Forbes Family Medicine Residency

Forbes Family Medicine Residency Program
MD and DO Dually-Accredited

At The Western Pennsylvania Hospital - Forbes Regional Campus, we affirm that the patient is a whole person whose unique physical and psychological makeup presents an equally unique set of needs. Our aim is to foster your evolution into a family medicine specialist who treats the whole patient with expertise and sensitivity.

The Forbes Family Medicine Residency Program provides an optimal educational environment in which you can develop your potential as an individual, physician, teacher, and learner. To this end, we provide a realistic practice setting, a personalized curriculum, family physician mentors, and a host of related educational resources and personnel.

Within this training network you will learn to offer continuing, comprehensive health care to patients and their families that is both therapeutic and preventive. Your understanding and skills as a physician will be cultivated through ongoing relationships with patients and colleagues in your office at Forbes Family Health Center and at The Western Pennsylvania Hospital - Forbes Regional Campus, the program's parent hospital. You will also spend some time at Forbes Hospice.

The residency program will develop your ability to coordinate hospital and community resources to provide comprehensive, personalized care to patients in a wide variety of practice settings.

When you complete the Forbes Family Medicine Residency Program, we believe that you will be able to competently manage most of your patients independently, yet know the appropriate times and methods for consults and referrals to other specialists. in either event, it will be you, the family medicine specialist, who will confidently initiate, coordinate and manage each patient's care to produce the best possible outcome.

Your Office, Your Patients

Forbes Family Health Center functions as a practicing physician's office. Here, you will develop your own panel of patients and have the experience of working within a group practice that strongly promotes continuity of care. You will be part of a team that includes registered nurses, medical secretaries, clinical nurse specialists, and a patient educator/nurse practitioner, all of whom support your learning in the Family Health Center.

At the core of the Family Health Center is a large precepting and resident work area, adjoining the clinical area with 14 patient exam rooms and a family consultation room. Some are equipped with special instruments and facilities for ENT exams and office procedures, such as colposcopy, cryosurgery, electrosurgery and minor surgery. The Center is also equipped for audiometry, tympanometry, spirometry, EKG, vision testing and similar evaluations. There is an on-site office lab for such routine tests as urinalysis, urine cultures, hemoglobin, serum glucose, pregnancy tests and microscopic exams. There is also a well-lit, state-of-the-art conference room just upstairs from the Family Health Center.

As a part of the program's interest in developing your interpersonal and communication skills, certain patient treatment and consultation rooms at the Center are equipped with video monitoring and recording. There is a full-time psychologist on the faculty who is available to precept and consult. Staff and family conference rooms, residents' lounge, library, precepting areas, medical records office, waiting room, patient education area and faculty offices complete the Family Health Center facility.

Both the resident work area and precepting areas are equipped with multiple computers having both Internet access and connections to the hospital's clinical information system.

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Learning Objectives

The program's primary goal is to prepare you to provide top quality, comprehensive patient care, both by treating illness and by supplying ongoing health maintenance for families. The curriculum's range and flexibility also allow you to pursue experience in areas of particular interest. Thus, in addition to undertaking the program's required rotations and extensive concurrent training in behavioral science, working with families, community medicine and practice management, you will have ample time for your choice of elective activities.

Professional Skills
To expand your skills as a physician, the curriculum will focus on sharpening your ability to:

assess patients' medical needs and independently treat those that are within the scope of your practice;
use specific diagnostic measures and problem-solving skills to analyze patient needs and prescribe therapy;
identify the emotional and social factors that influence patients' health;
consult with or refer to other specialists for problems that are beyond the scope of your practice, and coordinate their advice with other resources to our patients' best advantage;
lead and coordinate a team of nurses, therapists, counselors, other physician specialists, community agencies; and
organize and maintain an efficient medical practice.

Personal Development
To enhance your growth as an individual, a professional and a member of the community, the curriculum will present you with opportunities to:

develop good techniques for evaluating and implementing the findings of current medical literature;
teach and work cooperatively with other physicians and healthcare professionals;
gain insight into those factors that influence your behaviors and attitudes toward patients and colleagues; and objectively and comfortably handle challenging situations that arise with patients, families or communities.

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Important Facts About This Program

Family Practice is the only residency based at West Penn - Forbes Regional Campus.
There is no competition for patients. Each rotation provides you with the challenge of direct responsibility for patient care under the continual, appropriate supervision of attending physicians. Your second-year pediatrics, medicine and obstetrics rotations allow you to teach and work with first-year family practice residents. There are also opportunities in all three years to teach medical students.

The on-call experience is structured for learning.
Two residents are on call each night, one covering admissions and OB and the other acute calls Pediatrics. Each resident works autonomously, without the usual hierarchy of teams, although the other resident is always available for consultation and assistance. Residents call the attendings directly and run through their findings and plan of action with them. There is always a pediatrician in the hospital who provides 24-hour continuity of pediatric education. While on call, residents also answer phone calls from the Family Health Center office patients.

