Family Medicine Residency Program in Baltimore

The Family Medicine Inpatient service providers are a team which includes students, interns, upper-levels and the attending. We feel that it is important that the required internal medicine experience be with family physicians because our goals and objectives are so different. Our focus includes inpatient medicine, continuity of care, family, the role of the consultant, patient education and systems of care. The inpatient team manages patients from the Family Health Center and from community family physicians, who are also graduates of this program. They are also responsible for the Wednesday morning reports.

The Night Float team, of which the interns are integral components, serves as the nighttime continuity member of the FMI, and nursery. Night float runs from Sunday night through Thursday night. Responsibilities include admissions to the service, covering L&D until the continuity provider arrives for the delivery, and managing problems on the floor. It is during Night Float that residents truly become confident and independent.

Behavioral Science

This curriculum follows a three-year cycle that is implemented through the Behavioral Science Conference series (2nd and 3rd Wednesdays), direct observation of resident-patient encounters in the Family Health Center, small group teaching, case-based discussion, videotaping and feedback, on-site behavior health clinic, home visits, research, and precepting.

The CM objectives are met through a variety of activities including home visits, nursing home visits, health fairs, and collaborative experiences throughout the community. Community Medicine sites include:

There sometimes seems to be an impossible amount of training to fit into a family medicine residency, despite our department's commitment to making it as flexible as possible. There is flexibility in many of the set rotations, but more than that, residents have six elective months completely open to any experience they would like to create.

Geriatrics

This curriculum includes a block rotation in year one plus longitudinal experiences including:

The Family Health Department supports a robust Global Health curriculum, with local and international experiences. Residents and attendings are offered training by Physicians for Human Rights to perform Asylum Evaluations, forensic exams that support an asylee’s claim of physical or mental harm. Our annual Global Health Symposium highlights resident research and welcomes international speakers. Residents may elect to participate in the MedStar Global Health Track where they participate in monthly Global Health didactics and additional experiences, such as a 2 week Global Health boot camp rotation.

The Family Health Center offers outpatient substance use treatment though a Medication Assisted Treatment specialty clinic. Residents learn to treat substance use disorders through both hands-on and didactic learning. There is an emphasis on opiate use disorder and alcohol use disorder based upon community need. The MAT clinic uses a harm-reduction model with a goal of keeping care patient-centered and evidence based.

A unique aspect to our residency is that the family medicine inpatient service admits all pregnant patients with non-obstetric medical problems. In many hospitals these acutely ill patients would be admitted by a maternal fetal medicine specialist. In our institution residents get the opportunity to learn management of these high-risk patients with close supervision from family medicine attendings and collaboration with obstetric providers.

Our department continues to grow our OB service, with the goal of all residents graduating feeling not only competent but confident in their ability to practice obstetrics. We have regular simulations using MedStar's Simulation Center to help achieve this goal. Our graduates have been successful at getting privileges to practice obstetrics directly out of residency and obtaining spots in obstetrics fellowships. 

Over the course of their 3 years, residents learn to manage an array of benign gynecologic conditions and perform women’s health procedures. During time spent on the Family Health Center block, residents rotate through procedure clinics and perform colposcopies, endometrial biopsies, Nexplanon and IUD insertions. During the third year, the resident will spend 4 weeks rotating in a private OB/GYN office to further develop his/her understanding and management of more complex women's health issues. 

Osteopathic Medicine is highly regarded as a beneficial and integral part of our curriculum and patient care. Osteopathic Manipulative Therapy (OMT) is taught through precepting during regular patient office visits and during our weekly OMT clinics. We have didactic lectures covering principles of osteopathic medicine.

• Allopathic and Osteopathic residents rotate through our weekly OMT clinics at least twice a year.
• Osteopathic residents are encouraged to utilize their osteopathic skills and knowledge to diagnose and treat patients in a variety of locations, including inpatient and outpatient settings.
• Residents are taught how to bill for OMT.
• OMT tables are available in the Family Health Center for integrating OMT into the residents’ own continuity clinic.

During intern year, all residents will do a four-week rotation at pediatric inpatient rotation at the Children’s Hospital at Sinai Hospital.  During this rotation, you will be part of the pediatric residency team and work with an excellent group of pediatricians and pediatric specialists.   All residents with complete two four-week blocks of pediatric ED.  The second-year block is at the Johns Hopkins Children’s Center.  Third year residents rotate at the MedStar Franklin Square Medical Center. 

Residents additionally spend a 4 week block working in the busy MedStar Franklin Square Medical Center Newborn Nursery where they work directly with Nursery NPs, Neonatologists, Pediatricians, and Family Doctors.  Neonatal Resuscitation (NRP) certification is mandatory and allows the intern to accompany the NICU nurse practitioners to L&D for resuscitations. 

