CURRICULUM DESCRIPTIONS

Adult Medicine Teaching Service
Community Medicine
Complementary and Alternative Medicine (CAM)
Elective Experiences
Emergency Medicine
Evidence-Based Medicine
Family Health Center
Geriatrics
Gynecology
Intensive Care Unit
Medical Informatics
Nursery/Neonatal Intensive Care Unit
Obstetrics
Orthopedics
Pediatrics
Pediatric Subspecialties
Practice Management
Psychiatry/Behavioral Medicine
Resident Conferences
Resident Research
Sports Medicine
Subspecialty Medicine and Surgery
Surgery

Adult Medicine Teaching Service
You will admit patients to the inpatient family medicine teaching service at Cambridge Health Alliance's Whidden campus. The family medicine residency is the only residency in this hospital. The team each month is comprised of a third year, a second year and two first year family medicine residents. A night hospitalist float system is in place. Each day there is either hospital Grand Rounds, morning report, or a didactic lecture given by internists. Later in the morning "work rounds" with a family medicine faculty member are conducted with full access to internet and other electronic resources, promoting an evidence-based approach. ICU are managed with the guidance of family medicine faculty, all of whom have ICU privileges, as well as cardiologists and pulmonologists.

Community Medicine
A third year rotation, this experience addresses many different interactions your patients have with community resources. Practical experience in occupational medicine, school health, health education, and public health is reinforced through site visits and seminars. You will spend time with physicians practicing alternative or complementary medicine, including acupuncture and herbal medicine, as your patients will ask you about these treatments. You will also learn End of Life care with a hospice program, work on a community-based project longitudinally throughout each of your second and third years, attend seminars presented by community health specialists, and elect to participate in many other opportunities. Experiences during the work rotation include working in a free medical clinic for the homeless, spending time with a podiatrist, a pediatric dentist, the hospital chaplain making rounds, and a prison doctor in a medium-security correctional facility. You will also work with chronic pain specialists, learn about legislative advocacy, and see how a patients' competency is determined at Malden District Court.

Complementary and Alternative Medicine (CAM)
The Tufts FMR is excited to offer an evidenced-based medicine CAM curriculum for our residents and faculty. We recognized that our FHC population is using CAM for preventive and treatment of chronic conditions. In order to facilitate better patient care, the curriculum addresses the safety and efficacy of CAM used by our patients throughout the three years.

Elective Experiences
You can choose a wide variety of elective experiences for additional training in areas of interest to you. Residents are encouraged to take advantage of our Boston location and train in either community subspecialty office practices or at the many Boston teaching hospitals. Examples of electives residents have taken include family medicine electives in Mexico, Costa Rica and Belgium, an Obstetrics month in Los Angeles, a month at the Joslin Diabetes Center in Boston, and a Geriatrics month at Beth Israel Deaconess Medical Center in Boston. Many different international electives are also available, as are rural family medicine experiences.

Emergency Medicine
As a second year resident you will train at our Whidden campus, a busy suburban emergency department that averages more than 33,000 visits annually. Supervised by experienced emergency medicine physicians, you will be involved in the diagnosis and treatment of acute problems and emergencies. Basic and advanced life support prepare you for recognition, evaluation, and stabilization in code situations. Residents interested in more emergency room experience can elect to do an additional emergency medicine month at Whidden or at Tufts-New England Medical Center in downtown Boston.

Evidence-Based Medicine
The Tufts University Family Medicine Residency at Cambridge Health Alliance is committed to teaching residents and medical students an evidence-based approach to practice. Our Information Mastery Curriculum will teach you not only how to find the best answer to clinic questions, but also prepare you to be life-long learners to stay current and at the top of the field in Family Medicine. You will learn how to quickly access information from multiple sources by computer and become experts at critical analysis of the medical literature. We examine clinical practice guidelines to determine the best clinical practice of our specialty, and have bi-weekly MythBusters conference where we challenge common “medical myths” and clinical questions to see if they hold up to the best evidence available.

