The second year of the Family Medicine residency is as challenging as the first, but much more varied, as time is divided between inpatient work at the hospital and outpatient care in both the Family Medicine Center and other ambulatory sites.
A large part of the second-year outpatient medicine experience takes place during the Longitudinal Family Medicine Curriculum rotations. The rotations include time seeing continuity patients in the Family Medicine Center, longitudinal medical subspecialties (including endocrinology, hematology/oncology, infectious disease, nephrology, neurology and rheumatology), and dermatology spread over three one-month rotations. Also during this time, residents will continue to build their knowledge and experience in the Patient-centered Medical Home. They also spend two sessions per month in our GYN clinic learning outpatient gynecologic procedures, such as colposcopy, IUD insertions, and endometrial biopsies under the supervision of an OB/GYN preceptor in our FMC. Residents build on their pediatric knowledge by participating in the FMC Adolescent Clinic working one-on-one with our own Adolescent faculty and Behavioral scientist, focusing on the unique healthcare needs of the adolescent patient. Residents also continue to develop their skills in treating medically and psychosocially complex patients by participating in the FMC Complex Patient Clinic. Here, they work with the Behavioral Scientist, a Medical Faculty Member and a fellow resident to develop an individualized treatment plan for patients with complex needs.
Residents spend one month as Chief of the JFK Family Medicine Service, caring for patients admitted from our Family Medicine Center. This involves daily patient management, teaching rounds, and supervising the PGY-I resident and medical student on service in conjunction with the Family Medicine faculty.
The second-year residents spend one month in the pediatric emergency room at JFK Medical Center to learn such skills as caring for the febrile child, managing acute minor illnesses and injuries, and suturing techniques. They also spend one month in the main JFK ER where they care for a wide variety of medical, surgical, and trauma conditions in adult patients.
Residents study Intensive Care Medicine working with JFK’s Intensivists. The resident participates in the daily care of ICU patients, as well as interacts with intensive medicine specialists who staff the critical care units 24 hours a day. This enables residents to learn how to evaluate and manage critical patients and to perform appropriate procedures, including arterial lines, central lines, and code management.
Other rotations include orthopedics/sports medicine, geriatrics and one elective month. Our strong geriatrics curriculum includes a concentrated eight-week rotation learning the principles of geriatric medicine and multidisciplinary geriatric assessment. Residents work directly with our Director, Robin Winter, MD, who has a Certificate of Added Qualification in Geriatric Medicine. He is also the medical director of three nursing homes, where our residents rotate. Residents also learn principles of Hospice and Palliative Care medicine working with JFK’s Hospice team that provides inpatient hospice care as well as manages patients in both nursing facilities and at home. Residents start to provide longitudinal care for their own panel of patients in a long-term care facility for the latter two years of the program.
The Orthopedics and sports medicine rotation is divided between a large, local orthopedic group and our own sports medicine faculty in the Family Medicine Center. Learning opportunities include x-ray interpretation, casting and splinting, tendon and joint injections, and the potential for sporting events coverage.
During the second year, time in the Family Medicine Center increases from one half-day per week to an average of three half-days per week. As a second-year resident’s panel of patients grows, residents become more skilled in the management of a wide variety of health problems such as hypertension, diabetes mellitus, asthma, depression and anxiety. Also at this time, second-year residents begin to care for obstetric patients whom they will follow through the full course of prenatal care, delivery and post-partum care. Second year residents also begin to participate in our Centering group visits for prenatal and diabetic patients.
Second year residents spend one month on the night float rotation, managing acute issues with inpatients on the Family Medicine service, supervising the first year resident and providing phone triage of FMC patients, with ED assessments and patient admissions as needed.