Successful chronic disease management is a cornerstone of family medicine, but is easier said than done! To better equip our residents for this often challenging task and to better serve our highest risk patients, we developed an interprofessional collaboration model we call the chronic care management team. 

We began the project with patients with diabetes with a HgbA1c ≥9. Each patient comes in for an initial extended visit. They see a Family Medicine resident and a Pharmacy resident simultaneously who work on optimizing medication management under the guidance of both a FM and Pharmacy preceptor. Next the patient sees our dietician for nutrition education. Lastly, they see our social worker, who identifies any barriers to care and provides them with a summary sheet of take-home points and has them teach back lessons they learned. She calls them 3 days later to check on their progress and make sure they followed through with recommended changes. Additionally, she tracks their visits and A1c levels over time so patients are not lost to follow-up. So far, we have lowered the average A1c in this challenging group from 11.6 to 9.2!

We have since expanded the clinic to include patients with uncontrolled hypertension and are exploring adding patients with COPD next.

The Geriatrics curriculum prepares graduates to provide high-quality, evidence-based, patient-centered health care to older adults. Residents gain experience managing geriatric patients across a variety of settings, including inpatient, ambulatory, acute rehab, nursing home, and home visits. Turley Family Health Center received a grant from the U.S. Health Resources and Services Administration (HRSA) in 2018 to expand the geriatrics curriculum through a partnership with the USF Health Geriatric Workforce Enhancement Project (GWEP). In GWEP clinic, the attending physician, Family Medicine resident physician, and pharmacy resident collaborate to provide care for geriatric patients with a particular emphasis on addressing the often complex physical, cognitive, and psychosocial needs of older adults.  Through the GWEP grant, we developed an innovative program that coordinates medical with social services for vulnerable elder patients via a bi-directional referral process with the Area Agency on Aging of Pinellas-Pasco. 

Integrative Medicine (IM) is a holistic, patient-centered approach to medicine that strongly emphasizes a collaborative patient-practitioner partnership. It addresses all aspects of a patient’s health, including physical, emotional, social, and spiritual. It utilizes any appropriate and evidence-informed modalities and therapies that may contribute to a patient’s healing and achieving optimal wellness.

The USF-MPM Family Medicine Residency is the first and only Family Medicine residency in Florida to offer IM training through the University of Arizona’s Integrative Medicine in Residency program. This track is offered to PGY-2 and PGY-3 residents. Residents work through a competency-based, interactive, online curriculum at their own pace, getting additional training and advancing their skills in topics like:

• Nutrition
• Vitamins, minerals, and common supplements
• Mind-Body techniques and tools
• Introduction to Functional Medicine
• Integrative Pediatric and Women’s Health
• Integrative approaches to chronic disease
• Manual medicine
• Energy Medicine
• Integrative Approaches to Pain Management

Residents and IM faculty also meet regularly throughout the year to discuss topics and participate in group activities like acupuncture, Reiki, and yoga.

With the changing role of physicians in today’s healthcare environment residency programs have a responsibility and obligation to teach far beyond the fundamentals of direct patient care.  We must teach, role model and encourage a culture in which community responsibility and physician leadership are cultivated. In addition, we have implemented a curriculum to provide residents with the foundation and tools necessary to become the well-rounded and responsible healthcare professionals of tomorrow.

The overarching goal of the Leadership for Life Curriculum is to establish a supportive and fun culture where hard work is rewarded and professionalism developed and celebrated.

Towards these goals several residency activities and events are scheduled throughout the residency experience.

• New Resident Team Building Day is a full day of social and physical interaction activities designed to acquaint the new intern class with each other and with faculty.  It’s a day during a busy orientation process to get outdoors, put things in perspective and to have some fun.

• Residency Support Groups occur monthly in the first year of residency and less frequently in the PGY2 and PGY3 years. These group meetings are designed to allow residents an ongoing forum for team building, problem solving and skills training.

• Intern Out Day occurs mid year in the PGY1 year. This scheduled full-day away from all residency responsibilities addresses the question, “Who are we and how do we work best together?” The focus is on team building, cohesion development and stress management. It is also the celebration of completing over half of the most difficult year of postgraduate medical education.

• Halfway Done Day addresses the question, “Who am I as a healthcare professional and how do I balance the various roles in my life?” and occurs in the first half of the PGY2 year. The focus is on individual growth and development with recognition of the individual attributes that contribute to the collective “whole” of the healthcare profession. The day also serves to celebrate the individual’s completion of half of their postgraduate medical education while simultaneously addressing skills and attitudes relating to how to balance the competing issues of family, finance, physical, spiritual, personal and professional well-being.

• Almost Done Day is planned for the last quarter of the PGY3 year. This activity addresses the question, “What is my potential and how can I use my gifts and talents to fulfill my potential and contribute to my profession and my community?” This is an exercise in leadership development and is meant to stimulate and motivate soon-to-be graduates to face the future with determination and purpose.

