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The third year of the residency program is the
final stage of training for residents preparing for
their future in family medicine. The emphasis in the third year
shifts even more towards ambulatory care, while residents continue
to hone inpatient skills through on-call experiences as chief of the
Family Medicine inpatient service.
In the third year, residents spend a total of six months on Family Medicine Center
(FMC)/Longitudinal Curriculum rotations. During these rotations, the FMC functions as the
residents’ “home-base”, where they refine their outpatient management skills by caring for their
own panel of patients an average of four half-days per week. In the FMC, the third year resident
also takes on the role of team-leader, helping to coordinate delivery of care to patients in a
manner that fosters continuity and the concept of the FMC as a Patient-centered Medical Home.
Residents continue to learn principles of practice management, performance improvement and
evidence based medicine. On-going individuals and small group interactions between residents and
family medicine faculty, including our behavioral scientist and practice manager, facilitate
residents’ education in these dynamic concepts. Residents have administrative time during these
rotations to work on group and individual practice management, performance improvement and
independent research projects. Third year residents also learn to lead group visits for patients
with chronic diseases as well as prenatal and well child groups during these months. In addition,
the third year FMC/Longitudinal Curriculum rotations include training in the surgical subspecialties
of Urology, ENT and ophthalmology and exposure to various community agencies and alternative medicine.
A dedicated half-day for minor surgical procedures is also incorporated into four of the six FMC
rotations in the third year.
The third year resident spends a final month of inpatient training as Chief of the Family
Medicine inpatient service. This position requires residents to manage the entire panel of
patients, including newborn, pediatric, adult and intensive-care patients, in conjunction with
the Family Medicine faculty. As Chief, the resident also learns to supervise and teach junior
residents and medical students.
In addition, third year residents further expand their knowledge of ambulatory pediatrics,
gynecology and orthopedic/sports medicine with a month-long rotation in each area. An
ambulatory Pediatrics rotation allows third year residents to learn more about the science and
art of outpatient pediatric care by spending time with experienced local pediatricians in their
offices. During their Gynecology rotation, residents gain further experience managing common
outpatient gynecologic conditions. They also spend one half-day per week learning out patient
gynecologic procedures, such as colposcopy, IUD insertions, and endometrial biopsies, under the
supervision of an OB/GYN preceptor in our FMC. The Orthopedics/Sports Medicine rotation provides
additional exposure to common orthopedic problems, including a half day/week working one-on-one
with our own Sports Medicine faculty gaining experience in joint injections, splinting and other
procedures.
Two months of elective time in the third year enable residents to individualize their
curriculum, allowing them to choose additional time in the fields of special interest.
Throughout the third year, residents continue to provide longitudinal care to their patients
in long-term care facilities, to home visit patients, and to their continuity obstetric patients,
as well as to their regular panel of patients in the FMC. Residents have increasing autonomy in the
care of their patients and families over the course of their three years. At the completion of the
program, residents emerge confident and well equipped to handle the challenges of the independent
practice of family medicine.
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