Fairfax Family Medicine Residency Program: Concentrations

Women's Health includes obstetrics, gynecology, and the unique presentation and modulation of disease in women, especially as influenced by the hormonal changes of puberty and menopause. Care of women is a central part of Family Medicine Training at Inova - Fairfax Family Medicine. The internship rotation on the labor and delivery service allows residents to have an adequate number of deliveries for an exposure to deliveries; as well as in-depth participation in the OB-GYN outpatient clinic which provides extensive experience in prenatal care. Residents are supervised by OB-GYN attendings and our own FP/OB fellowship-trained Dr. Kendall Hancock, who works one-on-one with the interns on the prenatal clinic as well as the Labor and Delivery deck.

For all residents, training includes extensive exposure to preventive care in women, management of gynecological problems, and exposure to numerous out-patient GYN procedures including IUD and Nexplanon placement, colposcopy, cervical cryosurgery, diaphragm fitting, endometrial biopsies, and evacuation of Bartholin gland cysts.

Residents who seek a Concentration in Women's Health have the opportunity to participate in a variety of activities to enhance their expertise. This includes extra time in the colposcopy clinic, where residents learn to manage abnormal pap smears, with counseling, endocervical curettage, cervical biopsy and cryotherapy. We can also arrange for elective time in a clinic that performs and manages terminations.

For those interested in pursuing an FP/OB fellowship, using elective time to spend one full-time month on Labor and Delivery at the end of the second year gives residents the ample volume needed to be a competitive applicant for an obstetrical fellowship. As well, continuity with a community OB-GYN is added in for those seriously considering pursuing an FP/OB fellowship. The concentration is led by two FP/OB fellowship trained physicians: Dr. Lee Blecher and Dr. Kendall Hancock.

Care of the aging is a central component in Family Medicine, and in the training of physicians at Fairfax Family Practice. Residents who choose to concentrate in Geriatric during their residency have the opportunity to participate in a variety of activities to enhance their expertise in geriatrics.

Continuing care services at local nursing homes and assisted living homes provide for a forum for working with community home care, therapy, elder law and care coordinating services. Rotations are available with area hospice providers for residents seeking additional training in palliative care.

Membership in national geriatric organizations such as the American Geriatrics Association and the American Medical Directors Association is encouraged, and attendance at the national meetings is an option. Residents who complete a research project in Geriatrics are encouraged to present a poster at one of the national meetings. Interested residents will be assisted in the process of becoming a certified nursing home medical director.

Completion of an area of concentration in geriatrics will well prepare a resident seeking fellowship opportunities for a certificate of added qualification in geriatrics.

In the global and community health concentration (G&C), residents are trained to work alongside underserved populations worldwide.

Competencies:

Upon completion of the global and community health concentration, residents will be able to:

1. Organize and collaborate with multi-disciplinary teams domestically and internationally
2. Assess community needs and implement community level projects in conjunction with local stakeholders
3. Deliver care in resource low settings in a culturally sensitive fashion
4. Advocate for vulnerable populations

Global Health Survey Question Database
Drs. Kathleen Langan and Andrew Bazemore have been active in the Society of Teachers of Family Medicine's Group on Global Health. Through this group, they developed the Global Health Survey Question Database to help programs better evaluate their global health curricula.

• Download the Global Health Survey Question Database (Excel)
• Download the Global Health Survey Question Database Instructions

Entrance into the Track:

In January of intern year, interns will be introduced to the global and community health track. Those who are interested will complete a brief application form which will be due on March 1. The number of persons who can participate in the track is limited to 2 residents per year. Those not in the track are welcome to participate in meetings, didactics, experiences, and electives but will not have priority in the selection of domestic and international electives.

Benefits of Track Participation:

• Priority in selection of domestic and international electives
• Certificate of completion upon satisfying the track requirements
• Leadership and scholarly opportunities with a global and community health focus
• Mentoring and didactics focused on global and community health

Components and Expectations:

Completion of Two Approved Domestic and/or International Electives

Current Electives:

• November Honduras elective
• February Honduras elective: The residency has been participating in the Pinares project since 2005. This project collaborates with Shoulder to Shoulder (www.shouldertoshoulder.org). During the November and February electives, participants see patients at the Pinares clinic, assist with the Child Health Initiative (delivers a basket of evidence based interventions and screening tests to children at remote, surrounding villages), assist with a cervical cancer screening program, and assist with community projects (ceramic water filters and indoor cook stoves).
• June Dominican Republic elective
• July Remote Area Medical clinic in Wise County, Virginia

We hope to convey the importance of continuity when performing global health work. Therefore, we have purposefully limited the number of available rotations in order to focus our resources. However, we recognize that residents may have interest in or have existing relationships with other domestic and international projects. G&C residents can participate in these projects assuming that they satisfy our requirements for education and safety.

