What makes Natividad Family Medicine Residency unique?

Natividad Family Medicine serves a special role within our community. The program has a long legacy of providing resident-driven full-spectrum care, and prides itself in serving the underserved community of Salinas, which is in large part made up of Latinx farmworkers. Residents continuously improve their skills in a variety of areas including but not limited to outpatient primary care, high-risk obstetrics, pediatrics, inpatient medicine, emergency medicine, critical care, and addiction medicine. Natividad boasts a high faculty-to-resident ratio, allowing for a more intimate learning environment.  Our full-spectrum training, in which residents have a high level of responsibility for patient care, allows residents to feel comfortable and prepared to pursue a wide range of careers or fellowship opportunities upon graduation. Our alumni practice in a wide range of settings from outpatient family medicine to inpatient hospitalist medicine, obstetric care, global health, teaching and every combination of these.

What is the OB experience like?

Our OB service is high volume and our patients have many high risk conditions, resulting in a very rich and robust training environment for the residents. Residents gain direct experience managing high risk conditions including preterm labor, hypertensive disorders/preeclampsia, maternal trauma, trial of labor after cesarean, cholestasis, and gestational and preexisting diabetes. We work in a collaborative team made up of a family medicine attending, a OB-GYN attending, a FM/OB fellow, a resident, and often a medical student. Over the course of the rotation, the FM resident learns to “run the deck”, with the support and teaching of the fellows and attendings. FM residents also receive direct teaching and supervision from the FM attending on providing “couplet care” for postpartum moms and babies. In addition to their OB-GYN rotations, residents provide prenatal care in their continuity clinic and provide “couplet care” in the hospital by delivering their own clinic patients and providing postpartum and newborn care in the outpatient setting.

How many deliveries can I expect to do upon residency graduation?

Residents easily graduate with more than 100 vaginal deliveries, and interested residents have delivered over 200 babies in recent years.

I am nervous about OB…at an unopposed FM residency will I be supported on labor and delivery?

Our FM and OB-GYN faculty are in house 24/7 and provide teaching and plenty of supervision to the fellows and residents, and we all work together as a team. While the experience on OB tends to be high volume and rigorous, the wellbeing of our FM residents is of utmost importance at all times. There are always people nearby to help support and teach you!

What about cesarean sections; will I be competent in cesarean sections when I graduate residency? 

Our residents graduate prepared to independently practice maternity care including vaginal births, as most residents perform more than 100 births by graduation. Although residents do have opportunities to perform Cesarean sections, they need advanced training to achieve competency in surgical obstetrics, as 100-150 Cesarean sections are required for privileging at most US hospitals. Interested graduates pursue a fellowship in Obstetrics or Maternal-Child Health to get the required surgical volume…we highly recommend our Natividad fellowship Obstetrics fellowship (see link on this page)!.

How important is fluency in Spanish?

Natividad serves a predominantly Spanish-speaking population, and while many of our hospital staff and faculty speak Spanish, the residency program offers many resources to facilitate effective patient-doctor communication. Many residents arrive at the program already fluent in Spanish, but others come with limited experience, and end up learning a lot from the daily immersion! The most important thing is a willingness to learn. In the hospital and clinic we offer in-person and telephone interpreter services. We are very proud of our in-person interpreter services in the hospital, providing services for patients whose primary languages are Spanish, Triqui, Mixteco (Guerrero), and Mixteco (San Martin Pera). Phone interpreters are available for a wide array of other languages commonly spoken by our patients, such as Tagalog, Chinese, Arabic, Chatino and Zapotec.

How does the program support resident wellness?

Natividad is committed to supporting our residents as they pursue a challenging yet rewarding period of their lives. Our residency wellness committee, composed of residents and faculty, meets monthly to monitor resident wellness and suggest strategies and activities to optimize support for residents. Our buddy system pairs each incoming intern with a second-year and third-year resident, facilitating an inclusive support system for all residents. Our intern wellness curriculum includes sessions with trained faculty addressing themes such as mindfulness, gratitude, and burnout. When on an inpatient medicine service, bedside rounding promotes patient-centered care, team-based learning, improved patient advocacy and safety, and builds strong relationships with the nursing staff. We have day-long retreats off campus twice a year for in depth community-building. Many members of our community make use of the Wellness Track around the hospital to take a moment away from the busy inpatient services, get some fresh air, and incorporate exercise. Residents also participate in weekly Balint sessions, which are resident-driven and allow for self-reflection and peer support.

How does your program address the medical needs of the LGBT community?

Rather than siloing LGBTQ care into a separate clinic or rotation we incorporate LGBTQ care into every stage of our training. In our clinic we provide LGBTQ-inclusive care, starting by having sexual orientation and gender identity built into our EHR. We provide PrEP and transgender hormone therapy as a regular part of our continuity clinic. Our hospital is an LGBTQ-inclusive setting as well. We support residents in doing community medicine projects to explicitly reach out to segments of the local LGBTQ community. Faculty experienced in transgender care are available to precept and mentor as needed. HIV primary care is currently available as an elective at our infectious disease site with family medicine-trained physicians. Lastly, we maintain an open and diverse learning community where residents can be open and true to themselves as they learn, thrive, and grow together.

Are you a RHEDI program?

Yes! As a RHEDI (Reproductive Health Education In Family Medicine) Program, we offer comprehensive reproductive health training, including the full array of family planning methods, miscarriage management, and options counseling 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 during third year. During the GYN rotation in second year, FM residents rotate with OB-GYN attendings and also attend colposcopy clinic. Residents gain experience with procedures such as IUDs and implants in both outpatient and inpatient settings throughout residency.

Is your program family friendly?

Yes! Natividad is dedicated to providing a welcoming environment for our residents and their families. We understand the importance of having a good support system during residency to promote resident wellness. We have had many residents build and grow their families during residency, and we always work with the scheduling team to make adjustments to allow for parental leave.

What is the call schedule like?

Incoming interns have a call schedule focused on maximizing their inpatient clinical skills and building a strong foundation as they transition to second and third year. We have a night float system in which all residents do a total of 5 weeks of nights per year, which are split into a 2-week block and a 3-week block. The intern on night float takes hospital admissions and learns to take cross-cover on the rest of the patients in the hospital. The R2 on night float covers labor & delivery. The R3 on night float covers the ICU and step-down unit, while also supervising the intern and supporting the R2 as needed. (Check out the “curriculum” tab for more information.) During inpatient rotations, residents take turns covering weekend call, which is set up similarly to the nightfloat roles (1 R1, 1 R2, and 1 R3). While admitting and caring for inpatients, residents are able to build good relationships with specialists, allowing for continuous teaching and learning throughout residency.

Where do residents live?

The vast majority of residents live in Salinas and the surrounding areas including Monterey, Pacific Grove, Seaside, and Carmel Valley, with some living as far away as Morgan Hill and Santa Cruz. Residents are able to take advantage of the beautiful landscapes of the Central Coast and unwind by taking hikes, cycling, and walking along the open beaches.