• Behavioral Science Training
• Community Oriented Primary Care (COPC)
• Evidence Based Medicine (EBM)
• Family Oriented Outpatient Medicine (FOOM)
• Home Care
• Outpatient Clinic Linkage Program
• PGY1 Seminar
• PGY2 Seminar
• Practice Management

Behavioral Science Training

Behavioral science is an integral part of the Residency Program, emphasizing a systems approach to family medicine. This approach recognizes the interdependence of physiologic, psychological, familial, and societal contexts of health and illness. Throughout their training, residents acquire skills in assessing the cultural, social, political and economic issues that impact on a person’s well-being. Residents refine these clinical skills through supervision via a one-way mirror and videotape review.

In second and third years, residents participate in a weekly Behavioral Science Seminar focusing on issues such as sexuality, somatization, physical and sexual abuse, and chronic and terminal illness. Clinical applications are explored in the Family Care Unit, where residents learn the basics of family therapy by conducting sessions with patients and their families. Interventions emphasize interpersonal relationships, cross-cultural awareness, and family development. The behavioral science curriculum also stresses professional development. Residents are encouraged to explore how their strengths and values affect their clinical interactions.

Community Oriented Primary Care (COPC)

The COPC curriculum spans all three years of training and helps residents develop the skills needed for working with whole communities (not just individual patients and families) to improve health status. COPC is a model that was codified in the 1980’s by the Institute of Medicine. Steps include identifying and characterizing a community with which to work, assessing the needs and resources of the community, designing and implementing an intervention to address one or more of the identified needs, and evaluating the intervention. A crucial aspect of COPC is involving the community in the whole process.

The COPC curriculum is structured as an experiential class project. Each class is introduced to three nearby underserved communities during PGY1, including the Mission District, Visitacion Valley, and Bayview Hunters Point. At the end of PGY1, residents are introduced to the COPC model, and the class is asked to choose one of those three communities in which to focus their efforts. During the subsequent two years, residents, (in groups of 3-4, rotating every 3 months) under the supervision of two faculty mentors, undertake a COPC project in their chosen community. All COPC projects involve forming partnerships with pre-existing community-based organizations.

For more information on the COPC curriculum, see “Teaching Community-Oriented Primary Care through Longitudinal Group Projects” in Family Medicine 1998;30(6):424-30.

Examples of resident COPC projects include the following.

One class partnered with Everett Middle School and Community Bridges Beacon in the Mission District to develop a series of bilingual workshops on accessing health care, targeting new immigrant parents. Another class raised $250,000 with Visitacion Valley Jobs Education and Training, City College of San Francisco, and Jewish Vocational Services to implement a health care technology job-training program in Visitacion Valley. A third class joined forces with the Community Empowerment Center in Bayview Hunters Point and developed a pilot mental health workshop for youth outreach workers, focusing on post-traumatic stress disorder.

Evidence Based Medicine (EBM)

EBM is an individual two-week PGY1 rotation during which a resident works with Dr. David Thom to gain skills in accessing and using medical literature to answer significant clinical questions. During the rotation, residents learn to use (or refine skills in using) Medline to do literature searches and to access electronically available sources of medical information, including Systematic Reviews (e.g., Cochrane) and Critically Appraised Topics; use quantitative EBM techniques, such as number needed to treat (NNT) and number needed to harm (NNH), pre-test probability and post-test predictive value, absolute risk reduction, etc, to analyze study results; apply an EBM approach to interpreting study results, including evaluation of study design, internal and external validity, findings for patient-oriented evidence that matters (POEM) vs. disease oriented evidence (DOE); and use EBM principles to identify significant clinical problems, formulate one or more appropriate questions, search for studies, evaluate findings, and incorporate conclusions into every day clinical practice.

Residents use a combination of on-line tutorials, readings, and meetings with Dr. Thom and with the SFGH Medical Library's Information Services Librarian, Julie Haugen, to achieve the above goals. Residents generate questions from their own clinical practices and work with family practice inpatient service teams to answer questions generated by the teams. Residents present their findings during inpatient service rounds and monthly journal club meetings.

Family Oriented Outpatient Medicine (FOOM)

While on block, PGY2 and PGY3 residents, along with two faculty colleagues, participate in this self-directed learning seminar. By presenting active patients from their panels, group members set an agenda for learning and teaching tasks. Emphasis is on evidence-based medicine, the scope of family medicine, and the physician–family relationship.

Home Care

Residents are assigned homebound patients to follow during second and third year of residents. Lori Kohler, MD and Joanne Donsky, MSW supervise care. Multidisciplinary patient conferences about each patient make up part of the PGY2 Seminar.

Outpatient Clinic Linkage Program

Residents are “linked” to a group of Family Medicine preceptors beginning in first year. Linkage groups see patients together and meet quarterly to discuss patient care and practice management.

PGY1 Seminar

The first Friday of each month is set aside for this PGY1 curriculum. Emphasis is on essentials of Family Medicine, including COPC, chronic illness care, prenatal and pediatric care, prevention, etc.

PGY2 Seminar

A continuation of PGY1 seminar, this Wednesday morning series is organized around the life cycle and provides a more comprehensive presentation of important areas in Family Medicine.

Practice Management

This curriculum focuses on preparing residents to enter practice. It includes specific training in the clinical practice setting, participation in group practice meetings, and a seminar series covering practice management concepts and an overview of current trends in health care delivery.