Rotations at Ventura Family Medicine
Ventura Family Medicine is committed to training residents in full-spectrum family medicine so that they may have the skills to work anywhere. The Academic Family Medicine Center, our continuity clinic, is the core of our training program. A wide range of medical, pediatric, and surgical specialists welcome our residents into their on-campus outpatient clinics to supplement their training. The unopposed inpatient experience deepens and defines our training experience.
Because there are no other residencies at VCMC, the family medicine resident is the primary doctor for nearly every patient, be it a laboring mother or a critically-ill ICU patient. The hospital is structured to provide residents the support and supervision they need to practice high-quality medicine while preserving their independence. Residents communicate directly with specialists and care for patients throughout all stages of their hospitalization, providing a depth of learning that only comes from taking personal responsibility for providing good medicine to another human being.
CURRICULUM BY ACADEMIC YEAR
Below are overviews of each academic year. Listed are the minimum number of weeks, but the curriculum allows for some customization. Each resident will repeat 3-week blocks in two of the core rotations each year, allowing skill development in areas of interest.
PGY-1 residents build a basis for full-spectrum family medicine training under the supervision of senior residents and faculty attendings, transitioning from student to physician.
Obstetrics and Women's Health: 5 weeks
Pediatrics: 3 weeks
Inpatient Medicine: 12 weeks
Intensive Care: 3 weeks
Surgery: 3 weeks
Emergency Medicine: 3 weeks
Orthopedics & Sports Medicine: 3 weeks
Anesthesia & Palliative Medicine: 3 weeks
Vacation: 4 weeks
Second-year residents assume full ownership of their patients and refine their skills and knowledge base, while developing a teaching role with the interns. It is a rigorous year but also productive and satisfying.
Obstetrics and Women's Health: 7 weeks
Pediatrics: 3 weeks
Inpatient Medicine: 9 weeks
Intensive Care: 2 weeks
Surgery: 5 weeks
Emergency Medicine: 3 weeks
Community Medicine: 2 weeks
Elective: 6 weeks
Vacation: 4 weeks
In their final year, our residents prepare to transition to their post-residency careers by assuming a new level of independence in both inpatient and outpatient settings.
Obstetrics and Women's Health: 8 weeks
Pediatrics: 6 weeks
Inpatient Medicine: 3 weeks
Intensive Care: 5 weeks
Surgery: 3 weeks
Emergency Medicine: 3 weeks
Orthopedics & Sports Medicine: 3 weeks
Ambulatory Selectives: 3 weeks
Elective: 6 weeks
Vacation: 4 weeks
Our inpatient medicine service has four resident teams that care for the majority of the patients in the hospital. Each team is made up of a PGY-1, PGY-2 and attending. There is a short-call/long-call system with cap of 14 and rollovers to a nonteaching service. Overnight admissions and cross-coverage servcies are provided by our "NARC" team (the Night Admitting Residents & Cross-coverage team), comprised of a PGY-1 and PGY-3. A backup system is in place to call in extra help if the night gets too busy, and the cap maintains a good balance between service and learning. Highlights of the rotation include lots of resident-to-resident teaching and collaboration, a healthy amount of tethered autonomy, and a daily morning teaching session led by PGY-3s and attendings with a core curriculum of case-based topics.
Residents see an amazing variety of pathology in patients of all ages and fully participate in their care as the primary doctor. They progressively develop more complete and complex differential diagnoses and cogent treatment plans. The progressive responsibility and leadership experiences prepare the resident well for independent practice.
Total time on medicine rotations comprises four rotations in each of the first two years, plus two 2-week blocks of NARC in each year. The rotation is primarily inpatient, with the exception of 1-2 partial-days a week of continuity clinic and a day off each week.
VCMC’s ICU is a closed, mixed medical and surgical unit staffed daily by a resident team comprised of a PGY-1 and PGY-3. Overnight coverage is provided by a PGY-2 or PGY-3 on night float, giving that resident an opportunity to be "alone" in the ICU (the attending is available by phone and in-house when needed) and develop independence. Residents intubate, place lines and chest tubes, manage ventilators, and run codes under the supervision of a dedicated ICU attending (many of whom are family physicians and graduates of our program) and in collaboration with a multidisciplinary team including critical care nurses, respiratory therapists, pharmacists, nutritionists, physical therapists, and the palliative care team.
