Curriculum

Residents will spend 1 block with a combination of dermatology and wound care experiences. We believe that a rural family physician should be comfortable managing the majority of outpatient dermatological conditions. You should also have a good understanding of basic wound care principles and techniques so that you can aid in the healing of the countless wounds you will encounter in rural practice. If you plan to spend any time abroad, this experience becomes even more valuable. During this rotation you will spend time in both dermatology and wound care clinics while also doing inpatient wound care consultations.

Residents will spend 1 block each year working in our fast-paced emergency department. We see both pediatric and adult patients in our ED which provides a true rural emergency medicine experience while also having the volume and acuity of patients to gain a well-rounded experience. Your time in our emergency department will prepare you well for rural practice because you will gain the skills necessary to care for anything that walks through the door.

This is a longitudinal experience over the entire 3 years where you will be responsible for your own panel of patients in our designated Rural Health Clinic (RHC). Some residents will also have the opportunity to have their continuity clinic at the Consolidated Tribal Health Project that serves our local Native American population.

Geriatrics is an extremely important part of family medicine. For this reason, you will spend 1 total block dedicated to caring for our geriatric population. This will include seeing patients in your continuity clinic, rounding on patients in long-term care and short-term care facilities and making home visits. You will also receive dedicated lectures focused on caring for this often vulnerable and complex patient population.

Residents will spend 2 blocks per year working on the inpatient service in Ukiah and 1 block each year at the Sacramento VA, totaling 9 blocks over 3 years. In Ukiah, at our primary hospital site Adventist Health Ukiah Valley, residents will take care of a wide variety of patient types with an interesting mix of pathology. During this time, you will work closely with our dedicated hospitalist team as well as our family medicine faculty. We have an open ICU so you will be managing critically ill patients on a daily basis. We have limited specialists available so you will become adept at managing all aspects of your patients’ care. Residents on the inpatient service will also be responsible for all the inpatient procedures that come up throughout the day. You will become very comfortable with central line placement, paracentesis, thoracentesis, intubation, etc.

You will be provided with a combination of experiences in order to help you develop the foundation to be able to care for women of all ages. You will have 2 blocks of dedicated obstetrics training with perinatal, antepartum, intrapartum, and postpartum management experience. These experiences will occur in our maternity ward and in clinic under the supervision of obstetrics and family medicine physicians. You will also be provided with longitudinal experience that encompasses all 3 years of your residency where you will work with a fellowship trained family medicine physician providing full spectrum care, including obstetrics, to her patients in a nearby small town.

You will spend 2 weeks rotating through our ophthalmology clinic and 2 weeks in our ENT clinic. Eye complaints and ENT complaints are extremely common in family medicine clinics but can be overwhelming if you do not have a good foundation in these areas. You will learn proper exam techniques and treatment for the most common complaints in addition to learning when referral to a specialist is necessary.

1 block during the intern year and 1 block in PGY-3 will be dedicated to orthopedics and sports medicine. You will spend time learning from our local orthopedic surgeons and sports medicine physicians in their clinic as well as participating in calls where you will get familiar with managing all types of acute orthopedic injuries.

Our 1 block pain management rotation has two primary focuses. The first focus is to learn pain management strategies from our local pain medicine physician. Caring for patients with chronic pain can be very challenging for family physicians and to do so effectively often requires incorporating many different modalities into their care. You will learn how to incorporate behavioral health interventions, complimentary medicine techniques and appropriate opioid prescribing to better care for these patients.

The second part of this rotation focuses on medication-assisted treatment (MAT) for patients with opioid use disorder, which is a huge problem in rural America. This training also occurs under the guidance of our pain medicine physician, and all residents will be able to obtain their buprenorphine waiver by the end of the rotation.

1 block of inpatient pediatrics and 1 block of dedicated outpatient pediatrics will be completed in both PGY-1 and PGY-2 (4 blocks total). The inpatient pediatrics experience will take place at UC Davis Children’s Hospital in Sacramento on the general pediatric ward with pediatric residents and attendings. Housing will be provided. The outpatient pediatrics experience will take place in Ukiah with time spent at the Adventist Health pediatric clinic, Consolidated Tribal Health pediatric clinic and the local FQHC. While on outpatient pediatrics, you will also be responsible for caring for the newborns in the hospital. 

