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Hunterdon Family Medicine Residency Curriculum
The curriculum has been in a constant state of re-evaluation since the program began in 1953. The process of evaluation of rotations, teachers, residents and graduates is on-going with major resident participation.
The Family Practice Residency is scheduled as follows:
|01||Family Medicine Systems||Family Medicine Systems||Family Medicine Systems|
|03||Night Float / ED||Night Float / ED||Night Float / ED|
|04||Pediatrics||In Patient Family Medicine||In Patient Family Medicine|
|05||ICU||Infectious Disease||Dermatology / Hospice|
|07||Orthopedics||Community Medicine / Radiology||Pediatrics|
|08||Maternity Care||Sports Medicine||Elective|
|09||Night Float / ED||Night Float / ED||Night Float / ED|
|10||Pediatrics||In Patient Family Medicine||Internal Medicine Sub Specialty|
|11||Surgery||Pediatrics||Opthalmology / ENT|
|12||In Patient Family Medicine||Practice Management||Elective|
Family Health Center (5) - 1/2 days per week; Nursing home 1/2 day per month;
Hospice (2) - 1/2 days per week for 1 month
Camp Nejeda (pediatric endocrinology) 1 week
Longitudinal Requirements / Curriculum:
Alternative/Complementary Medicine; Palliative Care; Ethics; Procedure Workshops; Geriatrics/Nursing home; Evidenced Based Medicine/Journal Club; Home Visits, Behavioral Health
Months representative of total time spent on each rotation over the course of a year. Rotation order varies for each resident.
Family Medicine Service: FMS is truly a team effort, during which interns are exposed to the initial management and subsequent treatment of a variety of internal medicine problems both complex and routine. This is by far the most challenging rotation for interns and senior residents. Senior residents co-ordinate the management of patients from the 2 family medicine teaching offices as they need to be admitted and discharged to the teaching service while helping interns keep an updated sign-out, write orders and complete discharge summaries. Residents will not uncommonly have the opportunity to see patients they have taken care of for follow-up in the office, which takes the opportunity for continuity further than the hospital.
Pediatrics: Residents see newborns for the neonatologists, allowing them to become extremely comfortable with the newborn exam. The well-nursery offers residents the opportunity to learn about the management of common problems such as neonatal hyperbilirubinemia, dehydration, and neonatal sepsis. Residents have the option of going over the work-ups, imaging and exams of patients in special care. After seeing babies, residents then see patients on the inpatient pediatrics floor and go over the cases with our pediatric hospitalists who love to teach. The second half of the day on the pediatrics rotation is spent learning about outpatient issues in pediatrics. Residents spend time at Hunterdon Pediatrics Associated with pediatricians who go over exam findings, interesting rashes, and the management of a variety of routine outpatient problems as well as more complex pediatric issues. Wednesdays are spent at Hunterdon Developmental Center, where they are exposed to initial evaluations of children with autism, ADHD and developmental delay while also learning basic pharmacologic management of said problems. One day a week is spent in the emergency room doing pediatric emergency room cases. Residents also spend time in the outpatient offices of the pediatricians and in our regionally known Child Development Center to see the pediatric view of primary care.
Critical Care Medicine (ICU/CCU) During their ICU rotations, interns learn to become comfortable with the on-going management of critically ill patients. The first round through ICU is often about learning the language of the ICU, but all throughout, residents are learning the nuts and bolts of internal medicine while becoming comfortable with dealing with the course of critically-ill patients. This is important, because during the second and third year, residents are often co-managing critically ill patients and floor patients throughout the hospital during night-float along with the intensivist on call.
Maternity Care: R1s spend time on the OB floor doing deliveries with our 5 family medicine faculty that do obstetrics. The Family medicine OB attending on call does a one-on-one teaching session with the rotating resident each day. This is a wonderful opportunity for residents to become familiar with Ob/Gyn concepts and even those who are not interested in pursuing family medicine obstetrics have found it quite enjoyable. Residents have the opportunity to deliver with the 2 Ob/Gyn groups affiliated with hunterdon, with nurse-midwives, and with attendings from Hunterdon Family Practice and Obstetrics - a private practice associated with Hunterdon comprised largely of graduates from our program. Interns are also on-call for all cesarean sections.
