Curriculum

Rotations

Conferences & Lectures

Residents have protected time every Thursday afternoon from 1:00 to 5:00 pm for educa- tion. During the first hour, residents meet with their own Year Group (R1, R2, R3) to learn about behavioral medicine, practice management, outpatient medicine and a variety of oth- er topics. During the next two hours, all residents meet together for education on core topics in family medicine and procedural skills, with speakers from our own family medicine faculty, community specialists, and specialists from Stanford and UCSF. The last hour of the after- noon includes Journal Club, resident-faculty meetings, and wellness activities. One afternoon per month Senior residents care for their panel of nursing home patients at a local skilled nursing facility.

Residents and faculty attend morning report every weekday morning, which includes case presentations across all areas of family medicine, as well as simulation trainings presented collaboratively with our Simulation Center.

Behavioral Health

The Behavioral Health curriculum is longitudinal and integrated into all three years of train- ing. Each Year Group includes a monthly Behavioral Medicine topic. All residents receive 1:1 observation by Behavioral Health faculty in the continuity practice to hone their communica- tion skills. The Neurology/Psychiatry rotation includes outpatient experiences in neurology and psychiatry, and weekly sessions dedicated to seeing continuity patients for extended counseling sessions with Behavioral Health faculty. During the Community Medicine rota- tions, residents receive training in managing substance use disorders.

Pediatrics

Natividad’s pediatric curriculum provides residents with rigorous experience with the full spectrum of childhood illness presentations as well as preventive care for children of all ages.

Pediatric rotations include experiences on the inpatient pediatric unit, newborn nursery, and general and specialty pediatric clinics, with optional rotations in our level III NICU. Nativida- d’s pediatric service is staffed 24/7 by UCSF pediatric hospitalists, outstanding teachers who are highly engaged in resident education. Working in a community hospital, residents learn to stabilize and transfer critically ill children who need higher levels of care. In addition, resi- dents provide many pediatric acute and preventive care visits in the continuity practice, which serves a large number of young families. Residents are trained in procedures such as neonatal resuscitation, pediatric lumbar puncture and circumcision.

Night Float

During this rotation, residents “run the hospital” overnight: The first-year resident covers medicine, pediatric and surgery admissions. The third year resident covers ICU patients and helps with admissions and cross cover. Night float residents have a high level of autonomy, with in-house attendings available for support, including a family physician, pediatric hospi- talist, FM or IM hospitalist, OB/GYN, and anesthesia, and other specialties available as need- ed. Night Float is an intense rotation, but is rewarding and helpful in developing decision- making, teaching and leadership skills.

Family Medicine

The Family Medicine Inpatient Service includes a first, second, and third year resident and FM Attending, who care for adult and pediatric patients from our continuity clinic, community based Family Medicine practices, our HIV Clinic, and the Clínica de Salud del Valle network of community/migrant health clinics.

Inpatient Medicine/ ICU

Working with a cadre of hospitalists and critical care specialists, residents admit and care for adult patients with a wide array of medical problems. A group of dedicated subspecialists are available for consultation and teaching. During rotations in general internal medicine and ICU, residents acquire procedural skills including lumbar puncture, central line placement, point of care ultrasound, ventilator management, cardiopulmonary resuscitation, intubation, paracentesis and thoracentesis.

Obstetrics and Gynecology

Our OB/GYN training experiences include the R1 OB rotation, R2 night float, and outpatient GYN rotation. On labor and delivery, FM residents assume responsibility for all OB triage and all laboring patients on our busy unit. FM residents manage all patients in labor, including those with high risk conditions such as preterm labor, hypertensive disorders/preeclampsia, trauma, trial of labor after cesarean, and gestational and preexisting diabetes. Family Medi- cine Obstetrical Fellows, Family Medicine attendings, and OB/GYN attendings provide clinical supervision and teaching. Residents care for many pregnant patients in their continuity clinic and attend their continuity deliveries in the hospital. Residents easily attend >100 vaginal births during their training.

