Family Medicine

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Curriculum

Indiana University School of Medicine Arnett Family Medicine Residency provides residents with an exciting and well-balanced approach to learning in an environment that enhances both clinical skills and personal development. Faculty and residents regularly review the curriculum to ensure it meets the educational needs of our residents to maintain curricular excellence.

This residency program has a longitudinal approach where specific resident educational needs are met using select block rotations during a longitudinal experience in family medicine within the continuity clinic. The longitudinal experience begins in the first week of resident training. At the completion of the program, residents are able to function as capable and empathic physicians in both the medical and business aspects of family medicine.

First-year program rotations provide residents with unique learning opportunities through electives and core rotation experiences such as adult inpatient, obstetrics, and inpatient pediatrics along with continued care in the continuity clinic within the Family Medicine department.

Second-year rotations provided as part of the residency program continue to build on electives and core rotation experiences in adult inpatient, obstetrics, ICU, inpatient pediatrics, and general surgery.

Third-year residents complete final rotations through the residency program with an expanded clinical focus on several electives and core rotation experiences through adult inpatient and ICU.

Continuity Clinic

All ambulatory continuity patients are seen at the IU Health Arnett Family Medicine office. Residents share the panel of patients with the Core Faculty and follow the patients’ care throughout the three years of residency training in this program. Residents also perform nursing home visits along with home visits on selected patients throughout their time in the program. Total number of days that residents spend at the continuity clinic at the Family Medicine practice site depends on stage of training: PGY-1 residents have 105 half days; PGY-2 residents have 110 half days; and PGY-3 residents have 110 half days.

Adult Inpatient and Critical Care

Residents admit patients to IU Health Arnett Hospital. The physical environment at this clinical facility boasts an atmosphere of patient-centered care and was designed with safety in mind. A few of the hospital’s attributes include on-demand food service, bedside patient registration, systemwide electronic medical records, and a 24/7 Hospitalist Program that’s run by a team of Family Medicine and Internal Medicine physicians.

The resident inpatient service has an intern, an upper level resident, and a designated faculty member within the larger hospitalist group available to help provide exceptional patient care within the care team. Primary resident inpatient teaching service at IU Health Arnett Hospital is designed around the concept of residents admitting and following patients throughout their hospital stay. Night float has not been built into the rotations to allow daytime rounding, care and admissions in continuity over the assigned five-week blocks. Residents round daily six days per week, take admissions three days per week, and have assigned continuity clinic and longitudinal learning on the off afternoons. Transitions occur that are led by residents in the evening when transitioning their patients to the night float hospitalist. They receive a report from that hospitalist in a morning report to transition back to their care. Residents continue to care for continuity responsibilities (except for emergencies) during reduced clinics and longitudinal learning to preserve continuity. This allows residents to maximize the experience of caring for a patient through the course of a hospitalization while minimizing transitions and promoting effective transitions within a group of hospitalists, faculty and residents.

Residents have a total of 30 weeks inpatient at IU Health Arnett Hospital over a three-year span. First-year residents complete two five-week rotations of Adult Medicine. Second-year residents in this program complete one five-week rotation of Adult Medicine and one five-week rotation of Critical Care, and third-year residents complete one five-week rotation of Adult Medicine and one five-week rotation of Critical Care.

Inpatient Pediatrics

Residents in this family medicine residency program spend time at IU Health Arnett Hospital in Lafayette and at IU Health Methodist Hospital and Riley Hospital for Children at IU Health in Indianapolis. First-year residents complete a six-week rotation at Riley Children’s Hospital general pediatric services, nursery, resuscitation, and NICU-integration rounds during OB rotation, rounding with an attending physician for pediatric continuity patients admitted longitudinally. PGY-2 residents complete a four-week rotation at Riley Children’s Hospital general pediatric services night float, nursery, resuscitation, and NICU integration rounds during OB rotation, rounding with an attending for pediatric continuity patients admitted longitudinally. In the third year of residency training, PGY-3s complete newborn rounding and resuscitation needs for IU Health Methodist obstetric/newborn calls, rounding with an attending physician for pediatric continuity patients admitted longitudinally.

Obstetrics and Gynecology

Together, IU Health Arnett Hospital and IU Health Arnett Physicians offer many options for patients’ obstetric and gynecologic (OB/GYN) needs. IU School of Medicine Family Medicine residents at IU Health Arnett spend a total of two and a half months in obstetrics during PGY-1 and PGY-2. In addition, residents have longitudinal (continuity) patients for which they are responsible, providing the majority of prenatal care with an expectation to manage the delivery.

All residents experience the following procedures during the obstetrics rotation: spontaneous vaginal delivery; vacuum assisted vaginal delivery; laceration repair (vaginal, first degree, second degree perineal); labor management, including induction ripening and pitocin management, fetal monitoring, intrauterine pressure catheter placement and fetal scalp electrode placement; post-partum hemorrhage management; preterm labor management; limited ultrasound for fetal position; and management of pre-eclampsia.

In addition to the obstetrics rotations, residents during the PGY-2 year experience 25 four-hour clinical experiences that are scheduled longitudinally outside the Family Medicine office with OB/GYN physicians predominantly practicing gynecology. The total scheduled outpatient clinical hours is 100 hours. In addition, residents are expected to round on post-operative gynecology patients during their obstetric rotations and spend some time in the operating room for routine gynecologic procedures. Anticipated gynecology-focused inpatient time during the 10 weeks of inpatient obstetrics is a minimum of five hours per week totaling an additional 50 hours. Twenty hours in the 18-month curriculum of longitudinal learning (non-clinical) time is dedicated to gynecology and includes exposure to most areas twice.

