Curriculum Overview

Our academic year is split into 13 blocks with each block comprised of 4 weeks. Our goal with designing our curriculum is two-fold. We want to provide our residents with the knowledge and skills to practice family medicine anywhere in the world with special attention paid to skills necessary for rural practice. We also want to design a program that will benefit our local community by filling previously unmet needs. All in all, we think the curriculum here will not only be challenging but also rewarding as you help care for a population that is severely lacking in good primary care.

Dermatology/Wound Care

Residents will spend 1 block with a combination of dermatology and wound care experiences. We believe that a rural family physician should be comfortable managing the majority of outpatient dermatological conditions. You should also have a good understanding of basic wound care principles and techniques so that you can aid in the healing of the countless wounds you will encounter in rural practice. If you plan to spend anytime abroad, this experience becomes even more invaluable. During this rotation you will spend time in both dermatology and wound care clinics while also doing inpatient wound care consultations.

ER

Residents will spend 2 blocks during intern year and 1 block in both PGY-2 and PGY-3 working in our fast-paced emergency department. We see both pediatric and adult patients in our ED which provides a true rural emergency medicine experience while also having the volume and acuity of patients to gain a well-rounded experience. Your time in our emergency department will prepare you well for rural practice because you will gain the skills necessary to care for anything that walks through the door.

Family Medicine Clinic

This is a longitudinal experience over the entire 3 years where you will be responsible for your own panel of patients in our designated Rural Health Clinic (RHC). Generally, you will have 2 half days of clinic per week in PGY-1 and 3 half days per week in PGY-2 and PGY-3. In our clinic, you will see a wide range of patients from all walks of life with significant ethnic and socioeconomic diversity. This is where you will learn how to be a family medicine physician.

Geriatrics

Geriatrics is an extremely important part of family medicine. For this reason, you will spend 2 total blocks dedicated to caring for our geriatric population. This will include seeing patients in your continuity clinic, rounding on patients in long-term care and short-term care facilities and making home visits. You will also receive dedicated lectures focused on caring for this often times vulnerable and complex patient population.

Inpatient Medicine

Residents will spend 2 blocks per year working on the inpatient service in Ukiah and 1 block during intern year at the Sacramento VA, totaling 7 blocks over 3 years. In Ukiah, at our primary hospital site Adventist Health Ukiah Valley, residents will take care of a wide variety of patient types with an interesting mix of pathology. During this time, you will work closely with our dedicated hospitalist team as well as our family medicine faculty. We have an open ICU so you will be managing critically ill patients on a daily basis. We have limited specialists available so you will become adept at managing all aspects of your patients’ care. Residents on the inpatient service will also be responsible for all of the inpatient procedures that come up throughout the day. You will become very comfortable with central line placement, paracentesis, thoracentesis, intubation, etc.

Obstetrics/Gynecology

You will be provided with a combination of experiences in order to help you develop the foundation to be able to care for women of all ages. You will have 2 blocks of dedicated obstetrics training with perinatal, antepartum, intrapartum and postpartum management experience. These experiences will occur on labor and delivery and with local obstetricians in their own clinic as well as in your own continuity clinic. You will also be provided with a longitudinal experience that encompasses all 3 years of your residency where you will work with a fellowship trained family medicine physician providing full spectrum care, including obstetrics, to her patients in a nearby small town.

1 block during PGY-2 will be dedicated to gynecology with our local OB/GYN physicians mainly focused on common gynecological conditions in the outpatient setting.

Ophthalmology/ENT

You will spend 2 weeks rotating through our ophthalmology clinic and 2 weeks in our ENT clinic. Eye complaints and ENT complaints are extremely common in family medicine clinic but can be overwhelming if you do not have a good foundation in these areas. You will learn proper exam techniques and treatment for the most common complaints in addition to learning when referral to a specialist is necessary.

Orthopedics/Sports Medicine

1 block in intern year and 1 block in PGY-3 will be dedicated to orthopedics and sports medicine. You will spend time learning from our local orthopedic surgeons in their clinic as well as participating in call where you will get familiar with managing all types of acute orthopedic injuries. You will also spend some time working with and learning from our physical therapists to learn rehabilitation techniques and hone your musculoskeletal exam skills. We also have a partnership with the athletic department of our local community college, Mendocino College, where you will get to work closely with the head athletic trainer. You will have the opportunity to participate in sports physicals, in-game injury management as well as pre- and post-game therapy so that you get a feel for what it is like to be a team physician. For residents with extra interest in this area, they will have the opportunity to be designated as the team physician for a high school or college sports team. This is an exciting experience that will allow you to feel extremely comfortable managing a wide range of musculoskeletal complaints and injuries.