Family Health Center
Each resident is assigned to serve as the family physician for a panel of patients at the CHA Malden Family Medicine Center, our new building at 195 Canal Street in Malden. The Family Medicine Center is planned as a real-world group practice serving the primary care needs of communities north of Boston. The majority of our patients live in Malden, Everett, Medford, and Saugus. Besides family physician faculty, the facility will offer a variety of other services and learning opportunities. You will learn how to provide high-quality, cost-effective care in the full range of family medicine including care of adults, care of children, maternity care, preventive medicine, and procedures.

Geriatrics
At the 164-bed Glen Ridge Nursing Care Center, in Malden, MA, you will be working directly with a family medicine faculty geriatrician. This provides excellent training in this important field, focusing on the skills necessary for good geriatric assessment. Through didactic conferences and workshops in the Family Health Center we address the biology of aging, functional assessment, and prevention, diagnosis, and management of specific conditions such as falls, incontinence, and dementia. You will provide home care as well as care at Glen Ridge to your own patients throughout the last two years of training.

Gynecology
You expand your knowledge through care of patients in community-based gynecologists' offices. At Malden Family Medicine, you will learn colposcopy, endometrial sampling, and other skills from family medicine faculty. You will also participate in minor and major gynecologic surgery under the direction of a gynecologist. You will also spend time in an infertility treatment center, which provides a real-life setting for enhancing your knowledge of reproductive endocrinology and better appreciate the experience of infertility treatment for many of your patients.

Intensive Care Unit
This first year rotation at Tufts-New England Medical Center in Boston is a concentrated month of training in intensive care medicine in a tertiary medical center environment, with superb subspecialty consultants and significant exposure to the resources of a medical center. This experience adds to critical care skills obtained throughout the resident's three years of longitudinal experience at the Whidden Memorial Hospital campus intensive care unit. This rotation therefore provides residents an unusual breadth of ICU experience within one residency; residents graduate from Tufts feeling very comfortable managing ventilators and patients in the coronary care unit with appropriate consultation.

Medical Informatics
All residents receive a Treo handheld computer at entry into the residency. This device simplifies your life by serving as your cell phone, pager, and palm pilot with all services paid by the department. Our Family Medicine Center uses EPIC, a state-of-the-art electronic medical record. You will learn how to use computers in your medical practice, to obtain patient information, use the internet, and to access notes from residency conferences, important telephone numbers, and medical texts. Besides regular conferences on medical informatics, computers are used daily throughout the hospital and family health center to rapidly access answers to clinical questions raised in the course of patient care.

Nursery/Neonatal Intensive Care Unit
This first year rotation is a good example of the utility of training in both a community hospital setting and a tertiary medical center. Residents become proficient at performing a normal newborn examination, manage common neonatal disorders such as hypoglycemia, feeding problems, TTN, and hyperbilirubinemia. They also become certified in the Neonatal Resuscitation course and attend resuscitations with neonatologists at Boston Floating Hospital for Children at New England Medical Center. Each Thursday is a full day of newborn-related conferences in Boston.

Obstetrics
We believe that training in a tertiary medical center in the first year before moving to the community hospital setting for years two and three provide Tufts FMR residents with an unusual breadth of obstetrics experience. Our fundamental belief is that maternity care is an important part of family medicine residency training, and that family medicine residents should learn it from both obstetricians and your own family physician faculty. This commitment means that you will follow your own maternity patients at the CHA Malden Family Medicine Center and do your own deliveries and postpartum care with family practice attendings. All Tufts family medicine faculty provide maternity care.

You will first train under Obstetrics residents and attendings at Tufts-New England Medical Center where you will have great exposure to an urban population and high-risk obstetrics. At the end of your first year of residency you and your classmates will take a course called Advanced Life Support in Obstetrics that focuses on prenatal emergencies, taught by Tufts family medicine faculty and from other nearby residencies. As a second- and third-year resident you enhance the skills you developed in the first year.

