Curriculum Family Medicine

Dignity Health Family Medicine Residency Program at Northridge Hospital is always described in superlatives: The most challenging, the most interesting, the most educational … and the most fun!

PGY I  

• Inpatient Medicine:  5 Blocks
• Night Float:  2 Blocks
• Obstetrics:  1 Block
• Family Medicine Center/Community Medicine:  2 Blocks
• Pediatrics:  2 Blocks
• Surgery:  2 Blocks
• Vacation:  4 Weeks

PGY II   

• Elective:  1 Block
• Emergency Medicine:  2 Blocks
• Gynecology/Orthopedics:  2 Blocks
• Inpatient Medicine:  3 Blocks
• Night Float:  2 Blocks
• Pediatrics/Ambulatory Pediatrics:  2 Blocks
• Family Medicine/Community Medicine:  2 Blocks
• Vacation:  4 Weeks

PGY III

• Dermatology:  1 Block
• Elective:  5 Blocks
• ENT/Urology/Ophthalmology:  1 Blocks
• Family Medicine/Urgent Care Clinic:  1 Blocks
• Gynecology/Geriatrics:  1 Block
• Inpatient Medicine/Chief:  2 Blocks
• Night Float:  1 Block
• Senior Resident Obstetrics:  1 Block
• Sports Medicine:  1 Block
• Vacation:  4 Weeks

Ambulatory Medicine

• A cornerstone of Family Medicine is ambulatory continuity primary care.  At Northridge we fully hold to this core concept and believe we provide a well rounded, robust ambulatory care experience to our residents.
• All residents are responsible for their own panel of continuity patients.  This panel includes patients from all ages and demographics.
• Per ACGME guidelines, residents have 1-5 weekly continuity clinics depending upon their level of training and the rotation they are on.
• Our patient population is very diverse and residents get a broad experience in taking care of a variety of acute illnesses and chronic diseases.  
• We believe that the training our residents receive in our ambulatory clinic prepares them well for whatever type of practice they will ultimately work in.

Sports Medicine

• Sports medicine is an exciting and integral part of the curriculum at the Northridge Family Medicine Residency Program. The sports medicine program is headed by our very own primary care sports medicine specialist, Dr. Mandeep Ghuman. Residents have the opportunity to gain first-hand experience in evaluating and managing a variety of musculoskeletal conditions through our sports medicine clinics, which are held twice a week at the Family Medicine Center.
• In addition to these clinics, residents also rotate through dedicated sports medicine and orthopedic electives in their third and second year of residency, respectively. At the completion of their residency training, residents have successfully attained and honed skills in such areas as the orthopedic physical exam, the evaluation, management, and rehabilitation of musculoskeletal injuries and conditions, splinting and casting of fractures, and joint aspiration and injection.
• Residents have ample opportunity to enhance their sports medicine experience, while at the same time performing a valuable community service, by serving as team physicians and participating in athletic event coverage. Dr. Ghuman is one of the team physicians for California State University Northridge, a nearby NCAA Division 1 level college.  With the experience and skills gained in sports medicine through the course of their residency training, many of our residents have gone on to be team physicians in their own right upon graduation. 
• Fellowships in Primary Care Sports Medicine are increasingly popular and competitive in recent years. Our residents who want to specialize in this dynamic and growing field have taken the knowledge and experience they attained during residency to successfully pursue additional fellowship training. 
• No matter what your career path may be, the ability to care for musculoskeletal conditions and athletes is a vital and rewarding aspect of any practice. Sports medicine is a skill in which we are confident in which you will be competent upon the successful completion of your residency training at the Dignity Health Family Medicine Residency Program at Northridge Hospital.

Surgery Rotation

• Consists of both inpatient and outpatient surgical experiences, as the curriculum is designed to give residents a broad exposure to the breadth and depth of the surgical specialty.
• During the rotation, residents see a variety of cases and gain competence in the diagnosis and care of common surgical problems, learn to perform basic surgical procedures and perfect their techniques.
• Additional reading materials from books, journal articles, and other current literature are provided to further supplement the resident’s knowledge.
• Inpatient setting: Residents have numerous opportunities to scrub into a wide range of general surgeries as well as more specialized procedures in the hospital during the rotation.  Through direct patient care, residents learn the principles of pre-operative evaluation and preparation of patients, as well as post-operative care.
• Outpatient setting: Surgery Clinic is one of several specialty clinics available in the Family Medicine Center, which offers residents the exciting opportunity to gain hands-on surgical experience and learn common office procedures – including incision and drainage of abscesses, skin biopsy (excision, punch, shave), skin lesion removal, cryotherapy, and toenail avulsion. Surgery clinic is supervised by one of our faculty members who has a special interest in outpatient surgical procedures (Dr. Cindy Yang).
• Upon completion of training here at the Northridge Family Medicine Residency Program, graduates have extensive exposure to both inpatient and outpatient surgeries and are highly competent in their surgical skills.

