Curriculum

The specialty of Family Medicine is an ongoing longitudinal experience and physicians must be prepared to participate in the comprehensive care of patients’ problems in the context of an ongoing continuity relationship. The primary experience in family medicine is longitudinal, beginning in the first block of the first year and running through the entire 36 months of training. This experience is further supplemented by a focused one-month block rotation during the third year at the resident’s assigned clinical practice. UTMB Health Department of Family Medicine faculty members serve as role models, providing direct observation and feedback throughout the experience.

Behavioral medicine training is on ongoing longitudinal experience, complemented by a four-week focused rotation in the second year. Teaching and supervision are provided by UTMB Health Department of Family Medicine faculty members, including behavioral medicine professionals, through skills workshops, practice with standardized patients, direct observation and attending in residents continuity clinic and didactics. During the four-week behavioral medicine rotation, residents participate in a small group-learning format facilitated by faculty members who specialize in behavioral medicine. The educational experience is skills-based and rooted in empirical evidence for primary care practice. Each week of the rotation includes progressively more advanced/complex skills for mastery.

The family physician is often the point of first contact for children of all age groups. This affords many opportunities to assess development, ensure adequate immunizations, screen for dysfunctional behaviors and abuse, and counsel regarding healthy lifestyles. The ambulatory pediatric experience is an 8-week requirement split between the first and third year of residency. Residents in these rotations will be supervised by faculty members in the UTMB Health Department of Family Medicine and the UTMB Health Department of Pediatrics. Visits may range from acute (diarrhea, URI, vomiting, otitis media, etc.), to well-child checks and immunizations, to chronic problem management (asthma, ADHD, seizure disorder, etc.). Residents on this rotation also gain exposure to a vast array of pediatric infectious diseases.

The family physician should be proficient in the diagnosis and management of a variety of cardiovascular disorders. Family physicians emphasize comprehensive and continuing care to individuals and families, with particular attention to behavioral and lifestyle factors. At times the family physician may find it appropriate to seek consultation from a cardiologist to either manage or co-manage a patient for optimal care. Under the supervision of the cardiology fellow of the UTMB Health Department of Internal Medicine, residents on this second-year rotation will obtain supervised experience in the evaluation, diagnosis and management of patients with cardiovascular diseases. Residents will learn to evaluate and treat patients with a variety of cardiovascular diseases, working with acutely ill patients and as well as patients with stable, chronic cardiovascular diseases.

The community medicine component is both longitudinal through continued community involvement and activism, as well as a focused one-month rotation during the second year. During this rotation, residents work under the supervision of UTMB Health Department of Family Medicine faculty, including our in-house social worker. Residents will increase their awareness of community resources, issues surrounding substance use disorders, homelessness, the medically under-served and public health issues. The rotation also provides experiences in community education and advocacy. Residents spend time working with community service organizations and community-based clinics, and will have first-hand experience working with homeless, under-served and substance use disorder recovering populations. Residents will also work with the county health district to learn about the programs for public health needs.

The family medicine physician’s broad body of training is a natural overlap of that of the emergency physician. Emergency medicine represents the diversity of knowledge and skills necessary to develop competency in the initial triage, evaluation, stabilization, and management of the acutely ill patient with serious or life threatening medical issues. The resident’s experience in emergency medicine takes place during a focused one-month rotation in the first year in which residents are supervised by the faculty members of the UTMB Health Department of Surgery Division of Emergency Medicine. Residents will have the opportunity to work in the UTMB Health Trauma Center, one of only three Level I trauma facilities in the Houston/Galveston metro area.

Over the course of three years of training, family medicine residents spend 8 focused months on the family medicine inpatient service. Residents work on teams under the supervision of family medicine faculty members, as well as some medical students and physician’s assistant students. The presence of students gives family medicine residents an opportunity improve their teaching skills.

Family physicians should be competent in the diagnosis and management of surgical disorders and the appropriate and timely referral for specialized care. In order to increase experiences in this area, residents will complete two one-month surgical rotations in the first and third years. During these rotations residents work under the supervision of UTMB Health Department of Surgery faculty members in John Sealy Hospital and the Texas Department of Criminal Justice Hospital in Galveston.

The Essential Skills in Family Medicine one-month takes place as the first rotation for all first-year residents. During this experience, new residents gain a basic understanding of the workings of the university and department, and develop the skills necessary to be successful during their training. In addition to a general employee orientation, residents will be familiarized with the family medicine inpatient service, clinical facilities, local community resources, and our other healthcare services, including nursing home and services provided to the Galveston Independent School District. Residents will complete certifications as well as workshops and sessions on a variety of clinical topics. Residents on this rotation will shadow PGY 3 residents in the ambulatory clinic and hospital settings, and will progress to seeing patients under their supervision.

Family medicine residents’ experiences in surgical subspecialties include two two-week rotations during the third year focused on urology and otolaryngology. Residents work under the supervision of faculty members in the UTMB Health Department of Otolaryngology and community faculty members with Urology Associates of Houston in Houston and Pasadena, Texas.

Family medicine residents gain practice management knowledge and experience though longitudinal exposure to didactic lectures, workshops, and conferences, as well as through participation in our patient-centered medical home intitiative and a focused two-week experience during the third year. During this focused experience, residents participate in practice preparation workshops on business operations, contracts and negotiations, health information technology, financial management, health care delivery systems and payers, quality measurements and improvement, job search and preparing for the interview, malpractice and liability and more.

