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Index of Topics
What kinds of practices do your graduates
end up in?
The majority of our graduates have gone into private practice,
mostly in small groups. It is common for them to start out
working full time in the public health sector (Community Health
Centers, Indian Health Service, Correctional Medicine), and
in recent years post residency fellowships have become attractive
to our graduates. Fellowships ranged from 1 to 3 years and
are designed either to obtain additional training in research
and teaching for possible academic careers or to acquire additional
clinical skills in such areas as sports medicine and obstetrics.
Over the years about 60-65% of our graduates have stayed in
North Carolina to practice medicine. A record 100% of our
2002 graduates stayed in North Carolina.We have about 10-15%
of our graduates who choose academic careers. Four 2005 graduates
went into fellowships or joined faculties and five joined
practices locally or in other states. Approximately 25% have
full scope community practices that include obstetrics, inpatient
medicine and procedures. The scope of practice varies, but
those who do obstetrics tend also to include inpatient care.
Others include inpatient medicine, but choose not to do obstetrics.
Over the years about 75% of graduates report including inpatient
medicine, and in recent years about a fourth report obstetrics
to be part of their practice. Our goal is to train residents
so that they can leave this program feeling competent to provide
full-scope FP (delivering babies, inpatient care, procedures,
ambulatory & ED care) if they choose. Lifestyle factors play
a big part in graduates' choices about practice. (To
Index)
What changes do you foresee in your rotation curriculum?
There have been some major changes to the curriculum in
recent years in response to the requirement from ACGME limiting
work weeks to an average of 80 hours and duty periods to no
more than 24 hours without a break. Building on what we believe
to be a sound basic rotation curriculum we continue to offer
a mix of community and university hospital experiences we
have made a number of changes which we believe will serveto
improve the quality of residents' experience here.
- Call coverage on the Family Practice Inpatient Service
now begins at 12:30 p.m. All post call residents are required
to leave the hospital by no later than 12 p.m. the day following
call.
- We are excited to be able to structure six-week blocks
of what we are calling Quality Improvement in Practice into
both the R2 and R3 years. This new rotation, funded by a
Title VII Residency Training Grant, allows us to combine
a wide variety of experiences that focus on enhancing residents'
outpatient training. In addition to more time in pediatrics
and work at a site with low-income patient populations,
there is dedicated time to devote to CQI projects, an opportunity
to lead mortality and morbidity conferences, and a senior
project to develop skills in chronic disease models of practice
management.
To Index)
How much emphasis is there on maternal and child health?
One of the many strengths of our program is our Maternal
Child Health curriculum. Our program has been reported in
the literature (Fam Med, 2003; 35:174-80) as a unique blend
of education and patient care that combines the viewpoints
and philosophies of family physicians and midwives. The RRC
requires 3 months of OB/GYN -- we have 6 weeks of OB with
obstetricians in a large community hospital and then 4.5 months
of maternal child health with the FP faculty for a total of
6 months of exposure that includes OB and perinatal health
care of children. We teach appropriate intervention for labor
and delivery and newborn care and have a predominantly resident-run
clinic for acute child care and more complicated prenatal
patients.
The 'C' of MCH is also a strength of our program--newborn
care, FMC children's acute care clinic, pediatric care at
a health department, urban and rural pediatric settings, and
Teen clinic are all part of residents' experience during MCH
months. The residents also have 3 months of pediatrics with
the Pediatrics services at Wake and at UNC Hospitals. A second
year rotation includes at-risk populations in a rural pediatric
clinic.
(To Index)
Are changes in leadership anticipated?
There are no changes anticipated for the coming year.
(To Index)
What is the accreditation status of the program?
The residency program was reviewed in May, 2005 and received
full accreditation for three years. The next RRC review is
due to occur toward the end of 2008.
(To Index)
What are the strengths and weaknesses of the program?
Since this is such a common filler question during interviews,
we are probably making it difficult for candidates by answering
it here. On the other hand, for those who are creative they
will be grateful for the opportunity to explore the question
in depth using the list below as jump-off points or examine
other avenues of inquiry entirely.
