|Surgery||4 Weeks||Inpatient Service||12 Weeks||Inpatient Service||6 Weeks|
|OB Gyn||6 weeks||OB Continuity||6 Weeks||Family Medicine 3||6 Weeks|
|Peds||3 months||Night Float||4 Weeks||Derm / Surg||4 Weeks|
|Inpatient Service||6 Weeks||Elective||8 Weeks||Cardiology||4 Weeks|
|Night Float||2 Weeks||Psych-Geri||6 Weeks||Ambulatory||4 Weeks|
|Family Medicine||4 Weeks||Family Medicine 2||6 Weeks||Elective||14 Weeks|
|GYN Surgery||1 week||Orthopedics||2 Weeks||Night Float||2 Weeks|
|Ophthalmology||1 week||Elective||8 weeks||Pediatric Chief||6 Weeks|
|ICU||4 Weeks||EM||2 Weeks|
During each of the three years, residents have a rich exposure to patients on the family medicine rotations.
The G1 rotation provides a four-week period of time to become familiar with all phases of ambulatory medicine. The residents are closely supervised via observation and videotaping. Doctor-patient interpersonal skills are taught and reinforced by direct observations and didactic presentations. The residents learn how good communications, interviewing and patient education skills directly relate to quality care and patient satisfaction. In addition to the experience in the Hart Center, the resident also spends time at the City Public Health Department. Learning about community resources, teaching in-office laboratory methods and family systems are also included in this rotation. This is a call-free month for the intern.
Building on skills developed during the G1 experience, the family medicine rotation in the second year advances the resident further along the path to becoming a competent and confident physician. The resident sees an increased number of patients in the family practice center. Consultations and direct observations occur on a regular basis with the precepting family physician. Outpatient experiences in ENT and urology are also included in this rotation. In addition, residents spend time each week performing colposcopy in a one-on-one teaching session.
The G3 family medicine rotation, is an intensive, six-week experience in the FPC. Daily involvement in the family physician's office allows for continuity of care for selected patient problems. It also allows for involvement in practice management, an area of great interest to the third year resident. Precepting opportunities, coding, and additional gynecology experience are also available.
Residents spend a total of six months on our family medicine inpatient service over the course of 3 years. This service combines excellent teaching and responsibility for patient management with an opportunity to observe the scope and role-modeling of a practicing family physician. This service is under the direction of full-time faculty members. Patients are admitted from the Hart Family Practice Center and private family medicine groups. The usual census is 12 to 20 patients with the team consisting of one PGY1 resident, two PGY2 residents and one PGY3 resident. Residents have significant autonomy and responsibility for patient management. Third year residents function in a supervisory role. Teaching rounds are conducted daily with attendings from each group, case management and pharmacy. Formal lectures on core inpatient topics are given three times a week by faculty. This teaching service is highly rated by the house staff and is a popular elective for medical students. Additionally, we conduct morning report once a week and is largely run by residents with faculty oversight.
WellSpan York Hospital is well-known for excellent university-style internal medicine teaching services. In addition to subspecialty oriented services, the hospital has a number of excellent general medicine services. Each year, many medical students from the Drexel College of Medicine, Jefferson, and Pennsylvania State University do required and elective internal medicine clerkships at York. G1 family medicine residents spend four weeks on the Intensive Care Unit (ICU) rotation. The service is comprised of three interns and a supervising upper level resident. Each intern is responsible for the medical care of four to six patients under the direct supervision of the critical care attending physician. This service achieves an excellent balance between patient care responsibility, continuity, and supervision and teaching. Residents are also taught how to perform procedures commonly utilized in the ICU setting. ACGME work hour rules are followed.
York's family medicine program is proud to have a very robust experience in the care of children. Under the direction of three full-time teaching pediatricians, G1 residents spend 12 weeks on the pediatric service. There are generally three or four residents assigned to pediatrics for any given block. G3 residents spend six weeks on pediatrics as the supervising resident (Peds "Chief"). The supervising resident is always a family medicine resident. The daily schedule is divided among inpatient care, teaching and outpatient clinic. The five-month pediatric curriculum includes attendance to the newborn at C-section, newborn nursery, inpatient floor, and pediatric clinic. An excellent lecture curriculum is provided by pediatricians and is geared specifically toward family medicine.
WellSpan York Hospital has a Level 1 neonatal intensive care unit (NICU) fully staffed by hospital-based neonatologists. G1 residents spend two weeks assigned to the NICU and obtain certification in Neonatal Advanced Life Support during this time. A survey of graduates and results of the ABFP Intraining exam confirm that York has a particularly strong pediatric experience, and that graduates of the program feel quite comfortable dealing with sick infants and children. In addition, 30% of patients seen at the FPC (where residents have their continuity experience) are children.
The provision of maternity care completes the full cycle of family care. The family medicine residents provide longitudinal care for their family medicine center prenatal patients, care for them through labor and delivery and then continue to provide care for this growing family. The experience is one which confirms the essence of family medicine.
Supervision of prenatal care and labor and delivery is provided by 6 family medicine faculty members. They bring a breadth of experience including private practice experience. They supervise continuity deliveries and provide additional 1:1 family centered OB teaching during the GI rotation.
In addition, all G1 residents take a six-week rotation on the OB/GYN service at WellSpan York Hospital. York has an OB/GYN residency with an excellent teaching staff and conferences. As a referral center, the WellSpan York Hospital obstetric service provides a broad range of experiences. On this rotation OB/GYN and FM residents work side by side in an atmosphere of mutual exchange of ideas and learning experiences from both the OB specialty and the family medicine perspectives.
