Family Medicine Residency Curriculum

The purpose of the organized, procedural Family Medicine Residency curriculum at Wake Forest School of Medicine is to ensure that residents in training have appropriate exposure, both cognitively and experientially, to procedures in family medicine.

A full spectrum of office procedures is available for residents to master including:

  • Colposcopy
  • Cryotherapy
  • Joint and bursal injections
  • Sigmoidoscopy
  • Vasectomy
  • Circumcisions
  • Exercise treadmill testing
  • Endometrial biopsies
  • Radiofrequency skin surgery
  • Ultrasound
  • Common skin biopsies
  • Elliptical excision procedures

Curriculum Goals

The goal of the curriculum is to adequately train and certify each resident in the core procedures of our specialty in a coherent manner. Factors that affect a resident’s ability to competently perform a procedure include:

  • Preparation in the form of reading.
  • Practicing on appropriate models where available.
  • Repeated exposure to the procedure even if not completing it entirely themselves.
  • Actual performance in a supervised setting.

Faculty will actively scrutinize the resident’s technique and provide detailed feedback after procedures. If the resident demonstrates clear ability to perform the procedure, then credentialing for that procedure can be accomplished without reservation, allowing the resident to move on to independent performance without supervision.

Many procedural opportunities are woven through the residency curriculum in:

  • Surgery
  • Maternal health
  • Sports medicine
  • Gynecology
  • Emergency department
  • Inpatient service

Clinical Rotations

Rotations provide practice and education relevant to primary care, even if acquired in other specialty areas. Specific rotations have been carefully selected to meet the educational goals and objectives laid out by our department. Residents' evaluations of learning experiences are carefully monitored, and close contact is maintained between faculty representatives of our department and the other specialty departments in which the residents work.

Residents begin their training with an initial orientation period to acquaint them with their new surroundings and colleagues, including a team-building day. This is designed to lay the foundation for the study and practice of family medicine, as well as to give the resident a sense of his or her home territory before beginning rotations in other clinical departments.

Year 1 Overview

During the first year, residents can expect training that includes:

  • Eight four-week blocks are spent at Wake Forest Baptist Medical Center, the tertiary care hospital affiliated with the School of Medicine.
  • Two blocks are spent at Forsyth Memorial Hospital, an 800-bed community hospital located a few miles away.
  • Three blocks are spent in the Family Medicine Center, which operates under a shift or night float system.

The final two weeks of intern year consist of a two-week orientation to prepare for promotion and a more outpatient-focused curriculum. This orientation involves both clinical, leadership and social activities that focus on acquisition of knowledge and development of procedural skills consistent with the upcoming responsibilities that the residents assume in year two.

Year 2 Overview

In the second year, resident rotations and training include:

  • Two blocks are spent in the Family Medicine department acquiring urgent care skills and efficiencies. Community medicine and practice management are included in these outpatient rotations.
  • One month is spent as the supervising resident on the Family Medicine inpatient service.
  • One month is spent focusing on geriatrics with time in our own clinics along with the outpatient Veterans Hospital.
  • The surgery rotation is designed to provide residents with hand-selected experiences with the Salisbury VA Medical Center and our Wake Forest Baptist Medical Center surgical attendings. Ambulatory pediatrics occurs in the community.
  • The Gynecology/Obstetrics rotation is primarily focused in the Family Medicine Center, and family medicine residents follow and deliver their own obstetric (OB) patients during their second and third years. A block system limits the OB call to a total of ten weeks divided between the two years, shared with another resident. Extra blocks are available for those who wish to practice OB. Teaching and supervision is under the direction of our Family Medicine faculty members.
  • Orthopedics is centered on outpatient skills and is coordinated by our own Sports Medicine faculty.

Second-year residents do two two-week blocks of night shifts for the inpatient service. One block of elective time is available to tailor experiences and pursue unique learning opportunities. The remaining block of critical care (CCU/MICU) involves one week of nights, as part of a cutting-edge team caring for acutely ill patients.