Common diagnoses managed include sepsis, trauma, acute MI, pancreatitis, diabetic ketoacidosis, and more. The procedural training is superb, and residents leave the rotation comfortable dealing with acute illness. Residents serve as the point of communication between the medical team and the patients and families, developing their skills in critical health care decision-making and end-of-life discussions .
PGY-1 residents do a 3-week ICU block. There are 1.5-week night-float blocks in each of the PGY-2 and PGY-3 years. There is another dedicated ICU block in the PGY-3 year.
The ER experience is both focused and longitudinal.
A dedicated block each year provides concentrated ER training, while evening and weekend shifts scattered throughout other rotations maintain skills over a longitudinal experience. Our residents take the role of the primary ER resident, assessing and stabilizing patients under the supervision of our ER staff physicians. Residents learn acute care, accumulate procedural experience, and get point-of-care ultrasound training.
PGY-1 residents have a 3-week night-float block where they work alongside the PGY-3.
PGY-2 residents have a dedicated block of daytime ER where they gain additional experience and confidence in preparation for their senior rotation.
The experience culminates with the PGY-3 "Night ER Doctor" rotation, a 3-week block in which the resident is the primary ER physician under the supervision of an in-house attending.
All residents also cover weekend ER shifts over the course of several rotations.
OBSTETRICS AND WOMEN'S HEALTH
Every delivery at VCMC is performed by a Ventura resident, and residents are involved with all postpartum and antepartum care. During the day, a PGY-1 resident is “on deck” with both a family physician and an obstetrician immediately available for supervision and teaching. Overnight a PGY-2 or PGY-3 manages the OB floor with a family physician and obstetrician who are available by phone for consultation and come into the hospital when needed. This progressive responsibility allows residents to build their skills independently managing labor and delivering babies. A NICU staff member is always in house, and residents help with neonatal resuscitations. Postpartum patients are managed as couplets, so the resident who performs the delivery will care for both the mother and newborn until discharge.
All C-sections are done by a resident with an obstetrician or fellowship-trained family physician. Residents may sign up for additional (paid) C-section call overnight, and motivated residents have logged over 100 operations. Residents scrub into gynecologic cases 3-4 days a week as well. Residents are the primary operators for cesarian deliveries, tubal ligations, diagnostic D&Cs, suction D&Cs for incomplete SAbs and other procedures. On outpatient days residents rotate through our OB-GYN clinic and high-risk OB clinics, as well as an optional experience at Planned Parenthood.
Women's health and maternity care are an integral part of family medicine. Residents are privileged to participate in such an important event in a family as the mother's pregnancy and the baby's birth. We take pride in the fact that about two-thirds of our graduates include obstetrics in their practice, and approximately 30% have C-section privileges.
2 months of each academic year are dedicated to the OB-Gyn and Couplet Care rotation.
A team of three residents cares for all inpatient pediatrics patients, supervised by a full-time pediatric hospitalist as well as a complement of specialist pediatricians affiliated with UCLA. In addition to a full scope of general pediatrics, a pediatric hematologist-oncologist and a cystic fibrosis center admit to the resident service. Residents are also involved with the care of patients in our new PICU. There is also a strong outpatient experience at our on-campus Pediatrics Diagnostics Center with both generalist and specialist pediatricians. Residents may rotate by elective through our NICU as well. While on inpatient medicine, residents help with overnight pediatric admissions, extending the pediatric experience longitudinally.
Residents gain exposure to well child care, developmental assessments, sports participation physicals, adolescent medicine, and parent education. Subspecialists from UCLA come to Ventura to provide care closer to the patients' homes, allowing residents exposure to a broad array of pathology. In addition, there is a robust pediatric population in our continuity clinic, and pediatricians are present a few days a week to provide supervision to residents seeing their own patients.
There is one block of this rotation in each of the PGY-1 and PGY-2 years, and two blocks in PGY-3.
Many diseases encountered in family medicine are best treated with surgical interventions. Our residents are the primary surgery residents when on service. On call days, the resident takes all surgical admits, scrubs in on emergent surgical cases (typically as first assist), and runs trauma codes. Residents handle postoperative care for general surgery, neurosurgery, bariatrics, urology, and trauma patients. Midlevel providers help to decompress the resident rounding load. Outpatient surgical experiences include plastics, urology, ENT, wound care, and a "lump & bump" clinic for office-based surgical procedures.
We believe that family physicians need to be well-versed in handling surgical diseases. Our surgeons are approachable and enjoy teaching family medicine residents. Residents become comfortable with a wide range of pathology including trauma, cholecystitis, thyroid nodules, breast lumps, appendicitis, bowel obstruction, lower GI bleeding, lymphadenopathy, subcutanous masses, and others.