Night Float - One resident on the night float rotation takes calls Monday through Thursday nights. After midnight, the resident takes all calls and only awakens the other resident on call, if needed.

Call schedule is arranged so that residents see all types of patients at all points during the year, instead of limiting the exposure to one area of medicine to the few months they are on that service. The call-to-call variety of coverage is similar to the experience in practice after residency.

Frequency: First-year residents will be on call approximately five times per month; second year, three or four times per month; and third year, two or three times per month.

Exposure: Residents handle admissions to their own services, as well as respond to calls regarding acute problems, i.e. chest pain, shortness of breath, abdominal pain, etc., but not for routine problems or orders on all patients in the hospital.

Core rotations are done at West Penn - Forbes Regional Campus, so call is never taken at another hospital. The medicine service only takes admissions from two family practice groups and not from a variety of private doctors. The number of admissions is capped so that residents have time to learn from each patient.

Relationships between attendings and residents are different from most resident/attending relationships. While attendings teach, they are also open to discussing different ideas regarding patient management. The atmosphere of mutual respect and cooperation adds greatly to the learning experience.

The hospital administration is very supportive of the residency.
While benefits such as free, well-lit, gated parking and free meals are not enough to choose a residency, they do imply a certain appreciation. Similarly, the availability of 24-hour support services such phlebotomy says a great deal about how the hospital views the residents' role here - as doctors.

Forbes Family Practice Residency Program fulfills all requirements of the American Board of Family Practice and has been fully approved by the Accreditation Council for Graduate Medical Education since 1978.

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First Year

The initial year uses rotations through The Western Pennsylvania Hospital - Forbes Regional Campus to reinforce and expand the knowledge and skills you acquired in medical school, and introduces you to the care of families at the Family Health Center. The focus of this first year is inpatient experience in four basic areas including internal medicine, pediatrics, obstetrics, and surgery - plus emergency medicine.

The First Year Curriculum
LONGITUDINAL EXPERIENCE
FAMILY HEALTH CENTER 2 half-days per week
ROTATIONS
Months	Activity
2	Pediatrics**
2	Internal Medicine*
2	Obstetrics
2	Surgery
1	Cardiology
1	E.R.
1	Pulmonary Medicine/Night Float
1	ENT/Ophthalmology

*Internal Medicine is taught by a family physician who is board certified in geriatrics and has a special interest in developing teaching skills of the residents. The rounding attendings focus on day-to-day management issues with the help of a case manager. The teaching attending focuses on one or more patients for more detailed teaching of pathophysiology, treatment, physical examination, differential diagnosis or literature review. Particular emphasis is placed upon the practical application of evidence-based medicine.

**On the Pediatric rotation, residents run an active inpatient service with patients comprising a broad range of community pediatric problems. They also see all newborns in the regular and special-care nursery, attend high-risk deliveries, evaluate pediatric patients in the ER and see patients in the pediatric faculty's offices. Full-time pediatric faculty backup and teach on the service.

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Second Year

In the second year, the program emphasizes expanding your knowledge in pediatrics, internal medicine, and obstetrics, while increasing your responsibility as a senior resident. During this year, you will begin to serve as a supervising physician and teacher for first-year residents and medical students, particularly on these three rotations. You will be provided with specific training in teaching to prepare you for this role. Rotations are scheduled in ICU and family practice inpatient care. Additionally, there is one month of elective time and one month spent in the practice of a community family physician.

The Second Year Curriculum
LONGITUDINAL EXPERIENCE
FAMILY HEALTH CENTER 3 half-days per week
ROTATIONS
Months	Activity
2	Pediatrics
2	Internal Medicine
2	Obstetrics/Gynecology*
1	Elective
1	ICU
1	Psychiatry
1	Family Medicine Inpatient Service**
1	Family Medicine Office Rotation
1	Night Float

Electives:

Allergy
Anesthesia
Counseling
Endocrinology
Forbes Hospice
Gastroenterology
Hematology/Oncology
Infectious Disease
Neonatology
Nephrology
Occupational Medicine
Office Surgery
Pathology
Physical Medicine
Rheumatology
Sports Medicine
Women's Health

You may also design, in conjunction with your advisor, elective rotations to meet your individual needs and interests. You may take required rotations or medical selectives as electives.

*Second-year residents on OB/Gyn may choose a focus for their rotation:

You may do obstetrics with a nurse midwife at a birthing center or with an obstetrician; or

You may focus on office gynecology.