Strengths
- Broad scope family medicine training including MCH,
inpatient care, and the full spectrum of outpatient office
practice throughout all three years of residency, all taught
by Family Physicians
- Broad procedural experience taught by Family Physicians:
colposcopy, flex sigs, vasectomy, circumcisions, exercise
testing, dermatologic procedures, acupuncture
- Midwife on faculty
- Strong diabetes experience with special emphasis on
behavioral change components--as you know diabetes is becoming
a national epidemic
- Blend of community hospital, outpatient experience
and tertiary care experience--best of all worlds
- Exposure to diverse group of talented faculty clinicians,
teachers, researchers--strong identity as an academic department
- Diversity of resident physicians--we attract a unique
group of residents who enrich our program with their individual
interests and strengths.
- The state of NC is beautiful! And this part of North
Carolina provides particularly nice life-style options.
Weaknesses
- Intensity of program. This program is intended for
candidates who are interested in being trained for the broadest
scope of family medicine training. It takes commitment to
this concept. Candidates who are looking for intensity of
the program to significantly decrease after internship might
find our program too demanding for their style. Our second
and third year residents have increasing leadership responsibilities
in patient care and teaching of other residents and medical
students.
- Driving. Several of our rotations involve some commuting
(the rotations at Wake are most notable in this regard).
All the residents say these rotations are 'worth the drive.'
However, for those who do not like driving or commuting
this could be a turn-off.
(To Index)
With what innovations and leadership has the program
and UNC Department of Family Medicine distinguished itself?
We believe that one of the most important things a university-based
program can offer is opportunity to engage in innovative change
and advancement of the knowledge within the discipline. We
can point to a significant list of ways that our faculty has
worked to achieve distinction within the UNC University and
Hospitals sytems as well as nationally. You will find here
examples of exellence and achievement in:
Clinical
Care
Education
Research
and National Leadership
(Follow links for details.)
(To Index)
What can you tell us about intensity of call?
We follow the ACGME guidelines for frequency and duration
of call and no more than 80 hours per week on average for
any month. Most inpatient months are every 4th night call
schedules. Obstetrics and MCH are exceptions. The number of
residents available any given month will determine the call
on the OB service rotation. MCH is a q3 call on average, but
this is call from home, so when there are no active labor
patients, residents do not stay in the hospital. When the
months with call are averaged together with those where there
is no call, the average in-house call over the year is: q6
for R1, q8 for R2 and q12 for R3. The change in duty hours
requirements has significantly improved the consistency of
recovery time following call duty hours.
(To Index)
How are residents viewed by staff in other departments
of the institution?
This is a common question we receive from candidates who
are concerned about the way FM residents are treated in academic
medical centers, and they will only get an answer they may
believe when they come for an interview and talk with our
residents directly. It is our feeling that the high quality
of our residents over the years has built a strong reputation
among their colleagues in the institutions where we work,
and that there is an expectation for strong clinical skills
in the FM residents. Accordingly, we feel that the other departments
treat their off-service FM residents as equal members of whatever
team they are on.
(To Index)
Do you provide computing devices for residents?
The use of computers is increasingly important in the
practice of modern medicine. The residency program aids residents
in developing personal skills with information technology
in several ways. Personal data assistants (PDA's) have become
widely used in business and medicine. We have established
a system that relies on PDA's to relay information about clinic
schedules as well as beeper numbers, important phone numbers,
and so forth to all the residents in the program. We feel
this has been very successful and residents have found unique
ways to incorporate the use of Palms into their personal organization,
teaching, and communication with one another. It is possible
for individuals without the personal resources to acquire
a PDA to use part of the educational stipend that the program
provides to obtain a PDA and be able to take advantage of
these resources.
Our building has a well developed local area network,
now including wireless connections,which allows access to
word processing, graphics, laser printers and many other software
packages, as well as direct access to the Internet. Free online
computer searching of Medline is available through the UNC
Medical School. Connection is possible to the network, the
Internet, electronic medical records, electronic mail and
radiology studies from the FMC, our hospital inpatient office
and home computers.