1-2 G&C participants will be selected as the leader(s) of the February Honduras elective. In this role, you will coordinate the trip, arrange for pre-trip preparation didactics and readings, facilitate group learning activities during the brigade, assist with research projects, complete a trip report, and assist with brigade evaluation.

The residency program provides residents (both for track and non-track participants) with $1000 (over two years) for travel expenses associated with these electives. Residents are encouraged to apply for funding through the Benjamin H. Josephson fund to cover additional expenses. More funding may be available for resident travel depending on the number of residents interested in international electives.

• Years: PGY2 and PGY3
• Track requirements: completion of two approved electives

Scholarly Project with a Global or Community Health Focus

With assistance from G&C faculty and staff, participants will explore an area of interest within the global and community health domain. These projects can be quality improvement, research-oriented, or educational in nature. They do not need to be published in journals or presented at conferences though these dissemination mechanisms will be encouraged.

Scholarly projects of past residents:

• Effectiveness of Pre-Travel Consultation in the Primary Care Setting, presented at the International Society of Travel Medicine Annual Conference
• Assessing the Prevalence of Anemia in Children One Month to Eighteen Years in Pinares, Honduras, presented at the North American Primary Care Research Group
• Prevalence of Stunting in Rural Pinares, Honduras, presented at the American Academy of Family Physician Global Health Workshop
• Cervical Cancer Screening in Rural Honduras: Incidence of Positive VIAs, presented at the American Academy of Family Physician Global Health Workshop
• Continuity of Care in a Rural Honduran Preventive Medicine Program, presented at the American Academy of Family Physician Global Health Workshop
• Obesity Prevalence By Zip Code Using Geographic Information Systems
• Primary Care Workforce Access Improvement Act Primer, presented at the Health Policy Workshop
• Minimizing Malaria Risk When Traveling, to be published in the Journal of Family Practice

Organize Bi-annual Global Health Meetings

The residency has a long history of hosting global health speakers. The G&C participants will be responsible for organizing these bi-annual meetings with assistance from G&C faculty.

• Year: PGY3
• Track requirement: Organize 2 meetings

Past speakers have included:

Participate in Bi-annual Global Health Journal/Book Clubs

• Twice per year, G&C participants and faculty will discuss current journal articles or books pertaining to global health topics
• Years: PGY2 and PGY3
• Track requirement: Attend 75% of sessions

Attend One Global Health Conference

• G&C participants will be expected to attend one conference pertaining to a global health or tropical medicine topic
• Funding and time for the conference will be paid for by the resident’s continuing medical education funds and days
• If the resident is a presenter at the conference, the VCU Department of Family Medicine has traditionally paid for conference expenses
• Conferences attended by prior residents:
  • International Society of Travel Medicine
  • Consortium of Universities for Global Health
  • American Academy of Family Physicians Global Health Workshop
• Years: PGY2 or PGY3
• Track requirement: attend one conference - presenting at the conference is not required but is encouraged

Serve as the Coordinator for the Neighborhood Health Clinic Rotations

• PGY2s and PGY3s see patients at Neighborhood Health Clinic (a federally qualified community health center)
• Coordinators assist in the orientation of rising PGY2s to the clinic and participate in additional sessions while a PGY3

Didactics Related to Global and Community Health

These didactics are given to all residents:

• Global Health I (AB)
• Global Health II (AB)
• Global Health Systems and Policy (AB)
• Travel Medicine I (AB)
• Travel Medicine II (AB)
• Community Oriented Primary Care (WL and BP)
• Community Oriented Primary Care Practical (WL)
• Introduction to Health Disparities (WL)
• Tools for Reducing Health Disparities (WL)
• The Safety Net in Fairfax County (WL)
• Social Determinants of Health (WL)
• Seeing Patients in Resource Low Settings (TM) – typically given prior to Honduras brigades
• Micronutrient Deficiencies in Children (WL) – typically given prior to Honduras brigades
• Health Policy Workshop
  • Yearly advocacy workshop on Capitol Hill
  • Workshops on current health care legislation, current health care policy issues and advocacy
  • Participants attend Hill visits with their representatives and senators
• Space is limited
• Year: PGY3

Track Selection

• Track participation will be limited to 2 residents per year though this can be increased at the discretion of the G&C faculty depending on funding and resident interest
• Non-track residents can participate in lectures, journal clubs, and scholarly activities
• Non-track residents can also attend trips depending on the level of funding in the global health budget and depending on the residency’s ability to reconcile scheduling conflicts
• Track participants will have first priority for attending and scheduling global health electives
• During intern year, residents will have the opportunity to apply for the global health track
• To apply, residents cannot be on academic probation and must submit the application by the stated deadline
• The application will inquire about the residents' past experiences and career goals
• G&C faculty will select the 2 residents based on:
  • Evidence of prior interest in global health
  • Whether participation in the track will contribute to the residents' career plans
  • The residents' potential for completing the track successfully (i.e. submitting an abstract to a global health conference and leading a brigade)
• If the track participant is placed on academic probation, the G&C faculty will determine whether the participant is allowed to continue the track

Track Completion

To complete the track, participants must be in good standing (i.e. not on academic probation) and must complete the other requirements of the residency program Those who have satisfied the track requirements will receive a certificate of completion.