Surgery: The first year family medicine resident spends two months on the general surgical service. By assisting in the operating room, the resident will become familiar with common surgical procedures. Considerable emphasis is placed on pre- and postoperative care. The resident will spend time in the outpatient offices and will follow up with postoperative patients as well as patients who are referred to the surgeons by local family physicians. During this rotation, the resident will have dedicated time to work with members of the Anesthesiology Department. The resident will be taught intubation skills, learn perioperative assessment and pain management.
Emergency Department/Nights: During the first half of the night, interns are challenged with a variety of undifferentiated problems by doing admissions from the emergency room for hospitalists and subspecialists. Interns are capped at no more than 2 admissions at one time. From 11pm until the morning, interns see patients in the emergency room learning the nuts and bolts of urgent care, small procedures such as suturing, splinting and I&Ds, as well as the acute management of emergencies. The night-rotation offers residents enough volume to be able to learn from, while also allowing for ample one-on-one teaching time with the emergency room attending on at night-time, including one of our physicians double-boarded in emergency medicine and family medicine. The Emergency Department is busy with approximately 35,000 patient visits a year which affords the resident an opportunity to care for a large variety of urgent and emergent conditions.
Cardiology: Residents have the opportunity to become comfortable with doing admissions, consults and assessments of routine and complex cardiac problems under the direct guidance of cardiology attendings that love to teach, physician assistants and Nurse practitioners. This is a wonderful opportunity to become good at the interpretation of telemetry strips, EKGs, and echocardiograms. This in turn helps with call, during which residents often manage patients with a variety of cardiac issues including both non-urgent and acute onset arrhythmias, syncope, and chest pain on the telemetry floor. One ½ day per week, residents have teaching time with one of the resident’s favorite cardiologists who loves teaching.
Orthopedics: Residents work with orthopedic surgeons, sports medicine physicians, pain management specialists and physical therapists from several practices in our community who provide cutting edge care to our patients. The curriculum is designed to provide direct patient care experience with emphasis on continuity of care to become competent in managing common orthopedic conditions encountered in family practice. The rotation involves both inpatient and outpatient experiences in your training, thus residents also assist in orthopedic surgeries so that they gain exposure to a wide variety of procedures patients will undergo.
Night Float: Second and Third year residents share the responsibility of admitting patients for the Hospitalist and Family Medicine Services as well as covering house calls, ICU and floor emergencies. This rotation helps residents gain confidence and independence, as well as improve their time management and team building skills. The second and third year residents also hone teaching skills as they go over concepts in internal medicine and how to do thorough admissions with the intern. Senior residents are often co-managing ICU and floor patients who are acutely ill with the intensivist on call, helping them to truly hone acute care/emergent care skills.
Practice Management: This is a rewarding rotation in which residents learn the ins and outs of how a Family Practice office works from scheduling, to billing, to insurance. Residents spend time rotating through each of the office stations including front desk, business secretary, office manager, managed care, nursing, and nurse educator. Get one-on-one training with Hunterdon medical center’s Business Office staff to discuss billing and coding. They will often give residents direct feedback on their coding.
Infectious Disease-:This rotation allows for 2nd years to work one on one with our Infectious Disease specialist, Dr. Joseph Gugliotta, in both the inpatient and outpatient setting. Round on patients at the bedside, then see them as they follow up in the office. Residents have didactic sessions on the patients they have primary responsibility for. Residents learn about antibiotic selection and differential diagnosis in the undifferentiated patient with infectious disease symptoms as well as infection control topics. Dr. Gugliotta takes his responsibility to teach good internal medicine very seriously and so despite the long hours, residents love this rotation for the opportunity it gives them to hone general physical exam skills and differential diagnosis.
Inpatient Family Medicine Service (2nd half of year): 2nd years now take the role of “Senior Resident” leading the Interns and managing the Green Team as they round, and decide if patients meet criteria for admission or discharge. This rotation focuses on leadership skills, time management, and professionalism.
Sports Medicine: Residents rotate with orthopedists with a focus on Sports Medicine, with a physical medicine and rehab specialist who helps residents hone physical exam and procedure skills, and with the physical therapists at the hospital-associated physical therapy office.