Residents become equally comfortable with the management of a well-baby nursery and of IMC-level patients. The pediatric faculty are fantastic and committed to Family Medicine education. Of course, the inpatient experience is only one facet of the overall pediatric curriculum. Pediatrics is highly represented in our Family Health Center clinic, making up more than 40 percent of total patient population.

The Practice Management curriculum at the Family Health Center encompasses core tenets to prepare for proficiency in joining a practice after residency training.  You will have many opportunities for hands-on experiences to impact clinical care and safety. 

The core tenets of our practice management curriculum are:
–Patient centered care
–Billing & coding
–Quality improvement
–Patient quality and safety
–Contract negotiations

This longitudinal curriculum spans the course of your 3 years here at the Family Health Center at MedSTAR Franklin Square.  Whether it is through our billing and coding didactic sessions, completing a PDSA cycle during your Family Health Center blocks or participation in our twice monthly PCMH meetings, you will be immersed in the daily workings of a medical practice with opportunities to transform clinical care and office logistics.  Residents will have an opportunity to create new curricula, update or create new clinical processes for providers and/or staff.  There may be many opportunities to utilize your skills or interests to create a more effective, team based practice prepared for the 21st century.  The bulk of the curriculum is self-directed with appropriate guidance as needed, however, there are didactics that serve as a foundation for better understanding of these tenets.

Our formal practice management curriculum includes:

During the course of the three years of training, residents will rotate through Urology, Ophthalmology, ENT, Gynecology, and Geriatrics. The specialists with whom our residents work have long standing relationships with the department and often give residents freedom to adjust their experience based on interest.

Residents spend a total of four months working with hospital surgeons, including general surgeons and surgical oncologists, and orthopedists, and these rotations and attendings are rated highly by our residents year after year.

These experiences involve both the outpatient and inpatient evaluation and management of surgical issues, as well as management of postoperative patients in the hospital setting.

The musculoskeletal/sports medicine curriculum occurs in two block rotations, each 4 weeks in length, and a longitudinal experience in the Family Health Center. During the block rotations residents spend time in outpatient orthopedics, orthopedic surgeries, outpatient physical medicine and in MedSTAR physical therapy offices. Our longitudinal experience consists of MSK/sports medicine clinic each week in our Family Health Center, a monthly conference devoted to musculoskeletal issues and a small group splinting workshop each month. Of course during your 3 years of residency there will be many musculoskeletal issues you encounter in your clinic patients. There are many additional elective experiences available through the extensive MedSTAR Sports Medicine network.

Residents and students have opportunities to work with Dr. Kelly Ryan at Maryland racetracks caring for jockeys, providing medical coverage for running races such as Baltimore Marathon as well as opportunities to work with Towson University a Division 1 college working in the training room or providing medical coverage for an array of sporting events. There are also local opportunities at high schools in the area for residents to spend time on the sidelines.

Residents participate in daily 8am morning reports covering a variety of topics, including weekly Family Medicine Inpatient cases and weekly OBGYN cases. Tuesday Pediatric conferences include monthly Pediatric Grand Rounds, Neonatology cases, Pediatric cases, and Pediatric Board review. Thursday afternoons are protected didactic time for residents, who participate in interactive discussions and presentations that cover core medical topics, monthly board review, monthly hands-on simulation training, and monthly inpatient critical care simulations. The MedStar Simulation Training and Education Lab provides dynamic hands on experiences through live and alternative simulation models to enhance resident learning.

Throughout their training, residents will present conferences, including a Pediatrics Resident Grand Rounds, a Family Medicine Resident Grand Rounds, a Safety Conference, a Journal Club, and a Scholarly Activity. In addition to our annual Scholar’s Forum, the residency hosts an annual Preventative Medicine Symposium, and as well as a Global Health Symposium. Topics such as financial planning, population health, residents as teachers, and legislative updates are also a regular part of the core curriculum, providing the education needed to become a successful and informed physician.

We have a robust curriculum to help residents meet their ACGME graduation requirement for scholarly activity. Residents are encouraged to explore their clinical and academic interests by completing their projects over their 2nd and 3rd year. The MedStar system provides biostatistical support for all residency projects and hosts a yearly research symposium. Within the residency we have a strong research support team with several faculty members trained in research methods and EBM. Third year RESIDENTS present their scholarly activities as part of our Scholar’s Forum, which is part of our end of year celebration of graduating residents. Resident projects vary from highly quantitative statistical analyses to service-oriented projects to qualitative interviews with patients. We have presented resident projects at STFM National Conference for the past several years. Recent projects include: “Development of Racism in Medicine Curriculum”; “Training residents to provide preconception counseling to individuals living with HIV-A CERA Study”: “Implementing a Protocol for Evaluation and Treatment of Anemia in Pregnancy at the Family Health Center.