Curriculum

Our curriculum is structured to offer our residents maximum flexibility with the acknowledgement of the many paths available to family physicians. As an unopposed program, our residents learn early independence in a well-supported and positive environment in all areas of medicine.

Special emphasis is given to a well-rounded education including obstetrics, procedures, and the family unit. The program offers seven months of electives, which allow residents to tailor their experience and learning to their own interests, including focuses on Global Health or Sports Medicine. In addition to the general block curriculum, residents receive longitudinal exposure in geriatrics, management of health systems, wellness/psychology. Wednesdays (half-day) are also devoted to didactic teaching which focuses on a unique area to medicine each block on a rotating 18-month schedule.

Below is a general outline of our residency curriculum both verbally and visually. Click on links to learn more about specific rotations.

First Year

• 2.5 blocks Adult Inpatient Medicine
• 3 half-blocks Night Float (Adult Medicine)
• 1.5 blocks Obstetrics
• 2 half-blocks Inpatient Pediatrics
• 1 block Outpatient Pediatrics*
• 3 haIf-blocks Outpatient Family Medicine Center
• 1 block Emergency Medicine*
• 1 block Surgery*
• 1 block Geriatrics*
• 1 block Orthopedics*

Second Year

• 2 blocks Adult Inpatient Medicine
• 1 block Obstetrics
• 3 half-blocks Night Float (OB)
• 2 half-blocks Inpatient Pediatrics
• 2 half-blocks Outpatient Pediatrics
• 1 block Pediatric Emergency Medicine*
• 1 block Rural Family Medicine*
• 3 half blocks Outpatient Family Medicine Center
• 3 blocks Electives*

Third Year

• 3 half-blocks Inpatient Chief
• 3 half-blocks Outpatient Chief
• 1 half-block Night Float
• 1 half-block Advanced Surgical Specialties
• 1 block Gynecology*
• 1 block Internal Medicine Selective*
• 1 block Advanced Musculoskeletal*
• 1 half-block Obstetrics
• 1 half-block Inpatient Pediatrics
• 1 block Emergency Medicine
• 4 blocks Electives*

Block = 4 weeks 
* Vacationable block (up to 5 weekdays may be taken as vacation)

Required Rotations:

Advanced Surgical Specialties

The resident becomes familiar with the scope and practice of ophthalmology and podiatry services through a half-block required rotation in the private offices of Board Certified ophthalmologists and podiatrist. This rotation is taken in the third year of training and includes observation of ophthalmic surgery and podiatric surgery, also available is opportunity for observation of routine ophthalmic and podiatric exams and didactic discussions of common ophthalmic problems. Annually, a workshop in Ophthalmology is provided.

Cardiology

This is a one-block rotation in the first year of residency. Each resident is assigned to the supervision of a cardiologist, seeing patients in inpatient and outpatient settings. The goal of this rotation is to experience cardiology in various settings as it applies to the family physician. Clinical competency is stressed in five main areas: Angina, Congestive Heart Failure, Valvular Heart Disease, Acute Myocardial Infarction, and Arrhythmias. Following completion, residents should be competent in EKG interpretation, concepts of pre-load and after-load, proper use of pharmacologic agents in cardiology, and the use of diagnostic modalities.

Emergency Medicine

Emergency Medicine requires three one-block rotations during residency. Emergency Department physicians supervise the residents while teaching techniques necessary to provide care in an emergency room setting. Residents are expected to evaluate and provide care to all levels of patients. Typical skills honed include intubation, peripheral/central intravenous access, casting/splinting, suturing, trauma management, and efficient triage of patient cases. The rotation is done in the Emergency Department of Saint Joseph Regional Medical Center at either the Mishawaka or Plymouth campuses.

Family Medicine

This is a required rotation that consists of three half block rotations in the first, second, and third year. Training is in our Family Medicine Center, specifically devoted to the focus of development of skills in an outpatient setting. This rotation has a robust curriculum that includes training specifically in: Management of Health Systems, Community Medicine, Pharmacy, and Human Behavior Mental Health.

