Modern facilities in the state-of-the-art William B. Aycock
Family Medicine Building provide an ideal environment for
residents to develop and maintain a personal practice over
three years in a setting which emphasizes on-site precepting,
regular chart reviews and close monitoring of patient care.
Special attention is given to behavioral training using a
sophisticated video monitoring system to observe and tape,
and on outpatient procedures such as a dematology clinic,
flexible sigmoidoscopy, exercise tolerance testing, colposcopy,
and vasectomy. In the hospital, our department runs an inpatient
service for patients from the Family Medicine Center and other
community practices. The teaching emphasis is on humane care
of acutely ill patients, including interpretation of clinical
data, family systems issues, and coordination of social services.
The department also runs a maternal and child health service
for the patients of the practice, and those who seek their
prenatal care at the Orange County Health Department, and
Chatham Primary Care. The MCH service also provides physician
backup to a free standing birthing center staffed by midwives.
The service operates with a unique philosophy for integrating
maternal and child health care. Emphasis is on longitudinal
care of both the mother and baby throughout the pregnancy
and after birth. During Maternal/Child Health months on this
service residents work with Family Medicine faculty with special
interests in obstetrics to develop skills in continuity and
family oriented obstetrics, outpatient gynecology, neonatology,
developmental pediatrics, and adolescent care.
In the first year residents gain experience with inpatient
medicine in two hospitals. On a busy Family Practice Inpatient
Service in the UNC Hospitals, a university hospital system
located in Chapel Hill, residents take care of FPC patients
and patients from community practices. Wake Medical Center,
an extremely well-organized, efficient community hospital
in Raleigh, provides an excellent opportunity for residents'
training in each major specialty with rotations in Medicine,
Pediatrics, Surgery, and Obstetrics and Gynecology (To
Curriculum Summary). After first year all inpatient
clinical training is on services run by Family Medicine as
services in the UNC Hospitals to provide inpatient care or
maternal child health care to FPC patients or community practices.
Second and third year residents have a number of special outpatient
rotations, including a rural rotation in a local community
practice, two weeks devoted exclusively to improving behavioral
medicine skills, and another four months of in- and out-of-town
electives to develop individual skills. A six-week block in
each of the second year provides residents exposure to rural
and under-served populations, pediatrics in a nearby small
town and opportunities to learn techniques for CQI and practice
management skills. Another six-week block in third year is
devoted to developing an understanding of how to improve quality
of care in an outpatient practice through group projects that
have ranged from devloping preventive care guidelines to finding
ways to adapt the chronic disease model of care into this
practice.
Behavioral medicine teaching is a patient focused
longitudinal curriculum that emphasizes development of
the interpersonal skills necessary for providing effective
health care. Behavioral medicine
is integrated throughout all residency years. Teaching focuses
on mental health assessment, substance abuse, sexual health,
individual and family psychosocial issues. Residents gain
assessment, intervention, and counseling skills and integrate
them by working with the behavioral faculty in block rotations,
continuity rotations, family clinics, active precepting, case
consultations, combined meetings with patients and psychosocial
seminars in their third year. Audiovisual reviews of taped
patient care sessions, reviewed with residents by pairs of
physician and behavioral medicine faculty, augment the Behavioral
Medicine curriculum all three years. This is a valued
learning method supported by 15 color cameras in exam rooms.
Support groups and Balint-type groups provide opportunities
for residents to integrate personal and professional aspects
of their experiences with patient care throughout residency.
A skin clinic conducted once a week in the FPC is one of
the primary components of the dermatology
curriculum. There are also special clinics conducted at
other sites with dermatology attendings and structured didactic
elements, much of it developed by Family Medicine faculty.
As an ongoing part of residents' development in the Family Medicine Center practice management is incorporated into all
three years of the program. Time is allocated in the second
and third years to learn the principles of practice management,
explore medical computer applications, visit community practices,
and do career planning. Seminars, workshops and other conferences
on practice management topics are a regular part of the conference
curriculum.
Geriatrics is taught by an interdisciplinary group of family
physician faculty and faculty from the geriatrics fellowship
program. There are longitudinal components throughout the
three years that include didactic sessions during R1 and R2
family medicine months, home visits, time with nursing home
residents, and participation in a multidisciplinary team in
the second year.
The final major component of the curriculum is the conference
schedule. Weekly departmental conferences are conducted on
Wednesday mornings. The organization of the conferences in
a single half-day allows the program to arrange for residents
to be free of other duties in order to be able to attend the
Family Medicine conferences. All residents are expected to
attend. The conferences are organized around a set of themes
that are pertinent to the practice of Family Medicine and
teaching strategies are designed to rely on clinical cases
as well as to encourage learner participation.
Four months of elective time over the last two years of residency
provide individuals plenty of opportunity to tailor the program
to meet their particular educational needs. Residents have
used the time to round out a variety of areas of outpatient
medicine, take an intensive inpatient rotation, explore international
medicine, try out practices in communities they plan to work
in after residency, and acquire an understanding of the value
of complementary and alternative health care options that
their patients often ask them about.
Residents in the UNC FM Residency Program work with highly
respected faculty, nationally and internationally, as teachers
and researchers in Family Medicine. Individual faculty members
with special strengths in many different areas provide a wealth
of opportunity to explore a wide variety of educational topics.
Resident Life Style
The residency program strives to address the needs of today's
residents. We recognize that physicians in training are individuals
whose personal lives do not cease with residency. Ways we
acknowledge this are:
- Three weeks of vacation every year
- Well articulated maternity and paternity leave policies
- Resident support groups to help cope with normal residency
stress. Interns have a support group which meets twice a
month. Second and third year residents have Balint-type
groups designed to provide a forum for working out personal
feelings which arise when working with patients.
- A structured professional development curriculum across
all three years of training
- Individual faculty advisors as well as senior resident
'big sibs' advisor
- Creative ways to individualize curricula for people
with unusual backgrounds and personal goals
- An annual beach retreat designed to do some work in
a relaxed social atmosphere and which includes families