**On the Family Medicine Inpatient Service, residents function as senior resident on the service to which resident and faculty patients are admitted. This service includes a full spectrum of Family Medicine - adult medical and surgical patients, pediatrics, newborns, postpartum and psychiatric consults. The resident rounds daily with a Family Medicine faculty member.

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Third Year

The program's third year gives you advanced clinical practice in the Family Health Center, where you will spend four half-days each week. In addition to the required medical and surgical subspecialty rotations, you will choose or design electives to expand your knowledge in previously-introduced areas or integrate new ones of special interest.

LONGITUDINAL EXPERIENCE
FAMILY HEALTH CENTER 5 half-days per week
ROTATIONS
Months	Activity
1	Urology/Night Float
1	Neurology
1	Rheumatology/Physical Therapy
1	Scholarly Activity
1	Orthopedics
1	ICU
1	Geriatrics**
1	Family Medicine Inpatient Service
1	Family Medicine Office Rotation or Away Elective
3	Electives (see Second Year)

*On Behavioral/Devlopmental Pediatrics, you see Family Health Center patients in consultation with a behavioral pediatrician to sharpen your ability to assess and treat or competently refer a wide range of developmental and child behavioral problems. During this rotation, there is an opportunity to work with a local elementary school as a health educator and with a school doctor.

**Geriatrics is taught as a one month block rotation along with monthly multidisciplinary teaching rounds at our nursing home. Residents follow a panel of nursing home patients throughout this year. Experience at our well-established hospice is also part of the rotation.

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What Makes Our Program Unique?

Throughout the three years, your preparation as a family physician goes beyond the required rotations. This is mainly where residency programs differ. The Forbes Family Medicine Residency Program distinguished itself by providing the following longitudinal experiences:

Behavioral Science
Because family medicine will involve you in a therapeutic capacity in the lives of your patients and their families, your interpersonal skills are of primary importance. Moreover, it is likely that your patients will present you with a range of problems such as depression, stress-related illness and marital or sexual difficulties. To equip you to interact sensitively and to recognize, assess, and initiate treatment for such patients, behavioral science training experiences are incorporated throughout the program's three years.

A full-time behavioral scientist is available to all residents for consultation, co-precepting, and demonstration of therapeutic techniques for use with patients. Twice weekly, the behavioral scientist participates in inpatient rounds with residents and faculty. A weekly Patient Care Seminar (Balint) will allow you to discuss your patients from a behavioral standpoint and consult with peers and faculty, among whom are a psychologist and a family physician. Monthly core curriculum conferences address common psychosocial problems and include workshops that focus on skills such as counseling, telephone medicine, and working with families.

Videotaping
Videotape review of your patient sessions is designed to give useful feedback on your interviewing, counseling and problem-solving skills; nonverbal physician-patient/family interaction; and the efficiency with which you conduct office visits. These tapes are made in specially equipped exam rooms in the Family Health Center. You then review your session tapes with the behavioral scientist or a faculty member whose remarks can serve to heighten your ability to self-monitor and modify your approach as necessary.

Patient Education
Educating patients and encouraging them to become active partners in their own health care are strongly supported by the program's emphasis on patient education. As a resident physician, you will be expected to identify the learning needs of your patients and tailor a specific teaching plan to guide them to the required information.

Throughout the program's three years, a full-time nurse practitioner and patient educator coordinates the activities, assists you in developing patient teaching methods and materials, and serves as your resource for in-depth education with selected patients. Faculty and staff are also available to help you in your patient education duties.

The many patient-teaching aids at the Family Health Center include printed materials, video and audio tapes, anatomical models, teaching posters, and computer-based programs. Waiting areas and exam rooms also contain these materials for patients' use.

The Forbes Family Medicine Residency Program has established a program of excellence with national recognition for its patient education efforts. In 1991, West Penn - Forbes Regional Campus was honored with the national Patient Care Award for Excellence in Patient Education, presented at the annual Patient Education Conference.

Community Medicine
As a family physician, you will be an important and integral leader in the community you serve.

Community medicine at Forbes Family Medicine Residency Program is designed to provide you with the background you need to step into this leadership role. Therefore, community medicine is integrated throughout your three years, in many of your rotations. You will have opportunities to observe and work with community agencies, schools, and sports medicine programs. You will participate in our community-oriented primary care longitudinal project where we explore a local community and its health care needs in depth, and work with that community to improve its health care. In addition, our faculty are involved in a variety of community agencies and projects, and you are invited to team with them as they provide community service.

Resident Support Group
The program is sensitive to the unique stresses that new physicians sometimes encounter during their residency experience. To ease your transition into your new roles, the program begins resident support during the first-year orientation, when faculty confers with you on risk assessment and stress reduction, and addresses the fears and expectations of residents. A retreat for new residents further encourages supportive peer group cohesion, preparing the way for your future participation in the program's resident support group. This group is open to all residents and gives you the opportunity to develop effective communication and interpersonal skills while dealing with the positive and negative aspects of your residency in a supportive atmosphere.

