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Primary Care Medicine Program

Preparing Primary Care Internists: The Four Year

Click here for the application to the Primary Care Medicine Program

Preparing Primary Care Internists:  The Four Year
Primary Care Medicine Program

OUR GOAL
The Department of Medicine wishes to help selected Stony Brook medical students optimize their training in primary care internal medicine and maximize their chances of excelling in a career as a primary care internist.  To provide this opportunity, and to assist the UMC at Stony Brook in attracting additional excellent Stony Brook students to its primary care residency programs, we have developed a new 4-year pathway called the Four Year Primary Care Medicine Program (4-PCM).  This program uses the flexibilities built into the fourth year medical school curriculum, which permit a substantial beginning to primary care training, and the Department's three-year Primary Care Residency Track, to build a comprehensive and integrated primary care training experience.

The focus of the program will be in three principal areas, developing:

 

  • A strong primary care knowledge base (PCKB) in the prevention, diagnosis, and management of primary care problems;

  • A deep understanding of the psychosocial aspects and ethical issues inherent in primary care medicine (PS/E), with careful attention to communication skills and the development of a systematic approach to resolving medical ethical questions; and

  • Excellence in life-long learning skills, clinical decision making, the effective use of a multidisciplinary care team, and meeting the expectations of managed care systems (Information Management and Health Care Team Participation, or IM/TP).

     

      

SPECIFIC YEARS OF THE PROGRAM: THE ROTATIONS
AND THEIR AREAS OF FOCUS

In the descriptions of the individual years of the program (given on the following page in the left hand column), each rotation’s areas of focus (PCKB, PS/E, or IM/TP) are identified in parentheses, with the principle focus listed first, in bold font.  The rotations marked with one asterisk (*) are School of Medicine requirements for 4th year medical students, while those with two asterisks (**) are selectives in which the specific option(s) have been modified to accomplish the goals of the program.  The right hand column provides a summary of the standard Renaissance School of Medicine 4th year, for comparison.

The first year contains 10 block rotations of 1/2 - 2 months duration plus two important curricular components interspersed through the year.  All ten block rotations focus significantly on the primary care knowledge base, while five focus on psychosocial and ethical issues, and three deal substantially with information management and team participation. 

In addition to the monthly rotations, two important components of Program Year 1 will be taught at sessions held throughout the year:

 

  • Primary Care Medicine Ambulatory Block (PCKB, PS/E, IM/TP): During a 4-week block, participating students will begin to develop and care for their own panel of patients, working closely with a primary care internist at the Primary Care Center. 
  • Evidence Based Medicine (IM/TP): During monthly sessions with the Primary Care Residents, students will learn the principles of evidence based medicine and practice their application to specific types of clinical problems (eg., choosing a diagnostic test, deciding on a method of treatment, etc.).  Literature searching, medical decision making, and life-long learning skills will be emphasized in these sessions. Literature reviewed will serve as a bridge to review a variety of clinical topics related to primary care medicine.  Specific cases with questions and answers will be reviewed to put into practice the specific clinical problem reviewed.

     

     

     

    Monthly Rotations: (4-PCM Program)

    *1/2 month: Psychiatry in Medicine (PCKB, PS/E)

    *1 month: Neurology (PCKB)

    *1/2 - 1 month: Medicine in Contemporary Society (MCSIV): 2 week course or 1 month project (PS/E, PCKB)

    *1 months: A subinternship in Medicine at UH, to include 1 month on the General Medicine service at UH (PS/E, PCKB, IM/TP)

    1 month:  Ambulatory Primary Care (PCKB, PS/E, IM/TP), to be done at the Primary Care Center or arranged at a different site.

    **1 month: Didactic course (PCKB), to be chosen from:
    •          Laboratory Medicine
    •          Emergency Medicine
    •          Clinical Therapeutics

    **1 month: Surgical Specialties (PCKB); two 2-week blocks to be chosen from:
    •          Trauma
    •          Head and Neck
    •          Plastics/Dermatology
    •          Vascular Surgery
    •          Orthopedics (only if 3rd year. Surgery was done at Winthrop)

    1 month: Medicine Subspecialtiy (PCKB), to be chosen from:
    •          Cardiology
    •          Nephrology
    •          Geriatrics
    •          Endocrinology
    •          Infectious Diseases

     

    1 month elective, unspecified.