Maternity Care 

• We have two dedicated family medicine faculty (Dr. Diana Lev and Dr. Eric Gama) who provide low-risk maternity care and oversee our maternity care curriculum.  Both doctors are Family Medicine physicians who have completed an additional OB fellowship.
• Residents care for their continuity maternity patients during their family medicine continuity sessions in our family medicine center, where they learn about and model whole-family care. All family medicine patients deliver at Northridge Hospital, located next door to the campus of the residency program where we have a busy labor and delivery unit with the latest in remote fetal monitoring and excellent nursing staff.
• Residents round out their experiences in maternity care through following patients of select OB teaching staff. Daily teaching rounds with family medicine or OB faculty occur on the maternity care rotation. These rounds include practice reading fetal monitor strips, discussion of active inpatient cases and lectures on a core of other maternity care topics.  All deliveries are attended by the attending physician in addition to the resident. Residents learn to assist in Cesarean sections and tubal ligations and see a wide spectrum of patients.
• Caring for your pregnant patients can be one of the highlights of your residency experience !

Inpatient Medicine

• While our Family Medicine Center is at the heart of the residency, the inpatient family medicine service allows residents to gain experience in treating adults admitted to the hospital with acute illnesses.  Residents work in a team with one-on-one supervision from a faculty attending providing care to adults of all ages, including the elderly.
• Just like practicing family physicians, our residents manage – at any one time – medical, surgical, orthopedic, neurologic, and even gynecology patients.  These patients are managed by residents from admission to discharge, including critical care medicine.
• Faculty attendings not only teach in table rounds and morning report, but also at the bedside. The hospital faculty attendings comprise both family physicians and internists. Critical care specialists are available for consultation in the ICU and CCU.  Patient loads are kept manageable by graded experience, with service caps.
• Our residency is in the enviable position of having no other competing residencies. Therefore, because Northridge is a referral hospital, our residents see a wealth of pathology in the hospitalized patients they care for.  Residents learn to manage patients with varied illnesses such as pneumonia, cholecystitis, stroke, and hip fractures while also caring for patients diagnosed with CNS lymphoma or dengue fever.

Inpatient Pediatrics

• Our pediatric inpatient rotations here at Northridge provide residents with an exciting and unique educational experience. Our residents benefit from the fact that Northridge Hospital supports a full complement of general inpatient pediatric care on campus, including an NICU and a PICU.  Northridge Hospital is currently the only Level II pediatric trauma center in the San Fernando Valley.  Our residents, therefore, do not have to travel to outside hospitals to get their inpatient pediatric experience.

• Our hospital sees a large volume of pediatric illnesses annually that span the breadth of different diagnoses from common “bread and butter” cases to the more exotic “zebra”.  Daily rounding consists of walk rounds with the residents, where teaching is integrated into every patient case through article reviews, short didactic sessions, review of interesting physical findings, or discussions about new up-to-date perspectives on management.
• Our residents do not manage PICU or NICU patients, but the fact that these services exist at Northridge is a benefit to our residents. The Intensivists have a flair for teaching and add a different perspective to the approach of the more critically ill patient. They are in-house and available 24 hours a day for questions or consults.  Residents consistently report that they enjoy the teaching they receive from the Intensivists.  Electives are available in the PICU or NICU for interested third-year residents. 

Outpatient Pediatrics

• Inpatient acute care of pediatric patients is only one aspect of the pediatric educational experience here at Northridge.  Although it is important to know how to manage sicker hospitalized patients, much of the family doctor's future involvement with children will actually be in the outpatient setting. Fortunately for us, we have a busy outpatient practice with a large population of pediatric patients.
• Residents manage their own panel of patients, of which a significant number are children.  Residents can expect many pediatric visits encompassing both routine well child and acute care. Additionally, we have dedicated a set amount of lecture time towards pediatric topics.  Finally, each second year resident rotates at the NEVHC Federally Qualified Health Center in ambulatory pediatrics with a staff Pediatrician.

