At West Suburban Medical Center
You don’t have to. “Academic” is not a place, but a culture. We are a community hospital based academic program. Our residents routinely present at regional and national conferences, and our research arm is fully supported with a Director and Assistant Director of Research. When you look up the word “academic” in Webster’s Dictionary, the third definition is “irrelevant.” At times, the body of published research can seem that way, when we consider our own patients. The research and academic endeavors here are patient centered, often revolve around the social determinants of health, and aim to improve the lives of the patients sitting in front of us every day – highly relevant. In addition, the chance to lead and teach in teams is ever present. Whether it is with the numerous medical students here on rotation, or your more junior residents, you will learn and practice the skills needed to be an effective teaching clinician.
The buzz here is that we are OB strong. As Family Physicians, this part of the life cycle is as important as any other. Our residents are thoroughly trained in normal and higher risk vaginal deliveries under the supervision of Family Medicine faculty. More than a dozen of our faculty members are trained to perform C-sections and we operate a vibrant Maternal Child Health Fellowship. We do not believe in dabbling in subject matter. The stakes are too high and training is training.
Family Medicine has a unique position in delivering maternity care. The word obstetrics means “to get past an obstruction” and much of the field has evolved in that way. It is often quite high tech and low touch. Midwife means “with women” and much of the field has evolved in that way. It is often quite high touch and low tech. In Family Medicine, we have the opportunity to be high tech and high touch.
Family Physicians need to be expert at delivering well child care, treating common and acute pathology in the office, and recognizing more complex and serious pediatric issues. Our curriculum is centered on a strong continuity outpatient pediatric population while taking advantage of world class pediatric emergency and inpatient rotations at Lurie Children’s Hospital. We also deliver care to hundreds of newborns each year during the Maternal Child Health rotations, including care within our Level 2 Special Care Nursery.
Our ICU experience has a rich history of excellence. The resident team is comprised of Family Medicine residents, supervised by Critical Care specialists and the Primary Care admitting Attendings. Patients admitted to our unit are often very ill with common problems. For example, severe sepsis, respiratory failure from severe COPD or systolic dysfunction and flash pulmonary edema, DKA, or acute MI are routine principal diagnoses. There are also patients who present with uncommon illnesses, but those are fewer. Learning the pathophysiology of these presentations helps our residents to be that much stronger in the office. When one can see the end stage, intervention for prevention becomes a mission. Residents also have ample opportunity to improve their dexterity with intubations, central line insertions, and other procedures. Lastly, becoming comfortable with end of life discussions is not easy. The ICU offers the chance for residents to improve these skills, and again, carry them into other aspects of their practice.
The call schedule is great! PGY-1 residents do 5 nights of night float during each month of the Family Medicine Service, Maternal Child Health Service, and the ICU. For those months, that is the only overnight call. There is no call during the Surgery or ED rotations. For the Inpatient Pediatric rotation, overnight call is shared with a fellow PGY-1 resident from West Suburban. PGY-2 residents are on call roughly 3 nights per month, while PGY-3 residents are on call less than that. Senior residents also do 5 nights of night float in the ICU per year.
We strictly adhere to the ACGME common program requirements, and often, have even stricter internal requirements.
Teaching and learning opportunities abound. Every inpatient service has dedicated teaching rounds, bedside rounds, and case based didactics. In the office, our preceptors are highly skilled at facilitating your outpatient curriculum. A Tuesday afternoon structured conference series and weekly Grand Rounds add to the mix. Our faculty members consistently receive 5/5 on our MyEvaluations.com feedback tool.
Even before Orientation, our residents begin to form a bond that often leads to lifelong friendships. The culture of family weaves its way through every aspect of our program. Getting along? We consider that a low bar.
Our 4 continuity sites have arisen out of our almost 50 year history in the community. We often refer to them as “four delicious flavors of ice cream.” You cannot go wrong. While each site has its own personality, there are MANY more similarities amongst and between the sites. After the Match, you will rank the 4 sites and program leadership will assign you based on the incoming class’ preferences. Over well more than a decade of having the choices, not even one resident has requested to switch sites. The system works and affords a wonderful breadth of training opportunities, including a nationally recognized Federally Qualified Health Center (FQHC) network.