Pain Management

Our 1 block pain management rotation has two primary focuses. The first focus is to learn pain management strategies from our local pain medicine physician. Caring for patients with chronic pain can be very challenging for family physicians and to do so effectively often requires incorporating many different modalities into their care. You will learn how to incorporate behavioral health interventions, complimentary medicine techniques and appropriate opioid prescribing to better care for these patients.

The second part of this rotation focuses on medication-assisted treatment (MAT) for patients with opioid use disorder which is a huge problem in rural America. This training also occurs under the guidance of our pain medicine physician and all residents will be able to obtain their buprenorphine waiver by the end of the rotation.

Pediatrics

1 block of inpatient pediatrics and 1 block of dedicated outpatient pediatrics will be completed in both PGY-1 and PGY-2 (4 blocks total). The inpatient pediatrics experience will take place at UC Davis Children’s Hospital in Sacramento on the general pediatric ward with pediatric residents and attendings where housing will be provided. The outpatient pediatrics experience will take place in Ukiah with time spent at the Adventist Health pediatric clinic, Consolidated Tribal Health pediatric clinic and the local FQHC. While on outpatient pediatrics, you will also be responsible for caring for the newborns in the hospital.

In addition to the dedicated block experiences listed above, you will have a good amount of pediatric patient encounters in our emergency department and in your continuity clinics.

Street Medicine

This is a longitudinal experience that will encompass all 3 years where each of our residents will play a major role in caring for our homeless population. Often times the patients our street medicine team cares for are people who are unable or unwilling to see providers in the clinic for various different reasons. To help reach these patients, we have a dedicated street medicine team that our residents will work closely with to provide care for these patients in a compassionate and non-threatening way. Please review our street medicine website for more information about this program.

Sub-Specialty Medicine/Cardiology

Residents will spend a total of 2 blocks working with attendings from different medical specialties. 4 total weeks split into 2 weeks during PGY-1 and 2 weeks in PGY-3 will be spent learning cardiology from our cardiologists. The other 4 weeks will be split between 2 different medical specialties of your choosing that could include nephrology, gastroenterology, rheumatology and neurology. As a family physician, it is very helpful to spend time learning under attendings from different specialties. You will learn appropriate management of specific conditions you will likely see in your clinic as well as learn when it is and is not appropriate to refer to specialists.

Surgery

You will have 1 block during both PGY-1 and PGY-2 working with our general surgeons. Our general surgeons are highly skilled and eager to teach. During these months you will live the life of a rural general surgeon working side by side with them rounding on inpatients, seeing consults in the emergency room, managing a busy clinic and first assisting on a wide variety of common (and not so common) surgeries.

Didactics

Each Tuesday afternoon residents will be excused from all clinical responsibilities to attend didactics. The basic structure will include a mystery case, lectures over specific learning topics and board review. There will be certain days dedicated to Behavioral Health topics as well as time for hands on procedural training. This is an extremely important time for our residents where they can have a break from clinical responsibility and have dedicated time to learning in a fun and stress-free environment.

Procedures

Here at AHUV, we have a dedicated procedure curriculum where you will gain the skills necessary to perform a wide range of inpatient and outpatient procedures. Our residents are expected to be involved in all procedures that take place in the hospital with the oversight of skilled faculty. You will also have plenty of opportunity to gain experience performing procedures for your continuity patients in clinic as well as during dedicated procedure clinics. We have procedure lectures and skill labs built into our weekly didactics so that you can truly learn the ins and outs of all of the procedures you may come across during your career. Part of being a rural family physician is being able to provide everything your patients may need under one roof. This is how we prepare our residents.

Global Health

Our mission is to train family physicians well equipped to provide care for underserved patients in rural settings here locally and abroad. Whether you are practicing family medicine in a rural location in California or anywhere else in the world, the required skills are the same. You need to be comfortable managing simple cases and complex cases alike with limited resources and limited help from specialists or other providers. For these reasons, our program has made a commitment to incorporating global health into our curriculum. At our residency program you will hone your physical exam skills and learn how to rely more on your history and physical to make the right diagnosis. We have purposefully recruited faculty with a wide array of global health experiences and interests and you will be able to learn from and be mentored by these physicians. We will have lectures covering global health topics throughout the year and both our procedures curriculum and POCUS curriculums were designed with global health work in mind. This experience will culminate with the possibility to do up to 2 international electives where you will get to work under family physicians doing amazing things across the globe.