Call during this rotation for the FM resident occurs with a G2 OB resident who serves as mentor with the resident, minimizing competition for deliveries. The FM and OB departments have enjoyed an excellent working relationship for many years. A six-week obstetrics rotation is taken during the G2 year at WellSpan Gettysburg Hospital. Gettysburg offers a rural hospital located about 50 minutes west of York. Additional FPC teaching in colposcopy and gynecology are also provided. Emphasis is placed on health maintenance and patient education. Additionally upper year FM residents have enjoyed electives with the OB residents at WellSpan York Hospital, gaining additional experience including management of L&D and more C-sections.
WellSpan York Hospital has a superb emergency medicine department which handles over 64,000 visits per year, one of the busiest in the state. The department is well-organized for teaching and offers casting and splinting clinics, grand rounds, suture clinic and a number of other very practical conferences. The full-time emergency physician staff provides excellent experience and teaching for all housestaff rotating through the department. All G1 residents do one four-week block in the Emergency Department. Electives are available in the G2 and G3 year.
All G1 residents spend six weeks assigned to a surgical service. Surgical diagnosis is emphasized, and residents assist at cases where they participated in making the pre-operative diagnosis. Family medicine residents usually work one-on-one with a surgical attending and are the "first assistant" in the OR. Pre-operative and post-operative care are also important curriculum objectives. Residents participate in an active surgical clinic where they are encouraged to send their patients. Under the supervision of surgical residents and attendings, family medicine residents perform excisions and other simple outpatient surgical procedures under local anesthesia. One week of ophthalmology and one week of gynecologic surgery are included in the G1 year. G3 residents spend additional time in outpatient general, plastic and dermatologic surgery during the Derm/Surg rotation.
York's Family Medicine Residency recognizes the importance of geriatrics in any family physician's practice. As our geriatric population continues to expand, family physicians will provide a significant portion of their ongoing care. A longitudinal and block experience is provided. All residents are assigned two to four nursing home patients to follow over a two-year period. A geriatric block rotation is also required. This block includes supervised experience and teaching in the nursing home in a one-on-one situation with the Family Medicine faculty.
The G2 rotation is structured and coordinated by the Department of Psychiatry's education coordinator. The curriculum consists of evaluation, diagnosis and management of patients on the hospital's psychiatric consult service. An excellent elective in adolescent psychiatry is available. The psychiatry and human behavior curriculum includes didactic and clinical sessions. Didactic conferences are given bimonthly covering common psychiatric disorders and psychosocial emergencies including alcohol and substance abuse. Practical methods of office psychotherapy are stressed in the family practice center. The psychiatric teaching coordinator meets with a group of residents twice monthly to conduct a patient interview and psychiatric assessment or to review a videotaped patient encounter.
Family medicine residents are encouraged to do research projects. The hospital encourages research in all departments and has full time department od research to assist faculty and residents in the design, implementation, and analysis of research projects. Elective time can be devoted to a research project. "Residents' Research Day" occurs every May and provides an opportunity for all residents to showcase their research. Best research and presentation awards are also given at this event.
The York community is fortunate to have an excellent public health department. The Medical Director of the York Health Bureau has developed a curriculum for first-year residents which enables them to become actively involved in the daily activities of this busy program. Because of this interaction in the first year, some residents choose community Medicine as an elective in their third year. There are many opportunities for residents to get involved with the community including a homeless clinic, Tar Wars presentations and sports physicals, to name a few.
The program has an attractive and innovative call system which supplements conventional calls with night float rotations in all three years. The night float rotation is two weeks long in the G1 and G3 years and four weeks long in the G2 year. Residents assigned to night float rotations Sunday through Thursday from 9 p.m. to 7 a.m. plus one half day of Family Practice Center hours. The G1 resident does night float alongside the G3 resident who acts in a supervisory/teaching role.
The residents, faculty and the hospital personnel work together to form and maintain a supportive environment. Residents conduct a weekly business meeting during which ideas and suggestions to improve the program are presented and exchanged. Camaraderie is the spirit of the day and it is not unusual for residents to engage in social and sporting activities and other hospital-sponsored events. There is also a monthly resident support group.
The residents are also participants in determining the shape their future will take. The design of the curriculum, the selection of new house staff, selection of chief residents and the improvisation within individual rotations all bear witness to the residents' direct input into the program. The flexibility of the curriculum also allows residents to control their own destiny, enabling each resident to pursue their preferred personal emphasis in primary care.
Diversity is perhaps the most accurate manner in which to categorize each class of residents. There is no "typical" group. Historically, over 60% of the residents have come from schools outside Pennsylvania. Residents have participated in elective experiences in Africa, South America, India, and various locations within the Indian Health Service. These experiences have broadened the resident's perspective on public health and preventive medicine. York attracts residents from diverse cultural and religious backgrounds which enhances everyone's experience.
Family Medicine Journal Club is held in the evening at the home of one of the family medicine faculty members, as well as being incorporated in the noontime conference series. Several residents are assigned to review and present current papers from the literature. Faculty and department members contribute to the discussion in areas of critical appraisal of the literature and practice perspective.
WellSpan York Hospital's multiple residency programs generate a wide spectrum of excellent conferences. In addition to the above family medicine conferences, residents may attend other conferences when on specific rotations. These include emergency medicine, internal medicine, pediatrics, surgery, obstetrics, and gynecology conferences.
Core family medicine conferences are provided to cover the breadth of the specialty of family medicine. These occur on Thursday morning and are taught primarily by family physicians on our faculty. The focus is on the spectrum of challenges that present to family physicians in the office.
In addition, there is morning report two times per week and a monthly hands-on procedure conference covering such topics as dermatology procedures, sigmoidoscopy, endometrial biopsy, I & D, circumcision, etc.