Musculoskeletal problems constitute a large percentage of acute problems presenting to family physicians in their office. To enhance the sports medicine training core to the residency education curriculum, IFMC - Fairfax Family Medicine offers an additional focused experience in sports medicine.

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In addition to required core curricular experiences residents will participate in additional sports clinics under the supervision of a Sports Trained supervisor, have additional orthopedic operative and office exposure as well additional training room opportunities to enhance their experience in primary care sports medicine. Residents will shadow the sports medicine fellows longitudinally over two years. Additionally, the resident will be encouraged to participate in mass participation event coverage like the Marine Corps Marathon, Army 10-miler and Reston Triathlon with the fellows. An additional sports-related academic project will be required that could include co-authorship of an original article or book chapter or a case presentation at a regional or national meeting. The resident will be required to prepare a lecture on a sports related topic to present to their fellow residents.

For more information contact Anna Crutchfield, MD, Associate Fellowship Director, at anna.crutchfield@inova.org

Under the direction of Dr. Alex Krist, residents have the opportunity to pursue a concentration in research and health policy. Dr. Krists’ affiliation with VCU’s Ambulatory Care Outcomes Research Network (ACORN) affords residents an opportunity to participate in a wide variety of research studies.

Academic rigor is enhanced by Dr. Krist’s Master’s in Public health, expertise in research and his teaching of evidence based medicine throughout the longitudinal curriculum. For additional information related to current studies please visit www.familymedicine.vcu.edu/research/projects/index.html.

Dr. Bob Phillips and Dr. Andrew Bazemore are the Director and Assistant Director of the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care. Dr. Phillips and Dr. Bazemore are faculty members at IFMC - Fairfax Family Medicine and are available to assist residents in obtaining specialized health policy experience.

The proximity of the program to Washington, DC, allows the opportunity for direct involvement with legislators, from serving as "Doc of the Day" at the Virginia State Legislature, to personal lobbying with aides, congressmen, and senators.

For information on designing an area of concentration in research and health policy, contact Dr. Krist at alexander.krist@inova.org.

The IFMC - Fairfax Family Medicine program is proud of the level of resident involvement in the day to day operations and strategic planning of the office. The Chief Residents attend faculty meeting to provide input into decisions about office redesign and the ongoing process of transforming FFPC into a model of the Patient Centered Medical Home.

In addition, one resident serves as the coordinator of Resident Business Meeting, a semi monthly meeting of residents and faculty where business, financial, and development topics are reviewed, and residents receive information about their productivity and coding performance. The coordinator of Business Meeting works with Dr. Lee Blecher to select the topics for presentation and arrange the speakers. Contact Dr. Blecher for further information at lee.blecher@inova.org.

The FFPC Point-of-Care Ultrasonology Residency Track (aka POCUS Track) aims to provide the family medicine resident with education, training, and exposure to the use of ultrasonography at the point-of-care in the management of patients. This track is meant to exceed the required core education and training in residency. The POCUS track may be pursued by family medicine residents who wish to include a more-developed diagnostic skill set in their scope of their practice, or residents considering a POCUS credential of certification.

View Details About This Track

Family physicians are uniquely positioned to be able to provide integrative and holistic approaches in their interactions with patients. Under the guidance of Evangelia Tsapos, DO, and Katya De La Torre, DO, the osteopathic curricular track introduces elements of this integrative approach and allows osteopathic residents to practice manual manipulation skills while simultaneously introducing allopathic residents to the osteopathic philosophy and manual therapies.

All residents will have the opportunity to participate in lectures and hands-on practice integrative of osteopathic manipulation. Osteopathic residents who are specifically interested in completing the osteopathic track will have dedicated OMM clinic hours as a regularly scheduled component to their patient care sessions. They will also be involved in teaching their fellow residents, which will include participation in Noon Conference lectures, case presentations, and journal club meetings.

Attending annual AOA Conference is encouraged, but not required.

Residents who successfully complete the track will be well positioned to not only confidently perform osteopathic manipulation therapies post-residency but also gain the tools necessary to consider incorporating this skillset into their future practice.