In addition to the dedicated block experiences listed above, you will have a good number of pediatric patient encounters in our emergency department and in your continuity clinics.

Residents will spend a total of 2 blocks working with attendings from different medical specialties. 4 total weeks split into 2 weeks during PGY-1 and 2 weeks in PGY-3 will be spent learning cardiology from our cardiologists. The other 4 weeks will be split between 2 different medical specialties of your choosing that could include nephrology, gastroenterology, rheumatology and neurology. As a family physician, it is very helpful to spend time learning under attendings from different specialties. You will learn appropriate management of specific conditions you will likely see in your clinic as well as learn when it is and is not appropriate to refer to specialists.

You will have 1 block during both PGY-1 and PGY-2 working with our general surgeons. Our general surgeons are highly skilled and eager to teach. During these months you will live the life of a rural general surgeon working side by side with them, rounding on inpatients, seeing consults in the emergency room, managing a busy clinic and first assisting on a wide variety of common (and not so common) surgeries.

Each Tuesday afternoon residents will be excused from all clinical responsibilities to attend didactics. The basic structure will include a mystery case, lectures over specific learning topics, and board review. There will be certain days dedicated to Behavioral Health topics as well as time for hands on procedural training. This is an extremely important time for our residents where they can have a break from clinical responsibilities and have dedicated time to learning in a fun and stress-free environment.

Our mission is to train family physicians well equipped to provide care for underserved patients in rural settings here locally and abroad. Whether you are practicing family medicine in a rural location in California or anywhere else in the world, the required skills are the same. You need to be comfortable managing simple cases and complex cases alike with limited resources and limited help from specialists or other providers. For these reasons, our program has made a commitment to incorporating global health into our curriculum. At our residency program you will hone your physical exam skills and learn how to rely more on your history and physical skills to make the right diagnosis. We have purposefully recruited faculty with a wide array of global health experiences and interests, and you will be able to learn from and be mentored by these physicians. We will have lectures covering global health topics throughout the year and both our procedures curriculum and POCUS curriculums were designed with global health work in mind. This experience will culminate with the possibility to do up to 2 international electives where you will get to work under family physicians doing amazing things across the globe.

This is an important part of our curriculum that we are very excited about. POCUS is becoming more and more popular, and we feel that it is a very important skill to have as rural family medicine physicians. By the end of your 3 years here, you will have the knowledge and skills necessary to perform POCUS in all clinical settings including OB, cardiac, pulmonary, AAA, DVT, soft tissue, MSK and procedures. We have partnered with SonoSim to provide each intern with a SonoSim trainer to help learn the basics and get comfortable manipulating the ultrasound probe. In years 2 and 3, you will build on your skills with focused didactics, hands on learning at the bedside and dedicated ultrasound shifts in the ED. Our more experienced residents will also be able to participate in teaching our ultrasound courses to the interns and local providers interested in learning this unique skill.

This is a longitudinal experience that will encompass all 3 years where each of our residents will play a major role in caring for our homeless population. Often times the patients our street medicine team cares for are people who are unable or unwilling to see providers in the clinic for various different reasons. To help reach these patients, we have a dedicated street medicine team that our residents will work closely with to provide care for these patients in a compassionate and non-threatening way. 

The "Street Medicine Active Resident Training" (SMART) track was created in the Spring of 2022 to allow interested residents an opportunity to engage in longitudinal care for some of our community’s most vulnerable populations. One resident from each class is selected by a panel of community members to participate in the track. Chosen residents attend clinic at least once per month at a syringe exchange, the shelter, or on the street. These clinics are in collaboration with community partners (Redwood Community Services and MCAVHN Care and Prevention Network) and the Adventist Health Compass Team to provide low barrier access to medications for opioid use disorder, hepatitis C treatment, and primary care services. Our collaborators assist us with providing housing navigation, care coordination, and behavioral health services. We encourage participants in the track to choose a community medicine project related to their street medicine work to complete over the course of their residency. 

The SMART track encourages resident physicians to become competent in harm reduction focused treatments for substance use disorders and to provide compassionate medical services to people who may otherwise experience significant barriers to treatment in conventional medical settings. Our work is constantly evolving, and we value residents who enjoy the process of finding creative solutions to problems in a place with few resources. 

As far as we are aware, our program offers the only rural street medicine training track in the country.