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San Joaquin General Hospital offers a complete curriculum, which is in compliance with the American College of Graduate Medical Education and is fully accredited. Rotations by year and length can be found in table form below.
Rotations include:
Family Practice Wards:
Providing hands on experience
in an inpatient setting under the supervision of faculty physicians, senior
residents and specialty faculty as needed.
Internal Medicine:
Under the supervision of
senior residents and internists. This rotation provides experience in the
care of the more complex patient.
Community Medicine:
This rotation includes outpatient
Geriatric evaluations, home visits, public health, and student health.
OB/Gyn:
A fully staffed OB/Gyn department
offers training and supervision for residents during their rotation.
ICU:
Treatment of the critically
ill patient under close supervision.
ER:
Care of patients ranging
from ambulatory surgery care to the seriously ill/injured patient with
ER faculty supervision and a wide scope of specialist support.
Pediatrics:
Taught by pediatricians,
this rotation provides both in and out patient pediatric training.
Intensive Care Nursery:
Staffed by neonatologists,
offers education and true experience in the evaluatory treatment, and,
if necessary, transport of neonatal patients.
Orthopedics:
In and outpatient management
of the orthopedic patient under the supervisor of faculty orthopedic surgeons.
Medical Sub-Specialties:
Offering experience in pulmonary,
neurology, Infectious Diseases, hematology, oncology and endocrinology.
Surgical Sub-Specialties:
With training in opthomalogy,
urology and ENT.
Call:
Call varies by rotation,
and there is no call during ICU, Orthopedic, Cardiology and elective rotations.
With the exception of OB and Surgery, nights are covered by a night float
system.
Rotations (in weeks):
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In the three-year Residency Program at San Joaquin General Hospital, residents spend an increasing amount of time in Family Medicine. The program, which stresses both inpatient and outpatient medicine, emphasizes continuity of care and preventive care. Each resident has the opportunity to develop a patient population, providing continuous care to this group during the three years of residency.
Year 1
The resident
has on an average one Family Practice continuity clinic per week in the
first half of the year and two clinics per week in the second half.
The resident also has Behavioral Science seminars with Linda Quintana,
Ph.D., Behavioral Psychologist, on a regular basis, including videotaping
patient interactions.
Year 2
The resident
has on an average two Family Practice continuity clinics per week.
Behavioral Science seminars with Linda Quintana, Ph.D., continue on a regular
basis.
Year 3
The resident
has on an average three Family Practice continuity clinics per week.
Behavioral Science seminars are also held on a regular basis. An
eight-week outpatient block experience comprises experience in Podiatry,
Procedures, Psychiatry, Occupational Medicine, Dermatology and Practice
Management. Additionally, each PGY-3 resident provides care for one
to two patients in the Valley Gardens Nursing Home on a monthly basis for
the entire year.
Overview
The Family Practice Program, in order to provide continuity of care, and
provide for the broadest patient care training, has several areas of education,
which extend throughout all three years of training.
Behavioral
Science
The Behavioral Science curriculum is incorporated into all three years,
and offers individual and group education. Elements of the curriculum include
individual consultations, didactics, case presentations, videotaping, and
resident centered balint group meetings.
Family Practice
Family Practice Clinics are structured for continuity of care. Preceptors
from both the in house and community based faculy are present during cinics
for real time support. Clinics are generally scheduled twice a week for
first and second year residents, and 3-4 times a week for the third year
residents. Clinics last 1/2 day.
Nursing Home
Nursing Home visits are incorporated into the third year curriculum, with
each resident assigned to one or two nursing home patients. Rounds with
resident seminars are scheduled monthly. In addition, home visits are done
throughout the month along with a faculty member. Home visits patients
present a variety of medical conditions from elderly, to the chronically
ill, to OB patients.
Didactics
Regular noon conferences are given two to three times a week. Lecturers
include the faculty, specialists from other departments and outside speakers.
Grand Rounds are held on Wednesday morning, and may generally include speakers
from Universities with specific, relevant interests. PGY-1 Rounds follow
with timely lecture geared towards the first year resident. Additionally,
afernoon letures from 1:00-2:00 P.M. are scheduled on Monday, Wednesday
and Friday.
The Behavioral Science Curriculum is integrated throughout the program and involves small group seminars, lectures, videotaping sessions, co-precepting, and consultations, community agency experiences in substance abuse and mental health, and specialty clinics with family practice patients. Emphasis is placed on normal growth and development through the life cycle and the common dysfunctions that are seen in a family practice setting. Models of health and illness, family dynamics, personality disorders, behavioral medicine, and psychiatric disorders are explored for application in a multi-disciplinary management approach for family practice patients in the various rotations. Interaction with culturally and ethnically different individuals is explored within the context of the doctor-patient relationship and management component of medical problems.
PGY-1 residents visit selected substance abuse and mental health programs where they have the opportunity to participate with physicians providing direct patient care. Each resident is required to complete two half days of videotaping which are observed by Linda Quintana, Ph.D., Behavioral Scientist. The video sessions are then reviewed for interview styles, application of communication techniques, and the development of the therapeutic relationship. Throughout the first year residents participate in various seminars focusing on the family, the health illness model, the socio-cultural influences of medicine and the role of behavioral medicine. Support groups with emphasis on self-awareness, introspection and stress management are available throughout the residency program.
PGY-2 residents continue the integration of material presented in the first year with expansion of information to give in-depth assessment, differential diagnostic and treatment strategies for psychiatric and general medical conditions. Residents participate in this seminar with the third year residents on a rotating basis; topics are preselected on a two-year rotation. Teaching methodologies include didactic lectures, case presentations, patient interviews and role playing. Networking and referral to other community agencies is developed for services not provided within the scope of the family practice clinic.
PGY-3 residents participate in a psychiatric clinic designed for assessment, diagnosis, treatment and consultation on management issues for psychiatric patients being followed in the primary care clinics by the residents and attendings. The eight-week experience focuses on DSM-IV diagnostic criteria and management of patients experiencing comorbid psychiatric disorders that are appropriate for management in a primary care setting. Each resident conducts an assessment and follows patients for short term therapy in this clinic or can provide long term management in their own continuity clinics. Principles and techniques of brief therapy are utilized as an adjunct to pharmacological management.
Residents also participate in an Attention Deficit Hyperactive Disorder Clinic where family practice patients suspected of having ADHD are evaluated for appropriate diagnosis and management. Consultation with the school and family education are critical components of treatment. Emphasis is placed on the role of the primary care physician and appropriate treatment strategies for diagnosed patients. Consultation is available from the child psychiatrist at the Community Mental Health Center.
Regularly scheduled conferences and seminars are part of the didactics curriculum. Three noon conferences per week are scheduled throughout the year. Various specialty areas, i.e., Pediatrics, Radiology, Lab, Medicine, Geriatrics, Practice Management, Nutrition, Preventive Medicine, and Behavioral Medicine are covered with the content areas cycled every 18 months. Didactic lectures are held from 1-2 P.M. for ward teams on Monday, Tuesday and Friday.
One hour weekly Wednesday morning Grand Rounds are additionally structured seminars. The faculty coordinates topics and speakers for these.
All residents are required to do at least one clinical literature review and presentation during the residency.
Journal Clubs are held every other month in the Family Practice Center. The faculty coordinates and assigns readings for the journal clubs.
Additionally "PGY-1 Resident Rounds" are held one hour per week (Wednesday morning after Grand Rounds). Topics important for PGY-1 residents are covered during these rounds, i.e., blood gasses, chest pain, acute renal failure, patient interaction issues, charting, billing, etc.
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