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Family Medicine Residency: Areas Of Concentration

Because the specialty of Family Medicine is broad and the opportunities in practice are plentiful, we have developed several enhanced curricular options for our residents. We have added four Areas of Concentration (AOCs): Direct Primary Care, International Health, Obstetrics and Sports Medicine. These tracks offer our residents opportunities to augment their learning in specific areas of Family Medicine. Residents who elect an AOC will complete the outlined curriculum, gaining expertise and advanced skills geared for use in their future practices.

Residents who have specific interests in one of these areas of Family Medicine will benefit from the structured curriculum and guidance offered by the AOC Coordinator. The coordinator will work closely with the resident to individually specialize the curriculum.

To acknowledge the added expertise gained by these curricular tracks, the resident will receive a letter of recognition from the AOC coordinator. The Program Director will also recognize the resident's additional training in the resident's Graduate Summary letter.

Direct Primary Care - James Breen, MD

For residents who are interested in exploring the possibility of developing a direct primary care practice, our Program has assembled a plan of study and mentorship to assist residents in reaching their future practice goal.  Among the resources are information about the culture at the heart of the model, business start-up resources, as well as ways to gain firsthand experience with direct primary care during residency.

What is 'Direct Primary Care'?

Direct primary Care (DPC) is a term that encompasses a very broad array of primary care practice types. It is more a descriptor of a culture than a practice model; what direct primary care practices have in common id direct contracting between patients (or in some cases, their employers) and the primary care physician. By definition it excludes the intervention of third-party payers (commercial insurance or government-sponsored programs) in the relationship between doctor and patient.

By simplifying the relationship between doctor and patient in this 'insurance-free' model, DPC physicians avoid tangled incentives created by payers' directives and mandates.  This in turn allows physicians to focus their practice solely on activities that improve their care of patients, and to consider alternatives to the traditional office visit in their effort to deliver the most appropriate care in the most effective way for patients.  Because many DPC practices operate under a prepaid membership payment model (similar to a gym membership), they are not incentivized to produce volume, as is the case in a fee-for-service (FFS) world.  The membership model also ensures practices a reliable cash flow that will sustain its operation. With respect to cost effectiveness, the stable upfront remunerative support allows many DPC practices to offer their services for less than the cost of a monthly cell phone plan or gym membership.

There is a wide variety of clinical practice structures that classify themselves as DPC practices.  Many are small or solo independent practices, while others are large multi-site franchised practices that operate across multiple states.  There are traditional office-based DPC practices, as well as house call-only practices and those that operate out of the doctor's residence. DPC practices offer a wide array of clinical services as well; some include office-based procedures and lab studies with their membership, while other charge a small fee for these additional services. Many DPC practices negotiate discounts on ancillary services (imaging, labs) and even sub-specialty services for their patients.

Those who are interested in learning more about this Area of Concentration are encouraged to email Dr. James Breen, @ james.breen@conehealth.com or call him at 336-832-8468.

International Health - Jeff Walden, MD

Goals:



  • To develop knowledge and skills which promote improved care of international patients in the United States and in their native countries.
  • Specific learning areas include developing:
  • A global perspective on diseases and the burden of care needs.
  • An understanding of the factors limiting nations' medical care systems.
  • An appreciation of the stresses resulting from immigration into the United States.
  • Skills for working effectively with interpreters.
  • The ability to provide medical care in a patient-centered manner.
  • Competence in assessing patients' cultural viewpoints.
  • Improved foreign language proficiency, if desired.

Time Commitment:



Two months of electives - one in the second year and one in the third. At least one month will include approximately two weeks in Honduras with a medical brigade.


Curriculum

(flexibility exists in structuring activities):

Second-Year Elective Month

  • Attend Hispanic Clinic/review videotape encounter - four half-days.
  • Participate in UNC SOM Honduras Selective Prep Course - three days.
  • Assist in preparations for Honduras brigade - one day.
  • Participate in Honduras medical brigade - 14 days.
  • Present a noon conference on Travel/International Medicine - one day.
  • FPC continuity clinic - five half-days.
 
Third-Year Elective Month

  • Work in outside clinic with immigrant population -four half-days.
  • Assist in preparations for Honduras brigade - three days.
  • Prepare research study for Honduras trip - three days.
  • Team leader for Honduras medical brigade 14 days.
  • Present a noon conference related to the care of immigrants - one day.
  • FPC continuity clinic - eight half-days.
Longitudinal

  • Provide medical care for families from at least five disparate language and cultural backgrounds.
  • Foreign language development: immersion course, A Su Salud DVD-based study, etc.
  • Attend and present poster at an international health meeting (e.g. GHEC, AAFP International Health).

Obstetrics - James Breen, MD & Kehinde Eniola, MD

Goals:


  • To become competent at caring for low-risk pregnancies. This includes prenatal care, labor and delivery management, postpartum care and contraceptive management.
  • To become competent at performing vaginal deliveries.
  • To become proficient at performing operative vaginal deliveries, focusing on vacuum-assisted vaginal deliveries. This includes understanding indications for such intervention and proficiency at the required skill-set.
  • To become knowledgeable and gain experience in performing operative cesarean deliveries. This includes understanding indications for such intervention and proficiency at the required skill-set.
  • To become knowledgeable and gain experience in performing tubal ligations.
  • To be an active educator on OB topics in the residency program.
  • To develop scholarship skills in the area of Obstetrics.
 