Experience with electronic medical records is another
important part of the computer curriculum. The Family Medicine
Center has a computerized medical record, which has a web-based
interface. WebCIS, as the system is known, is in an advanced
stage of development. It is an on-line information systemthat
provides access to FMC dictations, hospital discharge summaries,
laboratory results, radiology and other imaging studies, patient
scheduling, problem lists, medication and allergies, and notes
from other clinics at UNC Hospitals. Within recent years it
has added the capability of online prescriptions and communications
features for clinicians and nurses to send one another notes
regarding patient care and continues to have a development
team involved in adding features to the system on a regular
basis.(To Index)
What is the "Educational Allowance" and how can it be
used? What are the annual salaries for residents?
Every incoming intern has a total of $2,000 that can be
used over the three years for educational expenses, including
books, subscriptions and travel to conferences. Most residents
have used it for 1-2 conferences, travel to elective rotations
and subscriptions.
The current salary scale for residents is:
- R1 - $43,000
- R2 - $44,500
- R3 - $45,500
(To Index)
Will I have the opportunity to teach medical students?
Yes! The opportunity to teach and to recruit medical students
into Family Medicine is one of the attractive features of
working at UNC. The University of North Carolina Family Medicine
student program is a vital part of the Department's mission
in the institution. Residents' interactions with students
on clinical rotations are vital to attracting medical students
to family medicine. Family Medicine interns also work with
third year students when rotating on Pediatrics, Medicine,
Surgery and Obstetrics services; our inpatient service frequently
has Acting Interns. In third year our residents have an opportunity
to precept under supervision in the FMC. All residents also
help with coverage of the Student Health Action Coalition
free clinic that is organized and coordinated by the medical
students at UNC Medical School. The continued presence of
psychiatry first-year residents on our service this year emphasizes
the importance of gaining teaching and supervisory skills.(To
Index)
Where do your residents work?
Our philosophy is that diversity of patients and patient
care settings is crucial for resident training. The Family
Medicine Center, where residents' continuity practices are
located, serves a cross section of Chapel Hill. Just over
half of the patients are adults between the ages of 20 and
60, with 25% of the patients over 65, 30% black, and 20% Medicaid.
Most of the hospital rotations take place at either the University
of North Carolina Hospitals, a tertiary care facility with
comprehensive facilities or Wake Hospital, a large community
hospital about 30-40 minutes away in Raleigh. Short rotations
in other settings--local practices, rural community health
centers and practices, the Student Health Service--provide
specific clinical experience and exposure to other kinds of
clinical settings. (To Index)
In addition to more traditional conferences, this residency
has conferences entitled "Critical Appraisal Rounds." What
is this conference?
Evidenced based practice has been a staple of training
at this residency since before its educational application
was popularized. One manifestation of this is our conference
series, Critical Appraisal Rounds. Residents and Faculty take
joint responsibility for presenting an interesting case or
clinical question and an article that relates to the question.
Discussion focuses on the quality of the evidence and whether
it changes management of the clinical problem. Approximately
once a month, the format is a formal debate about some aspect
of clinical care. The topics are diverse and timely. (To
Index)
Are faculty members involved in
research?
The University of North Carolina ranks fifth in the country
among departments of Family Medicine in NIH funding for research.
Reports of research in this department has included prevalence
of Disney cartoon characters shown smoking, relationship of
residency program characteristics to Match outcomes, and prevalence
of sexual concerns among female patients in outpatient clinics.
Numerous other research projects have conducted investigation
into rural health manpower, managing dizziness, nursing home
effectiveness for Alzheimer patients, pap smear quality, and
management of low back pain. Current research projects are
exploring spirituality in medicine, effectiveness of acupuncture,
and the treatment and management of osteoporosis.
