Health and wellness, if presented well, can spread through a community like a folk story, or like the spoken word, and I think that's one of the powerful things about family medicine.
LaKisha Garduño
Class of 2013
The UCSF Family and Community Medicine Residency Program is founded on a systemic understanding of health. We believe that the health of one individual is intimately and inextricably connected to the health of all individuals. We train residents to think systemically, addressing both the minutia of cellular processes and macrosystemic issues such as culture and policy.
This systemic approach leads directly to an understanding that everyone’s learning experience is connected, and that each of us has both things to learn and things to teach. We seek to find each resident’s strengths and learn together as a team.
We believe that residency is a time to transition from learning by reading to learning by doing. We are a fast-paced residency and a diverse and inquisitive community, learning through dialogue and shared experiences. Residents who learn best through action, who learn in community, and who enjoy being challenged thrive here.
Clinical Training:
Our residents train almost exclusively in San Francisco’s Department of Public Health (DPH) clinical network, where over 95% of the patients are uninsured or insured through Medicare or Medicaid. Resident continuity clinic is at the Family Health Center, the largest primary care clinic in the network. Residents are responsible for a panel of patients starting in their first year. Because we place a strong value on relationships in medicine, we prioritize continuity in scheduling, and our residents have approximately a 70% continuity rate with their patients. Intern clinic is every Thursday afternoon, allowing first year residents to gather together weekly and work with a consistent group of faculty preceptors throughout the year. Second and third year residents are also scheduled with consistent preceptors once a week while on outpatient rotations so that they can benefit from continuity teaching relationships.
The Family Health Center offers a wide range of services, including nutritionists, a behavioral health team, and many specialty clinics that residents rotate through for training. These include: Minor Procedure Clinic; Womens and Infants Clinic; Pain Group; Diabetes and Hypertension Group Visits; Substance Use Clinic; Teen Clinic; and Family Care Unit. In addition, residents rotate through a variety of specialty clinics for further training.
Our residency offers strong inpatient training, preparing graduates to manage advanced disease with confidence. We run an independent family medicine inpatient service, staffed by teams that are led by second and third year residents. On this service, we work very hard to address the severe illnesses endured by patients, and we work just as hard to address the social determinants of health that contributed to hospitalization.
Family and Community Medicine residents are the only interns on the labor and delivery floor at SFGH, where they are supervised by fourth year OB residents. Our second and third year residents manage the antepartum service and are present to support and mentor our first year residents on OB. During second and third year, residents have the opportunity to rotate at outside labor and delivery sites to increase their delivery volume and hone their skills.
Our residents are also the only interns on the SFGH pediatric wards, where they are supervised by second and third year pediatrics residents. Our residents also rotate through the SFGH nursery, where they see a high volume of neonates. During all three years of residency, residents spend a month in the pediatric urgent care clinic or pediatric emergency room. There, residents become very skilled at addressing common pediatric outpatient complaints. This training complements the pediatric training experience residents have in their continuity clinic, where they learn well-child and preventative pediatrics.
Classroom Learning:
Although clinical training is the core of residency, classroom time can help supplement the learning in the clinical environment and allows us to build a vibrant learning community. Each year of residency has a specific series of protected longitudinal curricula that are designed to meet the needs of residents at that stage of training. In general, our longitudinal curricula are structured with a focus on knowledge building in the first year of residency, skill building in the second year of residency, and practical application in the third year of residency.
In addition to a longitudinal series of clinical lectures and workshops, we provide a social medicine curriculum that runs through three years, a practice transformation and quality improvement curriculum, a behavioral medicine curriculum, and an advocacy and community engagement curriculum. All residents are required to do a quality improvement or practice transformation project and a community engagement or advocacy project during residency.
Because we value a learner-centered model of curriculum design, our residents also participate in a self-organized curriculum during the second and third year of residency in which residents identify their own learning goals as a group and develop a curriculum together to meet those goals.