Residents spend one block of each year on the surgery rotation, with an additional 3 weeks during the PGY-2 year covering the service as night float.
ORTHOPEDICS AND SPORTS MEDICINE
Our sports-medicine trained core faculty hosts a sports injury clinic in the AFMC. We have relationships with local schools to staff sporting events, including Friday night high school football. Our on-campus orthopedics clinic hosts each resident for two full months of dedicated orthopedics and sports medicine training. Residents learn x-ray reading, fracture management, joint injections, and post-operative orthopedics care. Residents work one-on-one with adult and pediatric orthopedic surgeons, sports medicine physicians, podiatrists, and physical/occupational therapists. Additionally, during ER rotations, residents reduce and splint fractures.
There are 6 dedicated weeks in the PGY-1 year and 3 weeks in the PGY-3 year for orthopedics and sports medicine
PGY-3 residents have a dedicated "ambulatory selective" block. They may choose from experiences focused on cardiology, diabetes, immunololgy/oncology, dermatology, psychiatry, and neurology/rehabilitation. An on-campus medical specialties clinic tower provides easy access for patients and residents, and the same specialists that consult in our hospital and advise on our continuity clinic patients welcome our residents into their own practices. Our faculty are here to teach, so residents do not simply "follow and observe" but are actively involved in managing patients.
The Academic Family Medicine Center, our continuity clinic, is where residents become family physicians. This clinic, located on the VCMC campus, is the hub of the continuity experience and the resident's "home" during residency. There are four suites, each containing 7-8 exam rooms, organized around a nursing station with the medical secretary, clinic assistants and a registered nurse to help you see patients. You will have a home suite and be part of the team with your fellow residents and staff, seeing patients 2 - 4 half days a week.
A secondary family practice site opened in 2106 at Las Islas, a FQHC clinic in the neighboring town of Oxnard, allowing senior residents an opportunity to experience practice in a FQHC setting.
Teaching: The full time family practice faculty bring years of experience to precepting resident physicians. We believe continuity and a sensitive approach to dealing with the patient as a person is the key to family medicine. The behavioral sciences are emphasized as integral to patient management. In addition, community family physicians are employed as preceptors to work on a weekly basis, bringing their "real world" experience to give the residents a well-rounded perspective.
Patients: The majority of patients are invited into your practice by residents; from your rotations in the ER, OB, Peds and Medicine clinics or inpatient services. Others are inherited from graduating residents. Some of our patients have "raised" several generations of doctors. We have a very interesting, diverse patient population. The main mission of VCMC is to provide high quality patient care to the underserved and thus the majority of our patients have public health insurance or no insurance. However, about 20% of the AFMC patients are employees of the county government. Residents get a wide range of experience in treating people from all walks of life. The presence of the insured population also helps ensure that all patients, affluent or poor, are seen in a clean, pleasant atmosphere by competent, caring staff.
Continuity: Patients see the resident as their own personal doctor. Every effort is made to schedule patients with their physician, even when the patient calls for a last-minute appointment. The nurse in the suite is often familiar with the patients and serves to improve continuity as well. Residents have the option of following their own patients when they are admitted to the hospital. Maternity patients from AFMC are delivered by their resident doctor and the baby and family are followed subsequently by the resident in AFMC. Patients become quite attached to their doctor. In order to train to become a family physician, you must be a family physician in your training. Continuity is a major part of that experience, something we emphasize strongly in the VCMC Academic Family Medicine Center.
Women's Health: The primary care practice in the AFMC gives you lots of opportunities in Women's Health. Maternity continuity patients are followed through prenatal care and delivered by their resident physician. There is an ultrasound clinic in AFMC which is taught by family medicine faculty. Residents place IUDs, do endometrial biopsy, colposcopy and other gyn procedures in AFMC in the practice of full spectrum women's health. Our system has a state of the art DEXA machine and Cheryl Lambing, MD, one of our core faculty, is a nationally recognized expert in osteoporosis.
Dr. Ron Bale, Ph.D. oversees our longitudinal behavioral health training. Dr. Bale has 30+ years of experience teaching family physicians and practicing psychology in a medical setting. Each resident works with Dr. Bale several times each year in a variety of settings.