Evaluations for Guidance
Resident Evaluation: Objectives and evaluations are established to guide, assess, and document each resident's experiences in rotations and at the Family Health Center. At the end of each rotation, the supervising attending physician evaluates you on a range of essential knowledge, skills and professional attributes. Family Health Center preceptors audit charts, directly observe your patient care, evaluate your specific clinical and practice management skills and document their observations monthly, using as their criteria numerous aspects of an ideal Family Health Center office visit.

Development Staffings: Twice a year, staffings are held for each resident. At these meetings, you complete a self-evaluation according to stated criteria and, with your advisor and a preceptor, review and discuss all rotation and office evaluations. With the benefit of this feedback, you and your evaluators outline a written six-month or one-year plan for your continued development.

Program Evaluation: Each resident is regularly requested to evaluate the teaching, rotations, and other learning experiences that comprise the program. Residents also participate in curriculum, patient education, research, and Family Health Center committees with faculty members and the residency director to plan and implement program modifications.

Family Centered Birthing
Residents at West Penn Hospital - Forbes Regional Campus learn an approach to obstetrics which is quite different than that typically practiced by obstetricians. Family Centered Birthing is a high-touch, low-tech approach in which assumptions about practice are challenged by evidence-based medicine, and the needs and desires of the laboring woman are supported when possible. Family Medicine faculty members back up most of the deliveries and serve as role models. They and our obstetrician faculty member support the residents as they work directly with their patients. We also have a nurse midwife who participates in precepting of prenatal visits and deliveries. You will learn to practice a safe and satisfying approach to the prenatal and birthing process that is consistent with the philosophy of Family Practice.

Women's Health
Forbes Family Health Center has more than a 10-year history of actively teaching women's health and offering an elective or longitudinal experience to senior residents in that area. In 1994, we received a U.S. Health and Human Services Grant to develop a comprehensive curriculum in women's health for the residency. The curriculum is informed by input from women patient focus groups, by evolving biomedical knowledge, and by attention to specific areas affecting women, such as violence and awareness of barriers to access which include financial need, multiple roles and communication problems.

Family Practice Conferences
Core curriculum conferences are presented for one hour, four days per week, with occasional additional times. These conferences provide an effective means for supplementing your knowledge of patient care and problem solving. We have a well-organized conference curriculum that includes all the key areas of family practice. Conferences are conducted by West Penn - Forbes Regional Campus Medical Staff physicians, faculty, residents, and contributing faculty from local institutions.

Salary and Benefits

Effective July 1, 2009

Resident Salaries

PGY1: $47,070
PGY2: $47,798
PGY3: $48,755

Relocation
$ 1,000 for new residents to be used for moving expenses or at the resident's discretion.

Vacation
PGY 1,2 and 3 residents will receive 15 days of paid time off (PTO) during the academic year which includes all vacation and sick leave. Also, residents have time off during six standard holidays unless call responsibility falls on a specific holiday. In addition, five days of educational leave are permitted.

Education Leave
Five conference days per year

CME Travel
Payment for reasonable conference related expenses up to $500 for PGY1, and $1,500 for PGY2 and PGY3.

Life and Accidental Death/Dismemberment Insurance
Benefit of $10,000 at no cost, with option of purchasing additional coverage.

Dependent Life Insurance
Three levels of coverage to choose for spouse/children.

Short-Term Disability
Provides 80% net income replacement after either a 15 or 90 day waiting period, depending on the option purchased.

Long-Term Disability
Provides 70% of salary if continuously disabled for more than 180 days. Convertible to an individual disability plan when residency ends. LTD benefit provided at no cost to resident.

Health and Welfare Benefits
A variety of medical & dental plans from which to choose a package that meets your individual needs. Prescription plan included with medical coverage. Vision plan at no cost for Resident and can be purchased for dependents. No waiting period for coverage.

Malpractice Insurance
Fully paid, including membership in the Pennsylvania Catastrophic Loss Fund.

Matched Savings Plan
Tax deferred long term savings plan available that includes a 50% match up to the first 2 1/2% of salary saved.

Meals
Daily lunches and all meals when on call. Meal tickets available for family when on call.

Mileage
Reimbursement of .55 cents per mile for residency related travel expense according to the program's Mileage Reimbursement Policy.

Books
May use any remaining travel fund for medical books.

Child Care
An on-site child care facility is available.

Miscellaneous
USMLE Step 3 or COMLEX Step 3 and DEA License reimbursed, lab coats provided and laundered; free on-site parking for one vehicle; discount on prescription drugs at health center pharmacies; discount for inpatient and outpatient health services provided at our facilities.