Second year residents obtain two months of obstetrics experience at our Cambridge campus, an extremely busy community hospital site averaging over 1400 deliveries annually. All continuity maternity care patients will also be delivered at Cambridge. Your family medicine faculty along with very supportive community-based family physicians and obstetricians teach prenatal care, management of labor, deliveries, and postpartum care. You will round on normal and high risk patients, follow women in labor, and deliver their babies. This provides appreciation of both normal and complicated labor. You will also learn use of modalities such as ultrasound and nonstress testing and assist at caesarian sections. Weekly teaching conferences at the residency site enhance your learning. Consultant Ob-Gyn faculty also regularly visit the residency to discuss high risk patients.

Orthopedics
Your Orthopedics rotations emphasize outpatient care. You join orthopedic surgeons in the emergency room, the operating room, and the office to learn diagnostic and therapeutic techniques. You develop a feeling of confidence in handling common orthopedic problems encountered in the family physician's office. This rotation is complemented by formal workshops in casting and splinting, as well as lectures from numerous community-based orthopedic surgeons.

Pediatrics
There is no better example of the benefit of our location and our ability to offer residents the best of both worlds than in Pediatrics. First year residents spend two months on an inpatient Pediatrics team at New England Medical Center's Floating Hospital for Children in Boston. The quantity and diversity of clinical problems encountered make this an exceptional experience not ordinarily found in community hospital-based residency programs. Supervised by third year Pediatrics residents and pediatrics attending teaching faculty, you have direct responsibility for patient care. First year residents also spend one month in the Floating Hospital's newborn nursery, developing expertise in care of newborns as well as performing neonatal resuscitation in the delivery room. You attend the teaching rounds, conferences, and seminars of this outstanding pediatrics residency at New England Medical Center.

As a future family physician, however, community hospital inpatient experience is also important. Your first-year academic medical center experiences will prepare you well for caring for children in the community hospital setting.

Because most care of children is done as an outpatient however, experiences in community-based pediatricians' offices is essential. You will round on the pediatricians' and family medicine pediatric inpatients each morning when on Community Pediatrics in the second and third years, followed by time in busy pediatrics office practices. A regular series of didactics presented by pediatricians and family physicians complete your experience.

Pediatric Subspecialties
One month of your second year is devoted to outpatient pediatric subspecialties at NEMC/Floating Hospital for Children, spending one half day per week in each subspecialty. Time in Pediatric Cardiology sharpens your cardiac auscultation skills. Tufts residents also train in pediatric outpatient subspecialty clinics such as Rheumatology, Endocrinology, Orthopedics, Neurology, and the International Adoption Clinic.

Practice Management
As a third year resident you will spend one week with your classmates at the Tufts Health Care Institute (THCI) experiencing the inner workings of a managed care organization. We also use THCI’s interactive on-line campus to for learning modules and longitudinal exercises to broaden exposure in Systems-Based Practice models and to teach Practice-Based Learning and Improvement. Practice management seminars are a regularly scheduled part of the didactic curriculum. Office-based family physicians are invited to come to speak about practical aspects of running an office practice. The American Academy of Family Physicians' workbook series called "From Residency to Reality" is provided to all third -year residents and the contents discussed with faculty advisors. Each month all faculty, residents, and staff of the CHA Malden Family Medicine Center meet to discuss office issues such as appointment schedules, record keeping, and other operational matters. Our residency's graduates report being very well-prepared for the practice management aspect of their careers.

Psychiatry/Behavioral Medicine
Inpatient psychiatry in your first year places you at work with all members of the team at Whidden Memorial Hospital's two inpatient Psychiatric units. You participate in therapeutic approaches which cause hospitalization. You will round with psychiatrists and respond, under supervision, to emergency psychiatric encounters. In the afternoons you will work with the Behavioral Medicine faculty. These clinical psychologists will teach you important and useful behavioral medicine techniques such as teaching patients relaxation and stress management, identification and treatment of alcohol and substance abuse in the office setting, and enhancing your communication skills with patients.

As a second year resident you will attend a week-long course with your classmates in "Clinical Training In Behavioral Medicine" at the Mind/Body Medical Institute of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. Here you will learn valuable skills you w can use virtually every day to help patients in your practice.