    1 month: vacation

    Note: Since there are only 10 1/2 months in the 4th year calendar, including the one month of vacation, your schedule should add up to 10 1/2 months, no more

    Monthly Rotations: (Standard SOM 4th year)

    1 month: unspecified elective.

    1 month: unspecified elective.

    1 month: vacation

    Not Available

    Not Available

    *Same

    *Same

    *Same

    *1 month of Subinternship required, a second month strongly recommended.

    Additional option of Surgical Anatomy.

    Additional options of:

    •          SICU
    •          Pediatric Surgery
    •          Cardiac Surgery
    •          Anesthesia

    1 month: unspecified elective.

     

    PROGRAM YEARS 2-4:

     

    THE PRIMARY CARE TRACK OF THE
    INTERNAL MEDICINE RESIDENCY PROGRAM

    Our Primary Care Residency Track continues and completes the 4-PCM program’s in-depth training in primary care medicine.  It follows all of the guidelines for a primary care residency set forth by New York’s Committee on Graduate Medical Education.

    Twenty percent of the residency time will be spent in primary care continuity settings, both at the DVA Medical Center and in the ambulatory practice of the Division of General Medicine at Stony Brook.  This allows 4-PCM participants to continue their UMC continuity practice and to develop a second one with a completely different patient population at DVAMC, Northport.

    Primary Care interns participate in an outpatient rotation at the university's student health service, which provides exposure to issues of adolescent medicine.  Interns also spend a full month focusing on the  psychosocial aspects of medicine, as taught by physicians, social workers and psychologists; the interns gain in-depth experience  in interviewing  techniques, as well as an understanding of  the many social and psychological issues which affect our patients and frequently come to the fore in the primary care environment. 

    During the second and third years of residency, Primary Care residents participate in four different Primary Care Months: Women's Health, Musculoskeletal Medicine, Dermatology and a "Practice Primary Care Month.”  Three of these months allow the resident to gain subspecialty experience in areas important for an excellent generalist, while the “Practice” month is designed to expose the residents to the diverse settings in which primary care is practiced, in order to facilitate career decisions.

    A monthly Primary Care conference utilizes a small group, evidence-based medicine approach to identifying clinical questions and developing the means to answering them.  Residents are encouraged to be active learners and to develop the skills necessary to continue life-long learning.

    The rotations of the residency years and their areas of focus are summarized in the table below.

     

    PRIMARY CARE CURRICULUM: PROGRAM YEARS 2-4*

    2008/2009 PRIMARY CARE CURRICULUM

     

    1ST YEAR
    RESIDENTS

    2ND YEAR
    RESIDENTS

    3RD YEAR
    RESIDENTS

    Medical Floors

    18 weeks

    4 weeks

    10 weeks

    ICU

    4 weeks

    8 weeks

    6 weeks

    CCU

     

    6 weeks

     

    MAR

     

     

    4 weeks

    Primary Care Block

    4 weeks

    8 weeks

    8 weeks

    Neurology

     

     

    2 weeks 

    Elective

     

    6 weeks

    6 weeks

    Emergency Room

     

    4 weeks

     

    Student Health Services

    2 weeks

     

     

    Night Float

    4 weeks

    4 weeks

    2 weeks 

    Day Float

    2 weeks

    2 weeks

     

    Subspecialties (Medical Floors)

    14 weeks

    6 weeks

     

    Geriatrics

     

     

    2 weeks

    Consults

     

     

    4 weeks

    LLT

     

     

    4 weeks

    Vacation

    4 weeks

    4 weeks

    4 weeks

    Continuity Clinic is two half days each week for all primary care residents

    CONCLUSION:  The Department of Medicine’s Four Year Primary Care Medicine Program combines a specially designed senior year of medical school with the three year Primary Care Residency Track, in order to provide selected Stony Brook Medical students with training for a career in primary care medicine.  Participants are eligible for tuition remissions for their senior year, contingent upon completion in good standing of Program Year 1, as well as matching and matriculating in the Stony Brook Medicine Residency Primary Care Track.