Yes, absolutely, and in many different ways. Community outreach occurs through the medical center, the clinic sites, within the different rotation curricula, and research. Some very recent examples include a partnership with a local Intimate Partner Violence (IPV) resource, leading to a National Award through the Society of Teachers of Family Medicine (STFM), and the development of a Medical Food Pantry.
Resident wellness and resilience was a focus, here, long before it became an ACGME topic. We have presented our curriculum at the national STFM Behavioral Medicine Conference. Whether it is support groups, Balint group, “5th Tuesday Fun Days”, our Annual Weekend Retreat, Gold Fish awards, a culture of micro-celebrations, or numerous other events and activities, wellness and resilience are paramount. In fact, physician wellbeing is now considered central to the “quadruple aim” of healthcare delivery. Patient care should be delivered at the lowest optimal cost, with the highest degree of safety, achieve the highest in patient satisfaction, AND with the highest degree of physician satisfaction. These four components are the measures of success.
Yes, we are a longstanding, dually accredited program, and now, with the merging of the accrediting bodies, will work to achieve full osteopathic recognition. There are numerous opportunities for both our osteopathic and allopathic residents to learn more and teach osteopathic manipulation techniques and philosophy. Our Director of Osteopathic Medical Education, Dr. Melanie Jessen, is a regional and national leader in the field.
We have a hybrid paper-electronic medical record system for the hospital and it is better for medical education and better for our patients. Our clinics all use Athena and our ED is fully electronic. Our ICU and medical floors have full electronic order entry, lab and imaging results, dictated consult notes, operative reports, discharge summaries and some H & Ps, with paper progress notes. Our OB / newborn floor has paper notes and orders and electronic results. There are plans for a full electronic system to be implemented soon. Residents often type notes in Microsoft Word and print.
Paper charts teach residents to think, to write concise notes and minimize medical errors. When you can’t copy and paste a note, you do have to think through your patients each day. When vitals and labs don’t auto populate, you write what is important and will change your decisions (and you only have to read the important things when you look at someone else’s notes). In the event review committee, while there are a large number of minor ordering errors reported each week within the electronic system, there are rarely ordering errors reported for the paper orders. Lastly, when the computer system fails, you don’t freak out, because you know how to write complete orders without the computer prompting you for each required field.
Many people worry that paper notes will take them longer. That’s true for about 2 weeks. After that, most people find their rhythm and by 6 months into intern year you write better, faster notes on paper than you ever did electronically. Learning to dictate also helps solidify oral presentations. Mostly we all stop noticing the paper records until someone who’s not used to it asks.
Reference that I Actually Recommend Reading: Hirschtick, RE. “Copy and Paste.” JAMA. 2006;295(20):2335-2336. doi:10.1001/jama.295.20.2335
Feeling prepared to practice is one of the most notable hallmarks of our graduates. It is the most important goal of training. Our graduates verify this intent through the PGY-3 “exit” survey, and employers verify it by their hiring practice.
The spectrum is wide. From a rural practice in sub-Saharan Africa to an appointment at a local medical school, our graduates practice within and between the full scope of Family Medicine. There is no “cookie-cutter” graduate. The curriculum and training prepares a resident to have the largest possible toolbox, and then choose which tools to use. Our post-graduate survey shows this to be the case year in and year out. Despite the great variety of practice, almost all are involved in teaching and leadership activities.
It is important to ask not only about the what, but the how. Change is always needed and the process for change is rich. Resident run committees, medical center committees with resident membership, Resident-Faculty Exchange, our Chief Administrative Strategy Team (CAST), our Lead and Chief Residents, our Advisor Program, the Housestaff Association, and the true desire for evolution are just some of the items that contribute. What we would change today may not be what we would change tomorrow, or yesterday. The healthy process and culture surrounding change is what prevails.
Please feel open and free to ask our residents and faculty this question. The stories you will hear will certainly inform your own decision making process. The stories will vary a great deal, but are uncannily tied by a unifying theme – passion.