The third year of the residency program is the final stage of training for residents preparing for their future in Family Medicine. The emphasis in the third year shifts even more towards ambulatory care, while residents continue to hone inpatient skills through on-call experiences and as chief of the Family Medicine inpatient service.
In the third year, residents spend a total of six months on the Longitudinal Family Medicine Curriculum rotations. During these rotations, the FMC functions as the residents’ “home-base”, where they refine their outpatient management skills by caring for their own panel of patients an average of four half-days per week. In the FMC, the third year resident also takes on the role of team-leader, helping to coordinate delivery of care to patients in a manner that fosters continuity and the concept of the FMC as a Patient-centered Medical Home. Residents continue to learn principles of practice management, performance improvement and evidence based medicine. Residents have administrative time during these rotations to work on practice management, performance improvement and independent research projects. Third year residents also learn to lead group visits for patients with Diabetes, as well as prenatal groups during these months. In addition, the third year Longitudinal Family Medicine rotations include training in the surgical subspecialties of Urology, ENT and ophthalmology, psychiatry and addiction, plus exposure to various community agencies and alternative medicine. A dedicated half-day for minor surgical procedures is also incorporated into four of the six FMC rotations in the third year.
The third year resident spends a final month of inpatient training as Chief of the Family Medicine inpatient service. This position requires residents to manage the entire panel of patients, including pediatric, adult and intensive-care patients, in conjunction with the Family Medicine faculty. As Chief, the resident also learns to supervise and teach junior residents and medical students. Two weeks are spent on night shift, managing acute issues with the 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. Night shifts are done Sunday through Thursday, giving the night shift resident weekends off.
In addition, third year residents further expand their knowledge of Orthopedic/Sports medicine with a month-long rotation. This rotation provides additional exposure to common orthopedic problems, including a half day/week working one-on-one with our own Sports Medicine faculty gaining experience in joint injections, splinting and other procedures.
Two months of elective time in the third year enable residents to individualize their curriculum, allowing them to choose additional time in the fields of special interest.
PGY-3 rotations also include Urgent Care and Hospitalist Medicine. Residents rotate in a private Urgent Care Center for a month working with on-site attendings evaluating patients who seek care for acute illness and injury, including exposure to minor procedures such as splinting and suturing. An additional month is spent rotating at JFK on an inpatient hospitalist service gaining experience in this growing field.
Throughout the third year, residents continue to provide longitudinal care to their patients in long-term care facilities, to home visit patients, and to their continuity obstetric patients, as well as to their regular panel of patients in the FMC. Residents have increasing autonomy in the care of their patients and families over the course of their three years. At the completion of the program, residents emerge confident and well equipped to handle the challenges of the independent practice of family medicine.