UCSF Fresno Family Medicine Residency

Fresno Community Regional Medical Center

The UCSF Fresno Family Medicine Residency Program is a dynamic program offering ambulatory and inpatient training, including obstetrics, in a variety of settings. Community Regional Medical Center (CRMC), a busy tertiary health care system in the San Joaquin Valley, along with several other rural health care systems based at federally qualified health centers and Adventist Health are some of the many partners UCSF Fresno FCM works to meet the healthcare workforce needs of the Valley. The program is distinguished by providing a wealth of clinical experiences and a broad scope of practice training that prepares graduates to work in resource poor settings. Training is further enhanced by weekly educational half-day didactics and workshops covering a diverse range of topics such as behavioral science, geriatrics, and procedural skills. The program’s model of community-based training provides a structure that balances the service, workforce and education needs of a large multi-cultural underserved and indigent population in the region.

The UCSF Fresno Family Medicine Residency program implemented the UCSF Double Helix Practice Transformation curriculum into their program in July 2016. A Continuous Quality improvement (CQI) curriculum has been implemented to cover all three years of residency training. QI didactics have been integrated into the R1 curriculum with material from the practice transformation curriculum. 2nd and 3rd year residents develop CQI projects; R2’s with their clinics and R3’s from their panel of patients. Residents are expected to present their findings at the annual UCSF-Fresno Family Medicine QI forum at the end of the year.

UCSF Fresno Family Medicine has also expanded their panel management and population health curriculum using practice transformation curriculum materials. Residents receive longitudinal training in patient registries and panel management including one on one time with faculty to review patient panels, optimize patient care and discuss future QI projects.

UCSF Fresno Family Medicine has also integrated practice transformation and team-based care concepts into the R1 clinic orientation sessions as well as in the didactic educational series. Multiple didactic sessions have been added to the curriculum to teach basic principles of the 10 building blocks to residents, faculty and staff.

We are currently developing an interactive timeline detailing how this residency implemented the UCSF Double Helix Practice Transformation curriculum into their program. It will be available on this page in Summer 2017.

Tips from the Residency Program...

What tips do you have for other programs looking to create time to teach these additional materials?
  • We used intern orientation to do some of the care team and team building activities as well as patient-team partnership workshops.
  • We built panel management teaching into the first half of intern clinics 3-4 times/year.
  • We built panel management and quality improvement teaching into rotation templates for PGY-2s.
  • We added the lectures into already existing resident educational time.
What tips do you have for other programs looking to identify which materials to use?

We looked at our program’s curriculum and tried to expand parts of the curriculum, such as our panel management and quality improvement projects. We also emphasized the care team thread as that was being implemented into the clinic as well.

How do you recommend other programs think about prioritizing these teaching sessions (or threads) throughout the three years of residency?

We made care team and huddles a priority in clinic. We built panel management and QI teachings into existing rotation curriculum and put an emphasis on them by having 2nd and 3rd years present their QI Projects at the annual QI forum.

What are some difficulties that other programs can anticipate in implementing these materials? Do you have any recommendations for how to overcome these difficulties?

We have had a difficult time training all faculty to incorporate the 10+3 Building Blocks of High Performing Primary Care into their daily teaching. We are working on improving this by training more faculty in practice transformation using the Practice Transformation introductory lecture and clinic assessment workshop.

How have these teaching sessions generally been received by residents?

Overall, residents have been very receptive to this new curriculum. They really enjoy seeing their panel of patients during panel management and have enjoyed doing the team huddles before every clinic.

Any final recommendations?
  • Include clinic staff in the 10+3 Building Blocks of High Performing Primary Care trainings and QI projects if possible.
  • It's helpful to have faculty working on clinic transformation and curriculum work together.