On Fridays throughout your three years of residency you will attend a Behavioral Medicine conference attended by all faculty and residents. This is followed by a weekly support group led by a behavioral science psychologist faculty member in the first year. During your last two years of residency you will meet for either a support group or a Balint group, a group process focusing on the doctor-patient relationship by discussing actual patients you have seen. Finally the behavioral medicine faculty videotape your patient encounters periodically to enhance self-knowledge and give you constructive feedback on communication skills.

Resident Conferences
The Tufts University Family Medicine Residency has an unusually extensive series of resident conferences, held five days weekly in the residency's Conference Room. Speakers include both family physicians and subspecialists from Tufts and other Boston institutions as well as Cambridge Health Alliance. You will also attend the weekly hospital Grand Rounds which feature nationally- known speakers from Boston and throughout the country. Journal Club and Evidence-Based Medicine seminars are also held monthly at which all residents and faculty discuss and evaluate articles from the recent medical literature. Rotation-specific conferences when on Boston rotations round out your didactic experience. The residency offers a weekly behavioral science conference held every Friday for all residents and faculty. Because residency can be stressful, this conference is followed by a support group for first years and a support group or Balint group for second and third-year residents. Our Balint groups focus on the doctor-patient relationship, including discussing the doctor's experience working with difficult patient problems.

Throughout your three years your faculty advisor will meet with you individually to review your progress and support your development. Furthermore, there is regular review and feedback provided by each rotation supervisor based on performance standards. You will also have regular formal reviews of your overall progress each year. Our residents play an integral role in assessment of our residency program's training experiences.

Resident Research
Tufts is recognized as one of the leading research universities in the United States. The Department of Family Medicine and Community Health has an active and productive research faculty who are involved in a broad range of research activities. These include the development of alternative approaches to the prevention of illness and the delivery of health care, nutrition, investigations into methodologies for the analysis of clinical and epidemiologic data, and health policy. For example, research on improving health delivery includes studies on adolescent obesity, public policy on lead poisoning prevention, and tobacco control. Also, the Family Practice Research Network (ReNet), in conjunction with the Massachusetts Academy of Family Physicians, provides the basis for intradepartmental collaboration among residency programs. Research is done in Boston and the Malden campuses.

Sports Medicine
Under supervision by our Sports Medicine Certified Family Medicine faculty, third year residents work with athletic trainers at Boston College's Department of Athletics, seeing Division I athletes on the Chestnut Hill campus. You will also participate in injury clinics, rehabilitation, counseling, pre-athletic screening services for schools and corporations. You will apply this knowledge to your patients in the Malden Family Medicine Center and can elect to work as a team physician for local high school sports teams.

Subspecialty Medicine and Surgery
Subspecialty medicine training formally occurs during two months of your second year. Boston's reputation for world-class subspecialty care provides you with a dazzling array of experiences designed to expose you to specialists to whom you will be referring as a family physician. These experiences can then be followed up by third year elective opportunities. You will spend time in the offices of medical subspecialists including allergy, gastroenterology, rheumatology, nephrology, neurology, and infectious diseases. As a third year resident you will spend a month-long rotation making hospital rounds and seeing office patients with community-based cardiologists. Every family physician sees a great deal of skin diseases; a month of dermatology during the third year teaches medical management and office surgical techniques for common skin conditions.

Subspecialty surgical experiences include anesthesiology, ophthalmology, otolaryngology, and urology. You will be exposed to the pre and post-operative evaluation of patients as well as common procedures your own patients will undergo.

Surgery
During your two general surgery rotations the emphasis is on pre-operative and post-operative evaluation and care. Operating room experience in a community hospital setting, working with enthusiastic community-based surgeons provides a great deal of hands-on experience. Without the hierarchy of a tertiary medical center, you will be allowed to do a great deal of assisting at surgery with expert supervision. You work up new patients, write orders in the hospital in consultation with your attending physician, and attend surgical conferences. You evaluate surgical emergencies and learn office-based surgery, in the surgeons' office and at the Malden Family Medicine site. Many residents also elect to do an additional emergency medicine month in either a community hospital or tertiary setting.