Because behavioral health is central to the practice of Family Medicine, we integrate behavioral health training into our continuity clinic. In the Academic Family Medicine Center, psychologists see patients with residents on a weekly basis. Psychology trainees are embedded in the clinic and available for collaboration. Residents may see patients from the psychologist or psychiatrist's regular schedule, or may schedule their own patients to be seen. Dr. Bale also meets 1:1 with each resident periodically to discuss patient care and personal wellness strategies. Finally, residents rotate with Dr. Bale in his HIV/AIDS clinic, seeing patients with HIV infection and co-morbid mental health problems. Residents are well-exposed to the diagnosis and management of depression, anxiety, personality disorders, substance abuse, and even more complicated diagnoses such as schizophrenia.
Behavioral health is well-represented in our didactic curriculum as well, with topics ranging from diagnosing anxiety disorder and pharmacologic management of depression to dementia and distinguishing delirium from psychosis. Regular reflection meetings are incorporated into the resident Core Conference, allowing residents (grouped by class) an opportunity to process their patient interactions and address resident stress.
There is an optional selective block in psychiatry, in which the residents work with the consulting psychiatrist in the hospital and the inpatient psychiatric unit, learning the hands-on management of psychiatric illiness in the inpatient setting.
Finally, each of the core family medicine faculty contribute to the behavioral health education by promoting patient care from the bio-psycho-social perspective. We relate to our patients as a whole person and place a great deal of emphasis on humanistic medicine, which becomes even more important in our medically-underserved population.
PGY-1s spend a block with our palliative care service. Led by our core faculty members, the palliative care service provides an opportunity to hone skills in goals-of-care discussions and symptom management. We believe that good Palliative Medicine is good Family Medicine, and this rotation establishes a foundation for patient-centered care that translates to all aspects of training.
PGY-1s spend a block's worth of mornings rotating in our anesthesia department, where they learn to manage airways, perform preoperative assessments, and gain exposure to the basics of intraoperative anesthesia. This establishes an important foundation for managing acutely ill patients in the ER and ICU settings later in training.
With four elective rotations over the three years, residents have an opportunity to focus their training on their personal career goals. We allow residents a good deal of latitude in creating experiences in the VCMC system and around Southern California that will fit their specific training needs. Residents have created a wide variety of elective opportunities to supplement their core residency training. Popular choices include language school, radiology, podiatry, dermatology, infectious diseases, and ultrasound.
Residents are allowed 6 weeks of "away elective" time in which they may rotate outside of Southern California. Most residents take advantage of this opportunity to either travel internationally or explore locations elsewhere in the USA. International electives have taken residents to Guatemala, Honduras, Mexico, Chad, Ethiopia, Nepal, China, Haiti, and many other locations. Many residents also use away elective time to explore settings that they are considering for future careers. Ventura alumni can be found just about anywhere, paving the way for a wide range of experiences.
PGY-2 and PGY-3 each have two months of elective.
HEALTH SYSTEMS MANAGEMENT
Our Management of Health Systems curriculum extends over the entire residency with the emphasis on practical education in the third year. This curriculum is taught through direct-hands on experience at the Academic Family Medicine Center. There are also didactic lectures which include topics such as medical documentation, billing, coding and medical-legal issues. We have partnerships with our department of public health and our pharmacy quality departments as well. During the third year, there is a set of meetings with the faculty to review aspects of choosing a practice, contracting, hospital privileging, personal finance, etc. in detail.
On Tuesday afternoons, for three hours every week the attendings relieve the residents of their clinical duties so that they may attend a protected core conference. This is a series of didactics presented by the core faculty and the VCMC physician staff and focused specifically on covering a core curriculum for family medicine residents.
Many rotations including medicine, obstetrics and surgery also have daily formal didactics in addition to teaching rounds. Medicine morning report occurs daily for those on the medicine rotation, and addresses a standard set of hospital medicine topics. There is an EKG rounds series with Dr. Leibovitch which prepares residents to pass a requied EKG exam prior to graduation.
The Ventura County Medical Center offers continuing education conferences for the physicians of Ventura County including the residents and faculty of the Family Medicine Residency Program. Certain conference series are approved for CME credit by VCMC, a CMA-accredited provider. Additionally, the Wednesday and Thursday morning CME conference series is approved by the AAFP for prescribed credit for family physicians, and residents are encouraged to attend. There is a bimonthly Friday morning Health Equity grand rounds series to improve our community's approach to equity and inclusion. A series of multidisciplinary tumor boards and monthly morbidity and mortality conferences from various specialties are also open to residents.