of the most common ailments that bring patients into the hospital, deliver their contunuity OB patients, and learn a great deal about hospital systems, with a strong focus on patient safety measures. Second year residents complete 2-4 weeks as the night resident prior to serving as the senior admitting resident (SAR) and supervising interns. The night work system was designed by residents to make for better continuity of patient care and to improve safety, while at the same time allowing for more resident elective time and overall decreasing resident work hours.

Geriatric Curriculum

The Rose residency has a three year longitudinal geriatric training program in addition to a designated two week rotation in the third year. Physician faculty teach residents special techniques required to care for the elderly. The experience incorporates ambulatory, inpatient, home and nursing home care.

Gynecology

This rotation teaches residents to diagnose and manage gynecological programs and to develop sensitivity to the health care of women. The experience includes ambulatory, inpatient and operating room experiences as well as colposcopy training at a variety of community settings to include clinics that serve the indigent, Planned Parenthood, the University of Colorado, and private physician offices. The experience can be tailored to match a residents individual values and interests in women's health care.

ICU/Adult Medicine

During the first year, residents will have the opportunity to increase knowledge and skills in the evaluation and management of common critical care problems. Some of the specific goals for this rotation include learning to understand and manage sepsis, congestive heart failure, asthma, COPD, community acquired pneumonia, pulmonary edema, and respiratory distress in the ICU. The resident learns to perform and interpret electrocardiograms, pulmonary function tests, indications for mechanical ventilation, and to competently read chest x-rays in a systematic fashion. Exposure to procedures in critical care medicine such as intubation and central line placement is provided.

Obstetrics

The obstetric block trains residents to diagnose pregnancy and manage the prenatal, labor, delivery and postpartum care of the uncomplicated obstetrical patient, as well as recognize and manage abnormal situations. On the Family Medicine Service at Rose Medical Center residents care for obstetrical patients and their infants, supervised primarily by family physicians. Each resident also spends four weeks on the Advanced Obstetrics rotation at another area hospital in their second year. Continued obstetrical care of families is taught by family practice faculty in the Family Medicine Center. Electives with opportunities to expand obstetric skills are offered.

Orthopedics

The orthopedic rotation provides an in depth exposure to the management of common and significant orthopedic problems with an emphasis on outpatient, trauma, and emergency care. This rotation may be taken in the Denver area or at Crested Butte ski area with substantial emphasis on acute trauma. Additional orthopedic experience in non-articular, non-traumatic diseases of the musculoskeletal system is gained through the focused experience in rheumatology.

Pediatrics

Pediatric block rotations are divided between nursery, ward and outpatient services. The nursery experience occurs on the Level I and III nurseries at Rose Medical Center and focuses on well newborn care, low and intermediate risk newborn problems, resuscitation and stabilization. The inpatient and outpatient experiences are at Children's Hospital, the regional pediatric referral hospital and include acute care, well child care, adolescent care and some exposure to subspecialty clinics. During the inpatient experience at Children's Hospital residents manage common inpatient pediatric conditions as well as care of the severely ill child. Anticipatory guidance, growth and development, child behavior, and well child care are emphasized longitudinally throughout the three years.

Practice Management

This one month rotation, taught at Rose Family Medicine, focuses on what it takes to practice medicine after residency. Residents attend office leadership meetings, learn about office budgets, advanced billing and coding, supervising staff and how to improve care through internal review of medical charts. Residents have time to visit outside practices and are encouraged to begin planning for life after residency.

Rheumatology

This 2 week rotation at the Denver Arthritis Clinic follows the cardiology rotation and exposes the resident to the workup and management of chronic arthritic conditions such as chronic osteoarthritis and rheumatoid arthritis.

Rural Rotation

During the rural practice experience the resident functions as a member of a community based practice seeing patients, making hospital rounds, and taking call. This rotation provides the second year resident with the opportunity to experience the role of a rural family physician. It is a fun and satisfying time for the resident. Many of the learning objectives of our longitudinal community medicine curriculum are taught during the rural month.

Sports Medicine

The overall goals of the Primary Care Sports Medicine rotation encompass four major, equally important areas: General Knowledge, Exercise, Sports Injuries and Team Physician experience. Specific curriculum objectives are defined for each component; there is overlap between the components in that knowledge andsskills gained in some areas will augment other areas. This is a broad curriculum designed to expose the PGY-I resident to these areas, not fully teach each aspect.

Surgery I and Surgery II

Office surgery is taught throughout the three years at the Family Medicine Center. A four week general surgical experience in the second year at Rose Medical Center includes ward, operating room and emergency room experience. Also, the resident has the opportunity to expand procedural skills in the third year while on the Surgery II rotation at Rose Medical Center. The Surgery II rotation emphasizes outpatient surgical evaluation and care through experiences in the Rose Breast Clinic, Gastroenterology and Colorectal Clinics, General Surgery clinics, and the Vascular clinic.

Surgical Subspecialties

The surgical subspecialties rotations involve intensive experience in urology, ENT, podiatry and ophthalmology. These have been specifically designed to maximize the experience as deemed appropriate for family physicians.

Copyright © 2009 RFMR | site by: eamills.com / Eric Mills | July 2, 2009 4:37 PM