All residents experience the following procedures during the gynecology rotation: endometrial biopsy, IUD insertion and removal, implanted birth control insertion and removal, geriatric gynecology management areas, obtain vaginal and cervical cytology, examination of vaginal wet mounts and KOH preps, colposcopy with cervical and endocervical biopsy, and evaluation and management of gynecologic emergencies.

Surgery

The highly qualified surgeons at IU Health Arnett Hospital have extensive experience in performing every type of surgery—from routine outpatient surgical procedures to complex surgeries requiring coordinated, multidisciplinary care. Advanced surgical treatment options encompass general surgery, trauma surgery, orthopedic surgery, cardiovascular surgery and neurosurgery. Family Medicine residents in the Arnett Hospital program spend time with local surgeons observing and assisting in their clinic and surgeries. During this rotation, PGY2 residents gain experience in caring for the surgical patient during a five-week rotation in surgery.

Common procedures performed include bariatric (weight loss) surgery, breast surgery, chemotherapy ports and catheters, minimally invasive da Vinci robotic surgery, endocrine surgery, gallbladder surgery, gastrointestinal surgery, hemorrhoid surgery, hernia repair, laparoscopic/da Vinci colon surgery, laparoscopic surgery, including antireflux surgery, and office surgery performed in an outpatient setting.

Elective Experiences

Orthopedic and Sports Medicine experiences are built into the Family Medicine Residency curriculum in a longitudinal format to promote skills development, retention and application. The dedicated, non-Family Medicine clinic time is divided between the PGY-1 and PGY-3 years during the longitudinal periods of the year. PGY-1 residents have 30 dedicated four-hour blocks assigned to primarily outpatient Orthopedic and Sports Medicine clinic sites. Some of the clinics are also assigned to physical therapy, occupational therapy and casting clinics. PGY-3 residents similarly have 30 dedicated four-hour blocks with a concentration on outpatient Orthopedics and Sports Medicine clinic sites. Some of their clinics are assigned for inpatient orthopedic exposure, including time in the operating room. The experiences are predominately office-based with a focus on outpatient evaluation and treatment of orthopedic related pathology. Up to one-quarter of the time is dedicated to orthopedic surgery and focuses on surgical correlates to clinical findings. The remaining time is dedicated to joint examination, injury care, rehabilitation, injection technique and exercise prescription.

PGY-1 residents complete 30 four-hour clinical experiences and eight hours of longitudinal learning. This elective requires participation in coverage for two sporting events. PGY-2 residents have eight hours of longitudinal learning and participate in coverage for one sporting event. PGY-3 residents complete 30 four-hour clinical experiences and eight hours of longitudinal learning; third-year Family Medicine residents participate in coverage of two sporting events.

Pediatricians who are part of Riley Physicians at IU Health Arnett provide comprehensive pediatric primary care throughout the West Lafayette region. The services include appointments for patients, birth to college-aged, including well-child and same-day appointments for illness, asthma management, comprehensive sports physicals, and developmental, behavioral, and learning disorders. Resident longitudinal clinic experiences are built to satisfy curriculum schedule requirements. Residents rotate directly with an IU Health Arnett Pediatrician during the first two years of residency training. These are carried out in clinic settings, didactics, group visits, workshops, conferences and OSCE. Residents complete 30 longitudinal clinics in each of the first two years of training.

The geriatric curriculum includes longitudinal components integrated into the Family Medicine continuity clinic and inpatient experience as well as independent exposure to geriatric practice apart from those experiences. There is not a “geriatric rotation or block” built into the schedule, but geriatric clinical days occur throughout the PGY-2 and PGY-3 years independent of integrated components. A minimum of 15 eight hour days are scheduled in geriatric exclusive clinic experiences—mostly in the ambulatory realm to meet 120 scheduled hours. This complements the nursing home continuity experience, inpatient geriatric consult experience, and structured ambulatory geriatric curriculum. Residents also rotate in the Senior Wellness Clinic and perform home visits. Focus areas include (but are not be limited to) Medicare Annual Wellness visits, high-risk medications in geriatrics, differing clinical prevention and chronic disease management guidelines in geriatrics, advanced care planning, home safety, screening for abuse, and screening for early onset cognitive decline.

Residents work closely with the Behavioral Health department within IU Health Arnett along with an embedded Licensed Clinical Social Worker to treat the needs of the patients in the continuity clinic. In addition to the experience received through longitudinal components within the continuity clinic, residents spend time in the Behavioral Health department working alongside psychiatrists and psychologists. Didactics also focus on education in the diagnosis and management of common mental health illnesses.

IU Health Arnett Hospital has more than 250 employed physicians and healthcare providers with an unwavering commitment to better health care for the people of West Central Indiana. The Family Medicine Residency department functions as a medical home such that health promotion and preventive medicine become part of patients’ active care plan. Residents actively participate in group determination of clinic policy and procedures regarding preventive medicine and health promotion. The faculty model healthy and balanced lifestyles, demonstrating dedication to family, patients, community and care of the self through exercise, community service and other valued activities. The Community Medicine curriculum is taught longitudinally with the learning experiences offered through the residency program. Curricular content traverses learning formats that include didactic conferences, journal clubs, small group discussions, preceptor room discussions, web based modules and patient care in all settings.

Other elective experiences are available in cardiology, dermatology, emergency medicine, endocrinology / diabetes education, ENT, infectious disease, nephrology, neurology, ophthalmology, pain management, pharmacy / anticoagulation, physical / occupational therapy, pre-anesthesia testing (PAT) clinic, pulmonology, radiology / interventional, senior wellness clinic, urgent care, urology, and wound clinic.