    Application for one of the five positions each year should be made by faxing or delivering your application to:
               
                Mandeep Kaur, MD (c/o Jacqueline Franco)
                PC4 Program Director
                Division of General Medicine
                HSC T-16, Room 020
                PHONE:  631-444-7383 
                FAX: 631-2493

    A complete transcript, your USMLE Part 1 score, a one-page statement of your interest in primary care and letters of reference from 3 School of Medicine faculty members should accompany the letter of application which must be received by May 1, 2006.

     Appendices A, B and C summarize the following important aspects of the residency program:  Teaching Activities, Learning Resources and Academic Projects.

    Appendix A: Residency Program Teaching Activities

    Morning Report: 7:45 - 8:45 a.m. Every Monday, Tuesday, Thursday and Friday.
    Floor Rounds: 9:00-11:30 a.m.  Residents round with the attending on all patients.

     

    Stony Brook has a closed faculty system which has important repercussions on the educational format.  One attending is responsible not only for all patient care, but also for all educational experiences for each team.  This means that as an inpatient team resident you will only have to contact one attending for any patient care concerns.  Also, it enables teaching discussion to flow from pathophysiology directly into management planning.

    Noon Conferences:        12:30 - 1:30 p.m. Every Monday, Tuesday, Wednesday and Friday.
    Medicine Grand Rounds:  9:00 - 10:00 a.m. Every Wednesday either at Stony Brook or Northport (teleconferenced to other site).
    Professors’ Rounds:     4:00 - 5:00 p.m. Every Friday.
    Morbidity and Mortality Conferences:    12:30 - 1:30 p.m.  Alternate Thursdays.
    Critical Care Conferences: 12:30 - 1:30 p.m.  Alternate Thursdays.
    Pathology Autopsy Conference: 11:45-12:30 Mondays
    Ethics Conferences:   12:00 - 1:00 p.m. Third Friday of month.
    Board Review:    5:30-7:30 pm Wednesdays, HSC 
    Journal Club:        8:00-9:00 a.m.   Third Tuesday of month.
    Medicine/ ER Conference:        12:30 - 1:30 p.m. Second Friday of month
    Appendix B: Learning Resources of the Department of Medicine

     House Staff Library and Learning Center: University Hospital, 15th floor
    *Computers with internet access for laboratory and imaging results, ekg's, discharge summaries, cardiovascular studies.

    *CD Roms are available -including Harrison’s Principles of Internal Medicine , Scientific American Medicine, Radiology Image Bank, Procedure Skills, Goodman and Gillman’s Principles of Pharmacology, ACP Journal Club, Heart Sounds, dermatology, hematology and anatomy atlases and more;

    * An extensive collection of medical textbooks and journals.
                           
    *Access Learning Center Library computer and UHMC computers from  home personal computer; free internet access from home.

    *Med-line and UpToDate on University Medical Center computers

    Access to Medical Literature
                            Health Science Center Library: HSC, 3rd floor
                            *Free copying service provided by the Department.
                            *Med-line access

    APPENDIX C: Academic Projects for Medical Residents

     

    The Department of Medicine requires each graduating resident to have completed a significant academic project.   Ideally, the project is selected during the first year, refined during the second year, and presented in the third year.  Each PGY-III is expected to present their project at a noon conference, or a special “Resident’s Day” symposium.  A progress report, or the finished product from the project, is due June 1 of each year.  Other variations are equally acceptable if the preceptor agrees, such as changing projects, and accelerated completion. 

    Each resident selects one of the attending staff as a preceptor.  The preceptor offers ideas, guidance, help and possible resources.  The PGY-II and III residents choose a preceptor of their liking.  The PGY-I residents are assigned a preceptor from a list of volunteers and have the option to choose another more suitable preceptor after they become more familiar with our faculty.

    The academic project should be a topic in which the resident is interested.  There are no limits on the choice of topic, so long as it is suitable for an academic exploration.

      Possible type of project:         Expected outcome:
    Scientific questions     Formal study (basic or clinical)
    Curriculum development  Recommendations for one rotation
    Health care delivery issue  Cost-benefit analysis; comprehensive survey
    Case report    Scholarly review and published report
    Practice issue  Scholarly review and practice guideline
    Interesting observation  Small series for trending; in depth lit. review
       
       
       

    We would like to see the academic project be one of the highlights of your residency experience and we look forward to working on it with you.