About Our Longitudinal Curriculum
The curriculum at VCU - Fairfax Family Medicine is based on the philosophy that the best way to learn how to be a family physician is to learn from experienced family physicians in a setting that reflects where and how they practice.
The program employs a longitudinal curriculum. The first year is largely hospital-based and traditionally structured with block rotations on all the major services where they develop a solid foundation of medical knowledge. Rotations include general medicine, adult and pediatric emergency medicine, surgery, pediatrics, critical care, and OBGYN. In addition all first year residents have regularly scheduled patient care in the Family Medicine Center including a month long Family Medicine Rotation to begin developing core office skills. In the second and third year, residents are based in the Family Medicine center full time where they follow a large, diverse population. They develop their own patient panel and assume the role of the primary care provider for their patients. Hospital care and specialty electives are incorporated into the office schedule, allowing maximum patient continuity.
The faculty functions as a "clinician teacher," which refers to a physician with superb clinical skills and active academic interests. Residents are "clinician learners”, which refers to early practitioners of family medicine whose skills and knowledge are developing in an academic environment. In this setting of academic excellence residents and faculty jointly pursue innovative methods to deliver the best in medical care for acute illness, chronic conditions, and preventive care.
Scheduling and Mechanics
There are 17 family medicine faculty providers and two part-time behavioral scientists at the family medicine center. The faculty and residents see over 50,000 patient visits per year at the family practice center. The faculty practice side-by-side with the residents in the center. Faculty time is divided on average of 60% clinical time and 40 % academic and administrative time.
The practice admits to two hospitals:
- Inova Fairfax Hospital, a large tertiary care, teaching hospital located 10 miles from the family practice center
- Inova Fair Oaks Hospital, a smaller community hospital adjacent to the family practice center
First year residents rotate for 12 months using block scheduling through the various services at Inova Fairfax Hospital. Additionally, first year residents spend one-half day per week seeing patients in the family practice center.
Second and third year residents are primarily based in the family practice center. The center has three teams of providers, each consisting of faculty, residents, mid-level providers and nursing staff. Second year residents are paired in a 1:1 partnership with a third year resident who share an office and a primary nurse. This partnership provides third year residents to serve as role models and mentors for their second year partner. In general, partners take call together, particularly during the first half of the second year.
Each resident has their own panel of patients for whom they serve as the primary physician. In addition to seeing patients in the office, residents also perform home visits and nursing home visits under the direction of our geriatrician.
To maintain maximum continuity in the office, electives rotations in the second and third year are arranged as two or three week (half day in length) experiences in the ambulatory care setting of consulting specialists.
During the second year, residents have 15 weeks of elective experiences:
- Urology-one week (full day)
- Newborn Nursery-two weeks
- ENT-two weeks
- Ophthalmology-two weeks
- Pediatrics-three weeks
- Free Elective-four weeks
Third year allows for 16 weeks of elective experiences:
- Orthopedics-four weeks
- Surgery-two weeks
- Free Elective-10 weeks
The curriculum incorporates didactic teaching via a core curricular lecture series, daily noon conferences and scheduled meetings.
Residents have dedicated lecture time for the core curriculum lecture series. The core curriculum lectures are presented by specialists and the family medicine faculty. The lecture schedule is:
- PGY-1 - second Thursday of the month 2-5 p.m.
- PGY-2 - Tuesday 2-5 p.m.
- PGY-3 - Wednesday 2-5 p.m.
First year residents also attend lectures, grand rounds and case conferences on their respective hospital services.
Noon conference provides the forum for a variety of educational opportunities. Residents and faculty meet together to discuss call from the night before and the hospital service. Additionally, noon conference serves as the venue for didactic lectures and workshops presented by family physicians and subspecialists; focused chart reviews presented by residents; case conferences (geriatric, obstetrics, behavioral science) organized by faculty members and various other topics of interest. Included in the noon conference schedule are adult/pediatric murmur clinic and dermatology clinic. These clinics are directed by board certified specialists providing residents the opportunity to further enhance their knowledge and clinical exposure within these disciplines.
One of the hallmarks of the program is preparing residents for successful practice after residency. Annually, third year residents attend a two day Practice and Office Management Conference that provides intensive exposure to important issues surrounding practice management. The annual conference is organized and facilitated by experienced faculty members from the VCU Family Medicine Central Department in Richmond, Virginia.
Additionally, second year residents attend organized Resident Business meetings held every other month at the family practice center. The content of the Business Meeting is coordinated by Dr. Lee Blecher and a third year resident business coordinator. The meetings provide a forum for discussion with respect to various practice management topics such as practice marketing, office economics, personal finance, medical malpractice and other insurance issues.
Resident Business meetings also provide the opportunity for residents to receive individualized reports regarding data specific to the number of patients seen, visit types and associated billing and coding. The individual reports are reviewed privately with the resident’s advisor.
The CEO of the practice provides up-to-date issues surrounding the current business climate associated with the practice of family medicine.
To further the development of hospital skills after completion of the PGY-1 year, second and third year residents rotate care for the practice’s hospitalized patients on a weekly basis. The residency provides hospital care for patients from the family practice center and functions as hospitalists for several of our affiliated offices. The combined hospital service averages 10-15 patients per day.
The hospital team consists of three faculty and four residents covering our two hospitals. One faculty and one resident are assigned to each hospital for the week. These four individuals spend the morning caring for the hospital patients and cover weekend call. One resident each week serves as hospital “swing” resident and rounds wherever needed most.
During the week, residents assigned to the hospital service divide afternoon “short call” duties caring for afternoon admissions, following up on tests and laboratory results and discharging patients who were not ready for morning discharge. Evening and night call rotates among all the residents; second and third year residents average call once every 7-8 days.
Evaluations and Outcomes
Resident performance is monitored on multiple levels. Feedback is an integral and consistent part of our program’s adult learning model. Due to the availability and close personal and professional relationships with faculty, feedback is immediate, personal and concise. Using a web based evaluation tool (MedHub), feedback from and about residents is solicited for each learning activity.
Each resident is formally evaluated biannually; the focus of which is the ACGME core competencies. Feedback regarding resident performance is solicited from faculty, staff, patients and peers. Data is gathered though direct observation, 1:1 consultation with faculty, small-group interactions, focused chart reviews, patient surveys and review of MedHub data. Our use of an electronic medical record provides data to assure uniformity of clinical exposure for each resident. This allows the faculty to make individualized curriculum adjustments to enhance the learning experience. Compiling data for over twenty years allows Fairfax Family Practice to demonstrate consistency and range of resident clinical experience over time, not just within an academic year.
Second and third year residents consistently score above the mean on the annual In-Training Examination. Our graduates have had a 100% pass rate on the ABFM Board Certification examination. Graduate survey responses indicate residents completing the program have felt “exceptionally well qualified” to practice medicine in a variety of settings. Practices employing Fairfax graduates have contacted the program informally to indicate “how exceptionally well prepared” our residents are for the pace of a busy, real-world office setting. As a result, the majority of graduating residents are afforded multiple job offerings.