Time Commitment:

2 - 4 months

Curriculum (Flexibility exists in structuring activities):

  • One to three months of Advanced Obstetric Electives. This experience will be with the OB Teaching Service and will include every fourth day inpatient call responsibilities, supervision and teaching of the interns and medical students on the service, and meeting the goals and objectives for the Advanced OB elective. The resident will have time to focus on managing high-risk obstetric patients, learning operative vaginal delivery techniques, and first assisting in cesarean deliveries with attending faculty. He/she will also attend the High Risk Prenatal Care clinic once per week.
  • A two-week elective in OB Ultrasound.
  • An optional two-week elective at UNC-CH Planned Parenthood Clinic focusing on early pregnancy counseling options and surgical and medical therapies for unwanted pregnancies.
  • A publication on an Obstetric topic. The opportunities include the publication of a Clinical Inquiry in The Journal of Family Practice or PEPID.
  • Attendance at the Family Centered Maternity Care conference sponsored by the AAFP.
  • Participation in teaching the Advanced Life Support in Obstetrics (ALSO) course with faculty.
  • Presentation of two noon conferences to the residency on OB topics using evidence-based information.

Sports Medicine - Sara Neal, MD

OVERVIEW:

 What is primary care sports medicine?

• Physicians who care for active people, from the weekend warrior to the elite athlete

• Co-ordinate care of athletes and athletic teams with athletic trainers, surgeons, physical therapists, coaches

• Primary care sports medicine physicians specialize in the non-operative management of musculoskeletal sports injuries and sport related medical conditions such as concussion

 

Do you have to complete a fellowship to care for athletes as part of a primary care patient population?

• Many physicians care for athletes in their practice without completing a fellowship in sports medicine.

• The fellowship offers additional training and a level expertise that would not typically be achieved through completion of a primary care residency

•  A Certificate of Added Qualifications is frequently required to work with professional and NCAA Division 1 teams.

 

What is a Primary Care Sports Medicine Fellowship?

•  An additional 1-2 years of training completed after residency.

•  Most fellowship programs require prior completion of a primary care residency  : Family Medicine,  Internal Medicine,  Emergency Medicine,  Pediatrics or Physical Medicine and Rehabilitation

•  A list of accredited primary care sports medicine fellowships is available at : www.amssm.org

•  Residents typically apply for fellowship positions at the beginning of their third year of residency

• Spots for Primary Care Sports Medicine Fellowships are competitive

 

What is an Area of Concentration in Sports Medicine? (AOCSM)

• curricular guide exposing the resident to focused activities in sports medicine

• mentoring program.  We have three faculty members associated with Moses Cone Family Medicine who have Certificate of Added Qualifications in Sports Medicine (CAQSM) who act as mentors. We also have several graduates of our fellowship in the area who precept at external sites for clinical experiences.

 

Goals of the AOCSM:

1)  Develop advanced examination skills of the musculoskeletal system.

2)  To expose the resident to primary care sports medicine and help facilitate the resident’s decision about further training.  It will also help prepare the resident to be a competitive applicant for fellowship, should that be their ultimate decision.

3)  To gain additional experience and develop proficiency in the following areas:

    • Diagnosing and managing sports medicine and orthopedic injuries.
    • Caring for medical problems in the athlete.
    • Performing orthopedic procedures, including: joint and soft tissue injection/aspiration, fracture management and reduction, casting and splinting, joint relocations, etc.
    • Performing musculoskeletal ultrasound for diagnostic purposes and learning ultrasound guided injection techniques
    • Use of braces, splints and orthotics for injury management
    • Performing sports pre-participation physical exams.
    • Assisting as team physician for various high school and college athletic programs.
    • Acting as an educator for Sports Medicine topics in the residency program.
    • Developing scholarship skills in the area of Sports Medicine.

Time Commitment for the AOCSM

•  4 months :  2 of these months overlap with rotations already required by ACGME for Family Medicine residents. The remaining 2 months are elective rotations.

•  Multiple after- hours events such as pre-participation physicals and coverage of sporting events as availability of the resident and opportunity allows.

 

Curriculum Details of the AOCSM

  (Flexibility exists in structuring activities):

•  1 required month of Sports Medicine/Orthopedics in both 2nd and 3rd years.

•  1 elective month of Sports Medicine/Orthopedics.

•  1 elective month of Sports Specialty, which may include Hand Surgery, Radiology, Pediatric Orthopedics, Rheumatology, etc.

•  Coverage of high school and college athletic events and training room with the Sports Medicine Fellow or Attending.

•  Performing pre-participation physical exams for Guilford College, NC A&T State University and other local schools.

•  Participation in Sports Medicine Seminars on Friday afternoons during Sports Medicine and Elective Months.

•  Participation and presentation at two Sports Medicine Journal Club meetings annually.

•  Publication on a Sports Medicine topic and/ or a poster presentation at a national meeting is highly recommended

•  Attendance at one or more national Sports Medicine conferences, including the annual AMSSM meeting, the AAFP Sports Medicine CAQ Review Course and Team Physician Courses.