|Rotation||Year 1||Year 2||Year 3|
|Pediatrics – Inpatient||5 weeks||5 weeks||–|
|Night Float (inpatient med, ICU, peds, surgery, OB, newborn)||5 weeks (split in 2 blocks)||5 weeks (split in 2 blocks)||5 weeks (split in 2 blocks)|
|Family Medicine Inpatient||5 weeks||5 weeks||5 weeks|
|Internal Medicine / ICU||10 weeks||10 weeks (5 Med, 5 ICU)||–|
|Obstetrics||5 weeks||(5 weeks during night float)||–|
|Musculoskeletal and Sports Medicine||5 weeks||–||5 weeks|
|Surgery||5 weeks (inpatient)||–||5 weeks (outpatient)|
|Emergency Medicine||5 weeks||–||3 weeks|
|Community Medicine||–||5 weeks||–|
|Outpatient Med Specialties||5 weeks||–||–|
|Pediatrics Outpatient||5 weeks||–||4 week|
|Elective||–||5 weeks||15 weeks|
|Neurology / Psychiatry||–||–||5 weeks|
|Practice Management||–||–||5 weeks|
Conferences & Lectures
Residents have protected time every Thursday afternoon from 1:00 to 5:00 pm for education. 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 other 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 afternoon includes Journal Club, resident-faculty meetings, and wellness activities. One afternoon per month first-year residents conduct group prenatal visits during this time while 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.
Natividad also supports many lunchtime CME lectures including Pediatric, Emergency Medicine, Medicine and Trauma Grand Rounds as well as Perinatal M&M.
The Behavioral Health curriculum is longitudinal and integrated into all three years of training. 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 communication skills. The Neuro/Psychiatry rotation includes clinical experiences in psychiatry. Third years also have about 10 clinic sessions per year dedicated to seeing their continuity patients for extended counseling sessions with Behavioral Health faculty. During the Community Medicine rotations, residents receive intensive training in managing substance use disorders, including screening and counseling techniques and treatment strategies, at multiple community based addiction treatment centers for men, women and teens. All residents complete buprenorphine training.
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 ward, newborn nursery, and Level III NICU, and general and specialty pediatric clinics. Natividad’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, residents 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.
During this rotation, residents “run the hospital” from 6:00 pm to the following morning. The first-year resident covers medicine, pediatric and surgery admissions. The second year resident oversees the labor deck and postpartum unit. The third year resident supervises the junior residents and covers the ICU, and assigns and supervises admissions. Night float residents have a high level of autonomy, with in-house attendings available for support, including a family physician, pediatric hospitalist, internal medicine hospitalist, OB/GYN, and anesthesia, with other specialties available as needed. Night Float is an intense rotation, but is rewarding and helpful in developing decision-making, teaching and leadership skills.
The Family Medicine Inpatient Service is comprised of a first, second, and third year resident and FM Attending, who work together to care for adult and pediatric patients from the Family Medicine Clinic, two county Health Department Clinics, community based Family Medicine practices, our HIV Clinic, and the Clínica de Salud del Valle network of community/migrant health clinics.
Internal Medicine/ ICU
Working with a cadre of internal medicine 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 inpatient maternity care experiences include the 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 unit, which averages 200 deliveries per month. 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, cholestasis, and gestational and preexisting diabetes. Family Medicine Obstetrical Fellows, Family Medicine attendings, and OB/GYN attendings provide clinical supervision and teaching.
In addition to their OB-GYN rotations, residents provide prenatal care in their continuity clinic and attend continuity deliveries in the hospital.
As a RHEDI Progam, we offer comprehensive reproductive health training, including the full array of family planning methods and miscarriage management in our continuity clinic as well as opt out abortion training at Planned Parenthood during the GYN rotation. Two of our core faculty are RHEDI trainers. Residents seeking advanced surgical abortion skills can participate in the TEACH Program’s CREATE fellowship. (website?)
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, residents work with Sports Medicine, Orthopedic Surgery, Podiatry, Physical Therapy, Collegiate Athletic Training and Ortho techs to learn principles of musculoskeletal medicine. Additionally, there are longitudinal musculoskeletal didactics and workshops (joint injection, musculoskeletal ultrasound, C-spine eval and backboarding) and hands on experiences such as preparticipation physicals for high school athletes in Salinas and staffing local college athletic events and the Salinas Rodeo.
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 surgeons and local surgical sub-specialists, acquiring skills including excisional biopsy, suturing techniques, vasectomies, circumcisions, and slit lamp exams.
Residents learn to evaluate and manage a variety of problems in the Emergency Department for a total of two months. 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 also an important environment to learn about the interaction of physicians and patients with law enforcement, public health agencies, and inpatient services. The emergency medicine attendings instruct and supervise residents in diagnostic and therapeutic procedures and point of care ultrasound.
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 agricultural settings. Residents work with community health leaders doing hands on work in free clinics at the homeless shelter, 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 develop strategies and interventions that impact our community health. Frequent one on one meetings with the Community Medicine faculty provide support and guidance.
Outpatient Medical Specialties
During this rotation, residents work with specialist preceptors at Natividad and the surrounding community including Allergy and Immunology, Nephrology, Endocrinology, Hematology/Oncology, Pulmonology, Gastroenterology and Rheumatology. Residents also work with family physicians and internists caring for patients with HIV in the Natividad Immunology Division Outpatient (NIDO) clinic and rotate in our radiology department.
During this rotation residents work with Natividad’s cardiologists, an enthusiastic and talented group of teachers. Residents participate in inpatient consultations, scheduled cardioversions, pacemaker/defibrillator surgical placement, and stress tests. They also spend time at Salinas Valley Memorial Hospital’s cardiac catheterization lab and see patients in Natividad’s outpatient cardiology clinic.
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.
In the Neurology/Psychiatry rotation, residents spend three half days per week working with local neurologists. In addition, they spend two half days a week with a psychiatrist in the Monterey County Mental Health Unit or other ambulatory behavioral health settings. Residents may participate in intake evaluations of newly admitted mental health patients, participate in group activities, or do ongoing treatment evaluations with the inpatient psychiatrist.