Year 3 Overview

Residents have a structured dermatology-procedure rotation in their third year. You will improve your dermatologic and procedural skills in a variety of observational and hands-on experiences, which include working with a medical center dermatologist and in the family practice procedure clinics (FPC) and wound clinic with our rotating faculty as well as a weekly session with a general surgeon at the local VA Clinic in Winston-Salem for excisions of common skin lesions. There are also a scattering of flexible sigmoidoscopy procedures and five structured stress test slots per week in our FPC.

Much of the third year is spent with community physicians and training. Rotations include the following:

  • Three blocks are elective and can be chosen from a wide array of rotations available through the School of Medicine and local community physicians, as well as distant and international sites.
  • Specialty surgery rotations (including Otolaryngology (ENT), Opthalmology, Radiology and Urology, General Surgery, Dermatology and Procedures) emphasize ambulatory care and involve learning in a variety of medical centers and community locations.
  • A Gastroenterology (GI) rotation is balanced between exposure to common GI disease and acquiring GI procedural skills.

Family Medicine responsibilities during this year include two blocks of outpatient urgent care paired with practice management and a quality-improvement project. Each third-year resident completes one and one half blocks of supervisory inpatient work on our Family Medicine Service.

Wake Forest Family Medicine Center Experience

The Wake Forest Family Medicine Center (FMC) is a 20,000-square-foot center that offers patients, staff and physicians the benefits of a community setting with over 50 providers at the center, including faculty, residents and physician assistants. In addition to other blocks and rotations, residents are scheduled in the Family Medicine Center for care of their own panel of patients for one or two half-days per week during the first year, two or three half-days during the second year, and three or four half-days in the third year. A ratio of at least one preceptor for every three to four residents in the clinic is maintained to enhance the training experience.

Emphasis is placed on clinical decision-making in the ambulatory setting. Residents work beside attendings, physician assistants and medical students as well as obstetric residents who rotate with the Department of Family and Community Medicine to gain experience in ambulatory medicine. Medical students from Wake Forest School of Medicine rotate through the center to learn about Family Medicine as well.

Research Opportunities

Residents are introduced to clinical research concepts through short educational seminars as part of our didactic curriculum. Residents are also guided through a quality improvement project by a faculty mentor allowing them to meet ABFM requirements, learn about their own individual clinic performance, and become familiar implementing simple research design and analysis. Active research conducted by faculty in our department includes exercise and nutrition habits, sports medicine, poultry processing and migrant farm workers, medical education, and work with the school based health alliance. Residents are encouraged to connect with mentors in these areas to assist with ongoing projects or develop ideas of their own.

Conferences and Didactics

Playing an important role in learning and collaboration, conferences include:

  • Noon conference schedule with two to three departmental conferences per week throughout the year.
  • One day each month all residents gather for a resident meeting and afternoon seminar, providing the opportunity for regrouping and a shared intensive learning experience.
  • Each class has its own additional monthly seminar with teaching and hands-on experiences targeted to their level of training.
  • A thirty-minute peer support session with Behavioral Science and clinical faculty once a week during the first year and twice a month during the second and third years.
  • One-on-one monitoring of clinical work involves videotaping, closed-circuit TV and direct observation.
  • A 15-minute Morning Report occurs three times a week and is one of our most beneficial teaching and learning opportunities.
  • Mostly residents and some faculty will present case-based topics that generate lively discussions.
  • A monthly resident-faculty lunch meeting offers a regularly structured opportunity to exchange ideas and information.

Residents also play an active role on departmental committees such as residency selection, curriculum, library and clinical operations. Additionally, each new resident is assigned a faculty advisor for the three years of training.

Evaluation

Procedures will be documented with online procedure reports in our MedHub Residency Management Suite and will state the level of competency the resident has achieved. Reports of clinical problems managed and procedures performed are available when needed for hospital privileges or specialty certification following residency.

Full licensure is expected after the completion of second year. Any fully licensed resident in either second or third year may take advantage of the excellent moonlighting opportunities available in the area.