Family Medicine Residency - Curriculum

Experience a wide variety of learning opportunities and rotations.

Resident schedule overview

Within a clinic-first curriculum model, all rotations are in two-week blocks (with the exception of Continuity OB and ICU).

Residents typically have two weeks of an inpatient-heavy rotation, followed by two weeks of a rotation with an outpatient (a continuity clinic) focus.

Several rotations are longitudinal, with experiences throughout all three years of residency.

Behavioral Science Education (BSE) is woven throughout the curriculum. Protected time with our behavioral science faculty and various training experiences are incorporated into numerous rotations and appear in the graphic below as BSE.

PGY1		PGY2		PGY3
Rotation	Duration	Rotation	Duration	Rotation	Duration
Inpatient Service	6 weeks	Inpatient Service	12 weeks	Inpatient Service	6 weeks
Pediatrics/BSE	6 weeks	Pediatrics/BSE	6 weeks	Pediatrics/BSE	6 weeks
Night Float	6 weeks	Night Float	4 weeks	Night Float	2 weeks
Obstetrics	6 weeks	Continuity Obstetrics	6 weeks	Psychiatry/Geriatrics	4 weeks
ICU	4 weeks	Electives	8 weeks	ER	2 weeks
ER/BSE	2 weeks	MSK/POCUS	4 weeks	Electives	16 weeks
Surgery	2 weeks	Psychiatry/Geriatrics	2 weeks	Dermatology	2 weeks
Dermatology	2 weeks	ER/BSE	2 weeks	MSK/POCUS/BSE	2 weeks
MSK/POCUS	2 weeks	Ambulatory Surgery	2 weeks	Family Physician Development	2 weeks
Family Physician Development/BSE	2 weeks	Family Physician Development/BSE	2 weeks	Cardiology	2 weeks
Cardiology	2 weeks	ENT/Urology	2 weeks	Community Health/BSE	2 weeks
Community Health	2 weeks			Gynecology	2 weeks
Ophtho/GYN	2 weeks
Palliative Care	2 weeks
ENT/Urology	2 weeks

Rotations: more information

Residents spend a total of six months on our family medicine inpatient service over the course of 3 years. This service combines excellent teaching and responsibility for patient management with an opportunity to observe the scope and role-modeling of a practicing family physician.

This service is under the direction of full-time faculty members. Patients are admitted from Thomas Hart Family Practice Center and private family medicine groups. The usual census is 14 to 22 patients with the team consisting of one PGY-1 resident, two PGY-2 residents and one PGY-3 resident. Residents have significant autonomy and responsibility for patient management. Third-year residents function in a supervisory role.

Teaching rounds are conducted daily with attendings from each group, case management and pharmacy. This teaching service is highly rated by the house staff and is a popular elective for medical students. Additionally, we conduct morning report once a week, run by residents with faculty oversight.

The program has an attractive and innovative call system which supplements conventional calls with night float rotations in all three years. The night float rotation is two weeks long in the PGY-1 and PGY-3 years and four weeks long in the PGY-2 year, divided into two-week blocks. The PGY-1 resident does night float alongside an upper year resident who acts in a supervisory/teaching role.

Pediatric Training is a true strength of our program. Residents get 6 weeks of pediatrics in each year. The rotation is a combination of newborn nursery, inpatient and outpatient care. Our PGY1 & PGY2 residents join residents from WellSpan Good Sam, WellSpan Emergency Medicine and visiting residents on a team led by our PGY3 resident.

Pediatric attendings are committed to teaching primary care focused topics. Mornings are devoted to newborn and inpatient care. Afternoon assignments include hospital coverage or outpatient care in the community health center. In addition to the pediatric rotation, 28% of visits in Thomas Hart Family Medicine Practice are pediatric patients.

Our night float rotation operates Sunday to Thursday 7pm – 7am. Two residents cover at all times – a PGY 1 resident with a PGY2 or PGY3 resident. Residents oversee care of our hospitalized patients and take consults/admissions from the ED to our service. A nurse triage center handles most outpatient phone calls, with occasional assistance from the night float team. Faculty attendings provide oversight by phone.

Behavioral science education and a biopsychosocial approach to patient care is woven throughout the curriculum during all three years of residency. Opportunities for experiential activities and case-based learning are emphasized when working with our behavioral science faculty (Dr. Tovar) during various rotations with protected time for BSE.

These educational experiences take the form of:

Shared office sessions: In some clinic sessions, patients are seen jointly by the behavioral scientist and resident. This experience provides the opportunity to be directly observed with patients and receive feedback specific to interviewing, communication and counseling skills. With Dr. Tovar as a co-participant, best practice approaches are modeled.