General Surgery

This is a required rotation. One month is spent with a Board Certified surgeon learning diagnosis of common and acute surgical problems, basic wound care, and pre/postoperative evaluation of surgical patients. Residents serve as the first assistant in the operating suite with their assigned surgeon. Procedures may include chest thoracotomy, subclavian catheters, suturing, wound debridement, and other minor surgical procedures.

Geriatrics

This is a three-year longitudinal experience, encompassing acute inpatient and outpatient care, nursing home rounds, and home visits. The director of geriatrics oversees this curriculum. During their second and third years, residents incorporate nursing home patients into their patient population and make regular visits to provide care.

Gynecology

The Gynecology rotation consists of one block with a Board Certified gynecologist and usually is done in the third year of residency. Comprehensive clinical gynecology education is emphasized with direct application to the skills needed for a family physician. Typical procedures include colposcopy, dilation and curettage, LEEP, cryotherapy, and the interpretation of Pap smear results.

Internal Medicine

The goal of the Internal Medicine rotations, required during the first, second and third year, is to enable residents to provide accurate assessment and treatment of medical patients. Each month a Board Certified family physician and a Board Certified internist staff the Medicine service. Rounds occur every morning at a designated time.  Discussion centers on medical cases with differential diagnosis, clear and concise presentation of patient cases, evidence-based medicine, and appropriate treatment regimens for a variety of disease states.

Medicine Chief

A Chief Medicine Resident oversees the inpatient Medicine Service. The position is assigned to a third year resident for the fall and winter and a second year resident in the spring. The purpose of the chief medicine resident is to enhance the educational atmosphere of the rotation by providing educational support either with formal or informal teaching as well as providing supervision of junior residents and senior medical students.

Musculoskeletal Medicine

Residents obtain clinical skills and knowledge in general orthopedics with special emphasis on primary care and sports medicine. Training in orthopedics takes place in the offices of Board Certified orthopedic surgeons. Training in sports medicine takes place in the office of our Sports Medicine Clinic. These two required blocks may be taken throughout the three years of residency and must include 1/2 block of sports medicine. Typical duties include participation in orthopedic surgeries, evaluation and treatment of common orthopedic problems. Some of the items include joint/muscle exams, fracture care, splinting and casting, indications for physical therapy, and evaluation and treatment of routine sports medicine injuries.

Night Float

This is a required rotation that is part of our Adult Medicine curriculum. A total of 3 half blocks are scheduled between the first and second year. An additional half block is in the third year.

Obstetrics

Residents receive instruction from our family practice program directors (all of whom practice OB), our OB/GYN consultants, and private family practice staff from the community. Antepartum care, labor management, and postpartum care are all covered. Resident responsibilities include evaluation of patients, presenting to the obstetrics unit for triage, and eventual admission or discharge. Our residents actively participate in the management of laboring patients and have the opportunity to be present at every delivery. They are also able to serve as first assistants on C-Sections. On average our unit delivers 120 babies per month.

Pediatrics

This rotation consists of four separate blocks taken during the first, second and third year of residency. Each block focuses on a different aspect of pediatrics. Inpatient rotations focus on composing differential diagnoses, developing procedural skills and formulating treatment plans based on pediatric drug pharmacology. Outpatient rotations focus on the care for children in our community and in the office. During the pediatric rotations, a staff pediatrician supervises each resident.

Rural Medicine

This is a one block required rotation during your third year where you will work with designated family physician preceptors in a rural setting, mainly in our Plymouth campus. The rotation will provide exposure to the full scope of family medicine as practiced in a rural setting, increasing the resident's preparation to independently function as a family physician upon graduation.