Family Medicine residents spend two months on a focused rotation in maternity care in their first year in which they are primarily under the supervision of UTMB Health Department of Obstetrics and Gynecology faculty members and midwives in the John Sealy Hospital Department of Labor and Delivery. Residents will also see patients at the Ball High School Teen Health Clinic under the supervision of UTMB Health Department of Family Medicine faculty members. This experience in women’s health is continued longitudinally in the following years, as all residents are expected to assume responsibility for antepartum, intrapartum, and postpartum care on a continuity basis.

During the one-month inpatient pediatrics experience in the first or second year, residents will admit and follow pediatric patients on one of the general medical, pediatric intensive care, and newborn nursery units of the hospital. Residents on this rotation will work under the supervision of faculty members of the faculty members in the Driscoll Children’s Hospital Pediatric Residency in Corpus Christi, Texas. Residents are an integral part of the pediatric team consisting of interns and upper level residents and excellent board-certified pediatric faculty members that provide direct teaching on the inpatient service. Housing is provided for the residents during this rotation.

Family physician’s training in geriatrics takes place both longitudinally and during a focused one-month rotation during the second year. Residents are exposed to ongoing didactic lectures and conferences on topics related to geriatrics, and continually care for geriatric patients in the family medicine clinics and the Gulf Health Care Center. During their one-month rotation, residents work closely with UTMB Health Department of Family Medicine faculty members to focus on caring for patients at the nursing home, particularly in its long-term care facilities and including hospice visits.

Family medicine residents gain experience in women’s health both longitudinally and during a one-month rotation during the second year. Residents are exposed to ongoing didactic lectures, workshops, and conferences on topics related to women’s health, and continually care for female patients in the family medicine clinics. During their one-month rotation in women’s health, residents will work primarily under the supervision of faculty members in the UTMB Health Department of Obstetrics and Gynecology to increase their experiences through work in the department’s ambulatory facilities, as well as the UTMB Health Breast Health and Imaging Center and performing colposcopies at two correctional facilities.

Family medicine residents gain training and experience in office-based procedures both longitudinally and through a one-month rotation during the second year. In a focused rotation, residents will work closely with faculty members in the UTMB Health Department of Family Medicine, Department of Dermatology, Department of Internal Medicine Division of Cardiology, Department of Radiology, and a local podiatrist. Residents will gain experience in a variety of office-based procedures, including colposcopies, IUDs, Implanon, skin biopsies, ingrown nail removals, joint injections and more in the weekly Family Medicine procedure clinic. Residents also learn additional procedures in dermatology, wound care and cardiology stress testing.

During this one-month rotation in the first year, family medicine residents function on a team with ICU specialists and fellows in inpatient settings. Residents work under the supervision of UTMB Health Department of Internal Medicine faculty members and fellows in the medical intensive care units at John Sealy Hospital and the Texas Department of Criminal Justice Hospital in Galveston.

Pediatric urgent care experiences enable residents to acquire the knowledge and skills needed to manage the wide variety of serious illnesses and injuries and their special considerations as applied to pediatric medicine. During this one-month rotation in the first year, residents work under the supervision of the UTMB Health Department of Pediatrics at their After Hours Pediatric Urgent Care facility.

During the one-month neurology rotation in the third year, residents have the opportunity to work on in the UTMB Health Department of Neurology ambulatory clinics, as well as part of the neurology consult team in John Sealy Hospital. The consult team includes an attending neurologist, internal medicine residents, fellows and medical students. On this team residents serve as teaching resources for students, providing guidance in the basics of patient management.

Family medicine residents gain a framework for working knowledge of the many aspects of musculoskeletal disease and gain the skills necessary to provide care for patients. Family medicine residents’ experience in orthopedics is both longitudinal and focused in two one-month rotations taking place in both the second and third years. In their first rotation, family medicine residents will work under the supervision of faculty members in the UTMB Health Department of Orthopaedic Surgery and Rehabilitation. In their second rotation, family medicine residents will work under the supervision of Nassau Bay Bone and Joint’s Daniel O’Neill, MD. Residents also participate in annual sports medicine physicals for the Galveston Independent School District.

During this one-month rotation during the third year, residents have the opportunities to gain one-on-one experiences working with faculty members in the UTMB Health Department of Internal Medicine Division of Nephrology to diagnose and manage difficult renal problems.

During this one-month rotation in the first year, family medicine residents function as a member of the nursery team, alongside UTMB Health Department of Pediatrics residents and interns. The team cares for the normal newborns and those in the intermediate nursery in John Sealy Hospital. Family Medicine residents also work closely with pediatric nurse practitioners in the nursery and complete the rotation with procedural experience and certification for circumcisions.

The Principles of Family Medicine experience encompasses the principles of Family Medicine within the most common clinical, behavioral and social issues in Family Medicine, along with teaching the first year module of integrative medicine. It also addresses the professional identity formation and self-care. This one-month rotation in the first year takes place during the winter holidays. Residents work closely with UTMB Health Department of Family Medicine faculty members. The purpose of the rotation is to revitalize interns’ commitment to the practice of family medicine, review current bio-psychosocial practices, learn and practice the application of behavioral medicine skills, improve practice management skills, promote team cohesiveness, and explore the benefits of alternative therapies.