Extended evaluation visits: During certain office sessions shared with the behavioral faculty, longer appointments can be scheduled to allow for more comprehensive evaluations of patient’s psychosocial and medical problems for the purpose of treatment planning. These extended visits can also be used for focused counseling or motivational interviewing and can be arranged during the rotations listed as BSE.

Standardized patients: Scenarios using actors as standardized patients involve handling common but challenging situations encountered in practice (such as breaking bad news, substance abuse counseling, disclosing a medical error). This training takes place in our simulation center, with debriefing and performance feedback provided immediately thereafter.

One-on-one didactic sessions: Protected time for individual education and coaching provides opportunity for consultation regarding difficult cases or instruction on motivational interviewing, cognitive-behavioral approaches to anxiety, insomnia and other conditions, personal stress management, etc.

Ongoing, Longitudinal BSE Experiences

Lectures: During the Thursday morning educational block, Dr. Tovar presents topics with a behavioral science focus. Among the topics covered this past academic year were:

Addressing health care disparities (Sept)
Self-care in the face of trauma (Oct)
Engaging family and support systems for transgender patients (Dec)
CBT for insomnia (Jan)
Approaches to engaging patients with depression (Feb)
Test-taking with confidence (March)
Assessment of bipolar depression (Apr)
Role of religion and spirituality in patient health (May)
MBTI workshop; intro to patient caring behaviors (June)
Chronic pain protocol; de-escalation; behavioral health education and maintaining wellness (July)
Adult ADHD, boundary crossing (August)

Personal Wellness: Practicing self-care ensures that you can fully participate in your education and offer the best of yourself to patients. As part of the quality improvement curriculum, first-year residents are required to complete a personal improvement project (PIP) under the guidance of our behavioral science faculty. This project can be crafted to serve as a personal wellness exercise (for example, adopting a daily meditation practice) so that residents are actively engaged in self-care while meeting this educational objective.

WellSpan York Hospital is well-known for excellent university-style internal medicine teaching services. In addition to subspecialty-oriented services, the hospital has a number of excellent general medicine services. The service is comprised of three interns and a supervising upper-level resident. Each intern is responsible for the medical care of four to six patients under the direct supervision of the critical care attending physician.

This service achieves an excellent balance between patient care responsibility, continuity, and supervision and teaching. Residents are also taught how to perform procedures commonly utilized in the ICU setting. ACGME work hour rules are followed.

WellSpan York Hospital has a superb emergency medicine department which handles about 100,000 visits per year, one of the busiest in the state. The department is well organized for teaching and offers casting and splinting clinics, grand rounds, suture clinic and several other practical conferences.

The full-time emergency physician staff provides excellent experience and teaching for all house staff rotating through the department. Residents do a two-week rotation in the emergency department each year. Electives are available in the PGY-2 and PGY-3 years.

All PGY-1 residents spend two weeks assigned to a surgical service. Surgical diagnosis is emphasized, and residents may assist with cases where they participated in making the preoperative diagnosis. Preoperative and postoperative care are important curriculum objectives.

All PGY-2 residents have a two-week outpatient surgical rotation. Residents participate in the general surgery clinic, plastic surgery office, vascular surgery office, cataract surgery observation and wound care. Under the supervision of surgical residents and attendings, family medicine residents perform excisions and other simple outpatient surgical procedures under local anesthesia.

We are so excited to announce the implementation of our longitudinal POCUS curriculum to our residency! For years, point-of-care ultrasound has been gaining popularity among different medical specialties, and the value of POCUS in clinical decision-making has been extensively demonstrated. Only recently have family medicine residencies been introduced to POCUS; in 2018, the American Academy of Family Physicians published its first guideline on POCUS curriculum. The guideline is unique among various other residency specialties curricula in that it illustrates the broad depth of family medicine knowledge and, in concert, the large variety of POCUS skills that are recommended to be covered.

Our faculty strongly believes that POCUS will become a fundamental clinical skill for all future family medicine physicians. Having the ability to add POCUS to the office visit will improve patient access, increase the diagnostic and therapeutic repertoire of the physician, and improve patient and physician satisfaction at each visit. To maximize resident experience and exposure to POCUS, we plan to implement a longitudinal curriculum spanning a resident’s entire training period.