Electives:

Allergy/Clinical Immunology

This is an outpatient-elective rotation in the offices of private allergists/immunologists. The goal is to gain clinical insight into the management of allergy and clinical immunology through observation and interaction with staff and didactic conversation.

Critical Care

Critical Care, an elective rotation, occurs in our Intensive Care Unit under the direct supervision of pulmonologists/intensivists. Instruction is given in all aspects of care for the critical patient including ventilator management, cardiovascular stabilization, renal and electrolyte management, and infectious disease. Extensive instruction is also given in pulmonary function testing. Resident responsibilities include initial history and physicals, daily rounds, and problem management on all patients under the care of our pulmonologists. Home Call, on average, occurs every third night. Procedures include endotracheal intubation, central line placement, arterial line placement, thoracentesis, and chest tube placement.

Dermatology

Dermatology is an elective rotation. This is primarily an outpatient rotation covering office dermatology. Emphasis is placed on the identification of skin diseases – pathogenesis, diagnosis, pathology, and treatment. Biopsy, excision techniques, use of topical agents, and repair of injuries are also emphasized.

Diagnostic Imaging

This is a an elective 2 week rotation that spans the entirety of Radiology – interventional, MRI/CT scanning, nuclear medicine, ultrasound, mammography and general radiology. Residents become familiar with the indications and interpretations for various diagnostic tests.

Endocrinology

Endocrinology, if elected, is taken in the second or third year of residency in the private office of a board certified endocrinologist. The elective is primarily a didactic experience with exposure to a wide range of endocrine problems as they present in the preceptor's office.

Gastrienterology

Gastroenterology is an elective rotation supervised by hospital staff gastroenterologists encompassing hospital and office procedures. The resident becomes familiar with diagnosis, pathophysiology and management of the broad spectrum of diseases in gastroenterology. Typical procedures include assisting or performing colonoscopies, sigmoidoscopies, upper endoscopies, placement of PEG tubes, ERCP, and various biopsy techniques.

Global Health Track

Global Health Track is an elective rotation that is available during the second and third year. Assistance to set up your rotation is personalized by one of our faculty who is our Global Health Track Coordinator.

Hematology-Oncology

This is an elective available in the second and third year of residency taken in the outpatient offices of Board Certified oncologists/hematologists, the Oncology unit of St. Joseph Regional Medical Center, and at Hospice. Time is spent learning the presenting complaints, complications, and diagnosis of cancer through hands-on experience and observation of various patients with malignancy.

Infectious Disease

This is an elective taken in the second or third year of residency in the private office of a Board-Certified infectious disease specialist, as well as in the hospital setting. The resident gains attitudes, skills, and knowledge in patients with infectious diseases.

Nephrology

This is an elective rotation available in the second or third year. Residents see patients in both the inpatient and outpatient arena. Emphasis is placed on chronic kidney disease patients.

Neurology

This is an elective rotation during the second or third year of residency. It is a combined inpatient and outpatient rotation working with Board Certified neurologists.

Pharmacotherapy

This is an elective rotation during the second or third year of residency. It is a 2-4 week rotation at the Family Medicine Center.

Scholarly Activity

This is an elective rotation. Research and scholarly pursuit are the priorities of the residency. While all residents are required to complete a family practice project, residents may also use this elective to more fully develop a specific research initiative. The goal is to broaden skills in the critical review of literature, research methodology, curriculum development and general scholarly pursuits.

Rehabilitation Medicine

This is an elective rotation that focuses on teaching the principles of rehabilitation and utilizing the community rehabilitation resources in a cost-effective manner. The resident will develop an understanding of, and participate in, the team approach to rehabilitation. This rotation will enhance both the residents' geriatric and community medicine experiences.

Rheumatology

Under the supervision of a Board Certified rheumatologist. Through observation and didactic interaction, the resident gains an understanding of topics in rheumatology with regard to their clinical presentation, diagnosis, and treatment. The focus is on the more common rheumatologic disorders seen in a typical Family Medicine setting.