• Life Balance Events occur during each year and are an opportunity to learn and practice the areas of life balance adapted from work by Dr. Thomas Stevenin. Each resident year group is given a budget to plan and implement an activity for all residents and faculty focusing on one of the elements of a balanced life: Health and Physical Condition, Home and Family, Life's Work or Profession, Financial, Mental and Personal Growth, and Self-fulfillment or Spirituality.

Prerequisite Training / Selection Criteria:

1. Expressed interest no later than December of PGY-1
2. Letter of recommendation from obstetrics faculty
3. Maintenance of good standing throughout residency training 

Participants of the obstetrics track are chosen from the PGY-1 class during that year.  This allows for structuring of their PGY-1 schedule to facilitate early exposure to the obstetrics rotation. Appropriate candidates with ongoing interest must deliver a positive rotational performance and obtain written support from obstetrics faculty. The selection of candidates will be based upon rotational performance and gauged level of interest/commitment. Professed commitment to practicing obstetrics following completion of residency is not a requirement, but it is highly valued in candidate selection.  

After acceptance, the obstetrics track begins at the end of the PGY-1 year. Integrated inpatient and outpatient experiences combine to meet the specific goals as stated, which most broadly are summarized by competent and confident non-operative family medicine obstetrics practice, a sound foundation for operative fellowship training if desired. Participants of the obstetrics track provide direct patient care and also supervise family medicine interns and medical students in the above settings. 

Goals of Training

• Demonstrate competency in labor management decisions. This includes management of inductions and interventions in the laboring patient including augmentation of labor, resuscitative measures, and operative delivery. Minimum 80 vaginal deliveries. Participants likely to achieve more.
• Deliver evidence-based and patient-centered care to low- and moderate-risk OB patients across the continuum of care (prenatal, triage, labor and delivery, inpatient post-partum, outpatient post-partum). Minimum 10 continuity patients delivered. Participants likely to achieve more.
• Deliver evidence-based and patient-centered care to mother-baby pairs following delivery.
• Demonstrate competency as first assist in cesarean section and tubal ligation.
• Increase fund of knowledge and develop teaching skills to the point of functioning effectively in formal and informal teaching of family medicine interns and medical students.
• Contribute to quality improvement exercises with respect to the existent practices of the current OB providers. 
• (Optional) Demonstrate competency in office-based gynecologic procedures such as colposcopy, LARC counseling/insertion/removal, etc.
• (Optional) Complete certification to become an instructor in Advanced Life Support in Obstetrics (ALSO).  

The goal of the telemedicine curriculum is to ensure that our residents have a foundational understanding of this expanding healthcare delivery model, while also teaching them advanced remote patient care techniques and progressive patient care models through a wide variety of hands-on telehealth learning opportunities. 

Our healthcare system, BayCare, has numerous well-established and expanding telehealth programs our residents participate in including video telemedicine acute and chronic care visits, eICU, hospital at home, telehealth wound care, remote/ mobile patient monitoring, and other novel methods of healthcare delivery.

As innovation in care delivery and technology continues to transform family medicine, we must ensure that our current and future family physicians have all the available tools and resources they might need to provide the best possible care for their patients.

_{** PGY-3 Dr. Peramsetty was recently selected to participate in the 2022-2023 Doximity Fellowship Program. Part of this year-long fellowship involves publishing six clinical cases for Doximity, as well as working with the Doximity team to enhance their network content and to contribute to product development. Many of us use the Doximity App to safely connect with our patients via phone or video.}

Wilderness medicine is defined as the practice of medicine in austere, resource constrained, and possibly remote environments. The skills taught by our Track promote knowledge and understanding: in wilderness medicine, pre-hospital care, disaster medicine, international and travel medicine, and tactical medicine. This track is offered to PGY-2 and PGY-3 Family Medicine residents and runs longitudinally over both years. Interns may participate if their schedule allows.

Your educational experience will start with didactic lectures. However, wilderness medicine cannot be taught in the classroom alone. We will spend most of our time outdoors building on core topics learned.

There are five longitudinal components that all residents will complete:

1. Didactics Lectures (4 curriculum modules + longitudinal topics) 
2. Clinical Experience
3. Research
4. Technical Skills
5. Leadership Skills

The four Didactic Curriculum Modules cover:

• Mountain Medicine
• Desert Medicine
• Tropical Medicine
• Dive and Marine Medicine

These modules will give the resident the required knowledge and technical skills to competently practice wilderness medicine. Each module is taught through week long seminars conducted by USF Health / MPM Family Medicine Faculty. Each of these modules will have required reading from Auerbach’s, Wilderness Medicine, additional texts, and key articles from the medical literature. These modules will all have associated field, experiential education, and research requirements. Through the experiential aspect of the track all Residents will gain hands on clinical experience. This will develop and hone their technical and leadership skills. 

The USF Health / MPM Family Medicine Residency program is the first and only Family Medicine Residency in Florida to conduct Advanced Wilderness Life Support (AWLS) training. Training is provided by 3 core faculty certified as Lead Instructors and various subject matter experts. All residents in the track will complete AWLS certification. However, this opportunity is open to all residents and faculty.