Community Medicine 

• We believe that developing competence in community medicine is key in preparing residents to enhance the health of the communities they serve. Understanding how culture and economics affect availability and delivery of health care services, working effectively with existing community partners, and developing competence in delivering health education to patients are key in delivering high quality cost-effective health care.
• The Community Medicine curriculum aims to create a longitudinal experience with the goal of exposing residents to a wide range of resources available through our clinic or in the community, such as: 
  • Nutrition/ Diabetes counseling with our dietician/diabetes educator.
  • Northeast Valley Health Center (a FQHC) is a site where residents learn about the non-profit organization’s mission for the underserved.
  • Child abuse screening center (CATS) is a service provided through Northridge Hospital.
  • A Patient Advisory Committee made up of patients from our clinic who meet with our doctors to discuss the needs of patients in our community. 
  • Field Trips to various community resources to gain first-hand experience of the organizations or programs available to our patients.
  • Middle School and Community Health Center health education lectures. 
  • Medical Safe Haven clinic for patients who have survived human trafficking.

Geriatrics

• The geriatric experience at Northridge is strong both in the hospital and ambulatory settings.  
• A significant portion of each resident's panel of clinic patients is made up of geriatric patients.  Residents, therefore, get a lot of experience caring for elderly patients in their own continuity clinic. 
• With attending guidance, residents on the inpatient service gain experience holding family meetings and discussing code status with patients and families. 
• Second and third year residents are assigned continuity nursing home patients whom they see monthly.
• Geriatric topics are included regularly in the noontime lectures, as part of the medicine and behavioral health curricula. 

Elective Experiences 

• Residents have 6 elective blocks in their 2nd and 3rd years.  
• Electives provide residents with the opportunity to explore areas of interest they have in family medicine, or in areas where they want more experience, in rural or community health, in future practice site experiences or in research.  Residents can select from a list of previously arranged electives or design their own educational experience, including the ability to do one independent away rotation during their senior year. 
• All electives must have educational value and be pre-approved. 
• Past elective experiences include:
  • Rheumatology
  • Podiatry
  • Infectious Disease
  • Outpatient Surgery
  • Geriatrics/ Palliative care and Hospice medicine
  • Pain management/ Addiction medicine
  • Diabetes camp in Lake Arrowhead
  • Global health relief experiences
  • Rural/ Indian health
  • Future practice site experiences
  • Research/ Scholarly projects

Call and Night Float

• We no longer do the traditional 24 hour overnight call at the Dignity Health Family Medicine Residency Program.  Instead, residents on inpatient rotations have intermittent long call shifts in which they cover until 8:00 pm and then sign-out to the night float team.
• Night float is a block rotation that residents do twice in their 1st year, twice in their 2nd year, and once in their 3rd year.  Residents on night float cover the inpatient services from 8 pm to 8 am.
• The night float residents consist of a team of a PGY-1, 2, and 3 during the first six months, and a team of PGY-1 and PGY-2 during the second six months.  There are gradually increasing amounts of responsibility throughout the rotation.
• Benefits of the night float rotation include:
  • No 24 hour call
  • Excellent experience and education in the admission and the management of inpatient and outpatient overnight issues, including adult, pediatric, and obstetric patients.
  • Additional experiences in assisting in emergency surgeries and cesarean sections.
  • Team approach to covering the inpatient service.
  • Skills learned include teamwork and time management.
• Our program also has the unique addition of a Hospitalist attending who is available weeknight in-house as well as full time Intensivists who are available to teach in-house 24/7.

Information Technology

• Northridge Hospital and the Family Medicine Center are fully integrated on the same EHR, which is Cerner PowerChart. 
• Residents have access to UpToDate on hospital and clinic workstations or via their own mobile device.
• RoshReview is a comprehensive board review question bank to which residents have access, for doing practice questions/ mock exams in preparation for their FM In-training exam and ABFM board exam.
• New Innovations, a web-based residency management system, allows residents 24 hour access to their call and office schedules and lets them report work hours, complete rotation evaluations and view their performance evaluations.
• Residents have access to the residency’s shared Google Drive, where they can review each rotation curriculum, important clinic documents and policies, reading assignments and journal articles, as well as access the Educational Calendar for the monthly didactic schedule.