The longitudinal curriculum will implement two major learning opportunities:

SonoSim ultrasound training solution: This breakthrough product overcomes longstanding barriers to ultrasound education. It complements clinical training by providing remote hands-on ultrasound training, didactic instruction and assessment. You will have access to the world’s largest library of actual POCUS patient cases with a broad spectrum of normal and real pathologic conditions. With this software, you will receive immediate probe-positioning guidance and expert feedback while scanning real-patient cases.

Lumify handheld whole-body ultrasound probe: This product approved through our health system’s steering committee, will be used for patient care and hands on workshops.

Our goal is to integrate the learning opportunities for use widely to provide a robust curriculum

WellSpan York Hospital's Family Medicine Residency recognizes the importance of geriatrics in any family physician's practice. As our geriatric population continues to grow, family physicians will provide a significant portion of their ongoing care.

A longitudinal and block experience is provided whereby all residents are assigned nursing home patients to follow over a two-year period. A geriatric block rotation is also included in the PGY-2 and PGY-3 years. This block includes supervised experience and teaching in the nursing home in a one-on-one situation with the family medicine faculty.

This rotation occurs in each resident year for 2 weeks. Focus is on learning key aspects of the office team and how it functions. Time is spent in the office seeing patients, learning about registries, learning office management and in PGY3 learning about leading an office with the medical director and practice manager. Additional topics for learning include value based care and insurance related topics.

The focus of this rotation is to learn about the community of York City & York County and the resources available to us and our patients. In PGY1, residents get a community tour, visit Leg-Up Farm and Early Intervention. In PGY3, residents participate in urgent care, a clinic for the uninsured and underinsured, and Arches.

Longitudinal learning

Thomas Hart Family Medicine Center

We moved into a brand new renovated space in 2023 with 30 rooms and 3 treatment rooms. WE provide care to more than 10,000 patients from a diverse background.

We provide prenatal care, continuity care to all ages, procedures, walk-in care, transgender care, musculoskeletal clinic, women’s health care and mental health care. Residents are assigned a panel of patients from day one of residency.

Didactics

At WellSpan York Family Medicine, we prioritize the continued medical education of residents, faculty and medical students. Our minimum five hours of weekly didactics consist of morning report, where an interesting case is presented by a resident and worked through from HPI to differential diagnoses and final plan. In addition, Grand Rounds occur every Thursday morning, providing a shared CME opportunity between family and internal medicine personnel.

Community educators often take part as guest lecturers. Residents and attendings at all levels have opportunities to present didactics on various medical topics each year. These are offered during morning lectures, which can include procedure conferences. The latter include using surgical tools and animal skin to practice suturing, biopsies, insertion of contraceptive devices, etc.

In addition, residents take part in group board review, M&M (morbidity and mortality) conferences, as well as quality and personal improvement projects throughout the year. Educational money allowances and paid time off encourage exam preparation as well as conference attendance. Faculty are readily available and happy to teach all! Daily inpatient table rounds are also excellent opportunities for learning and include mini lectures and EKG reading sessions.

Communication and patient experience

Communications skills training is a strength of our program. At various points throughout the residency, you will complete scenarios with standardized patient actors that involve common, yet challenging, situations encountered in medical practice. Examples include substance abuse diagnosis and counseling, defusing emotionally charged situations and disclosing medical error. Debriefing sessions with behavioral science faculty and actors provide feedback and coaching to help you further progress along the communication milestones.

Point of Care Ultrasound Training

We are very proud of our early adoption at the residency level of the use of ultrasound within our residency. Since 2015, our residency program has been teaching our family medicine residents and rotating medical students the wonderful uses of ultrasound, both in the diagnostic and interventional realm.

This didactic teaching occurs with regular didactics and at “point of care” while in the residency clinic setting. Residents will learn even more ultrasound techniques when they rotate onto Sports Medicine with our Faculty and Fellows showing them all the interventional uses of ultrasound, such as guided injection.

Research Activity

Family medicine residents are encouraged to do research projects. The hospital encourages research in all departments and has a full-time department of research to assist faculty and residents in the design, implementation and analysis of research projects. All residents work together and participate in quality improvement projects. Elective time can be devoted to a research project. "Discovery Day" occurs every May and provides an opportunity for all residents to showcase their research. Best research and presentation awards are also given at this event.

Residents participate in group QI projects annually and also do a longitudinal scholarly project beginning in PGY2. Examples of these have included individual QI projects, authoring book chapters, presenting at regional or national conferences, such as FMEC, AMSSM and ACSM to name a few.

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Family Medicine Residency - Curriculum

Experience a wide variety of learning opportunities and rotations.

Ongoing, Longitudinal BSE Experiences