A common theme of much of the research in our department
is improving the effectiveness of primary care. The faculty
members involved in these projects are involved in residency
teaching. Our philosophy is that ongoing patient care related
research enriches the learning environment. Residents are
encouraged but not required to do research. However, they
are required to do two projects during their residency. In
Year 2 during Family Medicine Month they do a short group
project examining an aspect of preventive care, and in Year
3 they do a major project over the course of the year aimed
at improving some aspect of the actual practice as it is conducted
in the FMC. Both projects involve a detailed examination of
the questions related, thorough search and review of the literature,
chart reviews of current practices, summary of findings and
recommendations. Formal presentations at conference time serve
to complete these projects. (To Index)
Are fellowships available here?
The Department of Family Medicine and University of North
Carolina are nationally renowned for the variety and quality
of fellowship training available. Our fellows have gone on
to take leadership roles in the AAFP and in departments across
the country. Opportunities for training in research are available
in the Department's Primary Care Research Fellowship. Clinical
fellowships are available in Geriatrics, and in Preventive
Medicine. For next year, the Department will continue offering
full-time fellowships directed at training leaders in Family
Medicine education and in Academic Medical Centers. Finally,
the Department has run a part-time fellowship for faculty
across the country since 1979. Almost 10% of all faculty in
Family Medicine in the United States are graduates of the
UNC Department of Family Medicine.(To Index)
How does your selection process work? Should I expect
further communication from you after the interview?
We participate in the Electronic Residency Application
System, and all applicants should consult their respective
medical schools to learn how to use this system. Using the
information available through ERAS we screen candidates' applications
and will begin inviting individuals for interviews as early
as we can, usually around September. We conduct formal interviews
on most Mondays and Fridays November through January. The
evening before interview days, some of our residents meet
with candidates informally over meals provided by the department.
Further application information is
available via this link.
At every step of the process, residents play a very active
role in selecting their colleagues. In early February, we
prepare a draft rank listing of all applicants based on a
scoring of academic records (50%) and interviews (50%). The
interview score is obtained by averaging faculty and resident
evaluations, and all evaluations are counted equally. This
draft match list is then modified at a combined resident-faculty
meeting before being submitted to the NRMP.
We honor the spirit and the letter of the National Residency
Match Program, which is designed to protect the interests
of medical students. Applicants should expect to receive an
acknowledgement from the program after their visit, but in
no case will there be a promise of a position in advance of
the match. We encourage further communication from candidates-often
there are additional questions that need to be addressed after
getting back home and some people like to come back for a
second look. We are perfectly amenable to that and will be
happy to help anyone who wishes to do so make the necessary
arrangements.(To Index)
How successful has your program been filling positions
through the Match?
Since 1993 the program has successfully filled all its
positions except one (in 1999) through the Match. That position
was filled the day after with an exceptional candidate. We
feel our failure that year could be attributed primarily to
a declining interest medical students have displayed for going
into Family Practice, a shorter than usual list of candidates
that we submitted, and an experimental application process
we tried that year. Given the fact that Family Practice residencies
across the country are experiencing difficulty filling in
the current climate surrounding specialty choice by medical
students, we would recommend caution in using this as a criterion
to make your choice about a FP residency. Many excellent
residencies have not filled on Match Day in recent years and
many will probably continue to struggle to fill initially.
If you like what a program offers, it fits your career directions,
and has the right combination of features to meet your personal
needs, that is probably of higher significance than an imperfect
Match record.
(To Index)
What sorts of opportunities exist for my spouse, significant
other or other family in the Triangle area?
The Triangle
has much to recommend it as a place to live. Three outstanding
institutions (UNC,
Duke, NC
State) offer a wide variety of graduate programs and employment,
as well as an excellent variety of cultural offerings. Unemployment
is low, with many industries located in the Research Triangle
Park and an economy that continues to have signs of growing.
Finally, the climate allows year-round outdoor recreation.
Both the ocean and the mountains are within "weekend distance."
The attractiveness of the area combined with a very comfortable
climate throughout the year have made the triangle area a
very attractive retirement community as well. (To
Index)
Last
Modified: September, 2007
Copyright
© 1998 UNC-CH Dept of Family Medicine -- All rights reserved
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