Pediatrics Emergency Department: Residents care for pediatric patients in our high-volume Emergency Department during this rotation. They evaluate and manage patients under the supervision of the Board Certified Emergency Department faculty and are responsible for triaging and treating patients in conjunction with the Emergency Department team of physicians, nurses and staff.
Community Medicine/Radiology (1 month): The community medicine rotation is designed to bring a broad, multidimensional view of the healthcare system to give residents a community context for patient care. Residents obtain an appreciation of how community life factors affect health and wellness. They spend time with various agencies that are part of the county or part of the Hunterdon healthcare system that provide highly utilized services to county residents that are more often than not underserved. 2 days a week, residents spend time with our radiologists learning the appropriate application of imaging techniques and specialty consultations in diagnostic imaging and nuclear medicine therapy, as well as learning the initial interpretation of radiographs as it applies to the management of the patient.
Hospice: Residents on this rotation split their time learning about hospice and dermatology in one month. During the hospice rotation, the resident is responsible for attending Tuesday morning multidisciplinary hospice team meetings where they learn about new Hospice admits, current hospice patients, and patients who need recertification for hospice. On Thursday mornings, residents go on home visits with Dr. Susan Bauman, the medical director of Hospice and Palliative Care, and gain insight into patient and caregiver’s experiences. The residents are required to keep a short log about these home visits and the impact it had on their hospice experience. The resident gains skills in learning about requirements and main focus of hospice, assessing patient levels of appropriateness for Hospice services, and providing care and support for patients and their caregivers during end of life.
Dermatology: Residents have the opportunity to work with Dermatologists, Dr. Cassetty and Dr. Sisack who provide one on one teaching. On this rotation, residents can be first-assists or be supervised first hand on several office-based procedures such as mole excisions, punch/shave biopsies, cryotherapy, laser treatments, and more. Residents gain exposure to variety of dermatological conditions, learn how to do skin exams with a dermatoscope, and learn how to appropriately describe skin lesions and rashes.
Camp Nejeda: Hunterdon residents have a unique 1 week experience in the months of July and August to serve as camp doctors for children with Type 1 Diabetes at Camp Nejeda in Stillwater township. Residents are part of the team of health care staff with nurses, and get to work one on one with a Pediatric endocrinologist to learn the nuts and bolts about insulin pumps and injectable insulin. On a daily basis, the resident and pediatric endocrinologist make insulin adjustments based on daily blood sugar logs. The resident run the health center treating basic scrapes, wounds, ankle sprains, and evaluating acute medical issues, and is also available 24 hrs on-site for emergencies. The camp provides residents their own cottage overlooking a beautiful lake, 3 main course meals and snacks, and provision to go on day trips with the children. The residents become part of the Camp Nejeda family where they learn about what it takes to care for a child with type 1 diabetes.
Medical Specialties Second year residents have 3 months of subspecialty to adult medicine. Experiences are both inpatient as well as in the private offices of the specialists. The goal of these rotations is for residents to encounter a large volume of patients with a variety of conditions often co-managed by family physicians and subspecialty colleagues. Options include hematology, oncology, nephrology, infectious disease, and other medical sub-specialties.
Gynecology: Gynecological training is also provided by participation in the outpatient offices of family physicians and gynecologists. Residents learn the care and treatment of a variety of womens' health care issues ranging from young women to the elderly. On Wednesday mornings during Gyn Clinic, residents work one on one with our Family medicine faculty and gain first hand experience with a variety of outpatient gynecological procedures such as colposcopy, endometrial biopsies, and IUD placements and learn to appropriately counsel patients about their contraceptive choices. Residents manage their continuity prenatal patients in the family health center during this month, and have the opportunity to deliver while on their gynecology rotation.
Electives: This schedule allows for 5 elective months during the second and third year. This extensive elective time permits individualized training geared toward the resident's passions, needs and future practice interests. Our proximity to the medical communities in Philadelphia, New York and the Lehigh Valley allow easy commuting for one time or longitudinal experiences while maintaining care of your continuity patients. Popular electives include sports medicine, dermatology, public health, palliative care, urban health, and international medicine. For residents interested in full or part time academic careers, teaching electives are available to help the resident obtain important skills for the family physician.
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Family Medicine Residency
Hunterdon Medical Center
2100 Wescott Drive,
Flemington, NJ 08822-4604