Curriculum Overview
Our residency’s longitudinal schedule is different from many other family medicine (FM) residencies. Most residencies use one-month “block rotations” during which residents focus on one medical setting (e.g., hospital medicine service or cardiology) with half-day sessions interspersed at a community office. In contrast, our default schedule is longitudinal. When residents are not on short hospital blocks, they have a schedule that centers on the continuity care site (CCS) and half-day residency learning experiences (“learning labs”). Examples of these schedules for each year are below. We also describe the hospital block rotations for each academic year below.
All of our residents get one week of conference time and three weeks of paid time off (vacation) every year. In the PG-1 year, the vacation weeks are pre-scheduled, though some exceptions are made for unique circumstances.
Curriculum: Definitions of Terms
Behavioral Medicine Clinic (BMC) – Half-day sessions in which PGY-2s and PGY-3s see their own continuity patients with a trained behavioralist. Once per month, a psychiatrist also joins the team to teach about medication management and assist with difficult diagnosis clarifications.
Continuity Care Site (CCS) – The outpatient practice in which a resident sees patients in continuity. Instead of having one “residency clinic” in which all the residents see their patients, we have three continuity care sites. At the CCSs, the residents are embedded in practices that are working to deliver high-quality comprehensive care. One of the many advantages to having multiple sites is that it allows residents to better practice leadership and innovation.
Educational Tracks – Although our specialty has a wide scope of practice, residents may be interested in exploring specific aspects of family medicine. Our residency has educational tracks to assist with this exploration and include geriatrics, leadership (advocacy, research and teaching), obesity medicine, sports medicine and street medicine.
Learning Lab (LL) – At LVHN we recognize residents’ learning styles can vary. Learning labs are half-day sessions in which faculty members facilitate small-group learning. The learning lab format allows time for more than just PowerPoints and lectures, with activities such as case-based scenarios, utilization of SIM, small-group discussions and board review questions.
Residency Activities – Weekly meetings which alternate between residency meetings with your chief residents, resident/faculty meetings to discuss residency updates/brainstorm for the future, and resident/faculty clinical meetings to discuss new guidelines and patient management.
Residency Reflective Activities – Weekly faculty-facilitated sessions in which residents practice evidence-informed medicine skills, develop patient-centered care competencies and allow for debriefing from difficult patient cases.
Selective – Time in resident schedules where a resident can choose a rotation in a certain specialty. Some selective time is used for prescheduled requirements to assure that we meet accreditation requirements (e.g., half-day sessions in pediatrics, women’s health, obstetrics or osteopathic manipulation), while the remaining is used for rotations of your choosing. A benefit of LVHN being one of the largest teaching hospitals in Pennsylvania is that there is a substantial number of rotation opportunities! As learners advance through their residency, they have increasing freedom to choose their own curriculum for selective time with the guidance of an academic adviser.
Team Time – Three-hour sessions at the continuity care site in which residents work with a faculty member to improve the care of their patients. These sessions include home visits, procedure clinics and working on practice improvement projects, registry management and more.
Tuesday Morning Activities – Weekly sessions which alternate between grand rounds, inpatient phone call review, complex case review (M&M), board review and hospital didactics.
Curriculum: Post-Graduate Year 1 (PGY-1)
Although most family medicine residencies focus on inpatient care during the first year, we recognize the importance of doctor-patient relationships and establishing continuity. Therefore, your PG-1 year begins in the outpatient setting, getting to know the community and its resources. We think of our first year as “interval training” in which residents alternate blocks in the hospital with outpatient time, when they focus on their continuity care site. This longitudinal curriculum allows residents to revisit rotations throughout their first year. Here is a sample of a PGY-1 outpatient schedule:
| AM | Patients at CCS | Tuesday Morning Activities/Learning Lab | Reflective Activities/Team Time | Selective | Selective |
| PM | Patients at CCS | Patients at CCS | Residency Activities/ Combined Learning Lab | Learning Lab | Learning Lab |
PGY-1 hospital blocks are 2-3 weeks in length. They include:
- Family medicine hospital service – at least 8 weeks
- Night float – 4 weeks
- Emergency medicine – at least 4 weeks
- Pediatrics – at least 4 weeks
- Newborn nursery/Labor and delivery triage – 2 weeks
First years have “short call” from 5-10 p.m. about once per week on ambulatory weeks. They have a weekend call day approximately once every 4 weeks.
Curriculum: PGY-2
Our second year is also about half inpatient and the other half outpatient with an ambulatory focus. The outpatient schedule for PGY-2s and PGY-3 looks something like this:
| AM | Selective | Tuesday Morning Activities/Patients at CCS | Reflective Activity/ Team Time | Patients at CCS | Selective |
| PM | Selective | BMC | Residency Activities/ Combined Learning Lab | Patients at CCS | Selective |
PGY-2 hospital blocks are no more than 2 weeks in length. They include:
- Family medicine hospital service – about 8 weeks
- Night float – 4 weeks (1 week at a time)
- Addiction medicine – 1 week
- Critical care (ICU) medicine – 2 weeks
- Maternity care (Labor and delivery and postpartum) – 2 weeks
Second years have a 24-hour call on Saturday about eight times throughout the year. They also have “jeopardy call” about five times per year. During jeopardy weekends, residents are only called to the hospital if another resident is sick or as a backup provider when the inpatient volume is high.
Second- and third-year residents are permitted to take “away selective” for up to one month. During this time, residents can participate in learning experiences at other health care institutions or in international medicine experiences.
Curriculum: PGY-3
Our third year is focused on giving the residents as much family medicine exposure as possible. Therefore, most of the year is spent in the ambulatory setting. The outpatient schedule for PGY-3 is the same as PGY-2 (see above), but the residents spend a greater percentage of time at their CCS.
PGY-3 hospital blocks include:
- Family medicine hospital service – about 8 weeks
- Night float – 4 weeks (1 week at a time)
- Pediatrics – 2 weeks
Third years have a 12-hour call on Sunday about eight times throughout the year. Like the PGY-2s, they have “jeopardy call” about five times per year. During jeopardy weekends, residents are only called to the hospital if another resident is sick or as a backup provider when the inpatient volume is high.
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