Natividad residents receive comprehensive reproductive health training, including the full ar- ray of family planning methods and miscarriage management in our continuity clinic as well as opt out abortion training through the TEACH (Training in Early Abortion for Comprehensive Healthcare) during the GYN rotation. Two of our core faculty are TEACH trainers. Residents seeking advanced procedural abortion skills can participate in the TEACH Program’s CREATE fellowship: https://teachtraining.org/create

Musculoskeletal/Sports Medicine

This curriculum includes all three years of residency and prepares residents to provide team based care for patients with musculoskeletal concerns. During two dedicated rotations, res- idents work with Sports Medicine, Orthopedic Surgery, Podiatry, Physical Therapy, Colle- giate Athletic Training and Ortho techs to learn principles of musculoskeletal medicine. Ad- ditionally, there are longitudinal musculoskeletal didactics and workshops (joint injection, musculoskeletal ultrasound, joint exams) and hands on experiences such as preparticipa- tion physicals for high school athletes in Salinas and staffing local college athletic events and the Salinas Rodeo.

Surgery

Our Surgery curriculum includes a general surgery inpatient rotation, in which residents work with our general surgeons in managing pre-, intra- and post-operative care and assist in the OR, and an outpatient surgery rotation, in which residents work with general sur- geons and local surgical sub-specialists, acquiring skills including excisional biopsy, suturing techniques, circumcisions, and slit exams.

Emergency Medicine

Residents spend 2 months on rotation in Emergency Medicine. This includes trauma and emergencies such as injuries, poisoning, shock, respiratory and cardiac arrest, as well as the acute care of the full spectrum of medical, psychiatric, and surgical conditions. The ED is al- so an important environment to learn about the interaction of physicians and patients with law enforcement, public health agencies, and inpatient services. Resident perform many procedures including laceration repair, splinting, reducing joint dislocations, incision and drainage of abscesses, and point of care ultrasound (POCUS).

Community Medicine

This rotation combines independent work and scheduled modules to help residents learn how to advocate for the health of the greater community in their role as a family physician. The first module involves multiple health promotion activities in community and agricultur- al settings. Residents work with community health leaders doing hands on work in free clin- ics and street medicine team, health presentations to farm workers, and visits to migrant labor camps. Residents also provide health education to promotores, community leaders in health education, who in turn educate residents about local community needs.

The second module leads residents through a Community Oriented Primary Care (COPC) process addressing a public health issue of the resident’s choice. Here residents conduct patient health surveys, meet with local leaders, explore partnerships and coalitions and de- velop strategies and interventions that impact our community health. Frequent one on one meetings with the Community Medicine faculty provide support and guidance.

Elective Rotations

A wide range of elective opportunities are available locally, including specialist preceptors at Natividad and the surrounding community including Allergy and Immunology, Cardiology, Nephrology, Endocrinology, Hematology/Oncology, Neurology, Pulmonology, Gastroenterolo- gy, Rheumatology, and Interventional Radiology. Other local electives include HIV and infec- tious disease care, hospital medicine and Correctional Medicine. In addition, some elective time can be used for Board preparation and studying Spanish. Two away electives are per- mitted; popular options include Pediatric Emergency Medicine, Rural Health in King City or Quincy, CA, or global health in Mexico and Central America.

Cardiology

During this rotation residents work with Natividad’s cardiologists, an enthusiastic and talent- ed group of teachers. Residents participate in inpatient consultations, scheduled cardiover- sions, pacemaker/defibrillator surgical placement, and stress tests and patients in Nativida- d’s outpatient cardiology clinic.

Practice Management

The resident on the Practice Management rotation is the acting “Clinic Chief” for the month, learning practice management skills from faculty and attending leadership meetings in the clinic and the hospital. During the rotation they have multiple opportunities to explore differ- ent practice models in the community.

Geriatrics

This five-week rotation includes ambulatory geriatric clinics, home visits and work with the VNA and Community Social Services for the Elderly. The rotation is augmented by a geriatric lecture series and monthly visits to provide longitudinal care to a panel of patients in the skilled nursing facility during years 2 and 3. The resident on the Geriatric rotation oversees the acute needs of the nursing home patients and organizes the monthly visits by residents to the skilled nursing facility.