Curriculum and Continuity Clinic

Continuity Clinic at EVMS FM

Continuity Clinic and Immersion/Hybrid Rotations

EVMS Family Medicine believes that your continuity clinic is where the majority of your clinical knowledge and expertise develop. With that idea in mind, our residency program has developed immersion (also known as hybrid) rotations to allow you to spend more dedicated time on your specialty weeks. This, generally, allows our residents to spend two weeks dedicated to their specialty rotation in each four week block with one half-day per week spent in continuity clinic.

The remaining two weeks of the block are spent dedicated to continuity clinic. We feel that this establishes a solid foundation for you to learn from your specialty and elective rotations while building the foundations for your clinical practice following graduation.

Advantages of Hybrid Rotations:

• Simpler schedules: less worry about balancing clinic with other experiences during a rotation
• Better experience with community faculty due to less interrupted time you will spend with them during a rotation
• Ability to still maintain continuity with your patients due to maintaining at least one half-day of continuity clinic during your specialty rotations 

Continuity clinics

Family Medicine has two Family Medicine Practice sites that our 16 PGY-1s are assigned to at the beginning of their training (i.e. your “continuity clinic”).

• One Family Medicine Practice site is Portsmouth Family Medicine in Portsmouth and is adjacent to Maryview Hospital.
• Our second Family Medicine Practice Site is Ghent Family Medicine in Norfolk and is on the main campus adjacent to Norfolk General Hospital.

Both continuity clinics operate in a similar manner, have identical faculty to resident staffing ratios and are about four miles apart from each other. Each continuity clinic has dedicated conference rooms and study areas for residents to utilize during their training.  

Following Match, and after we take your preferences into consideration, you will be assigned to either Portsmouth Family Medicine or Ghent Family Medicine. Approximately 7 –9 PGY1s are assigned to each clinic. You will maintain your continuity panel at one of these two clinical sites over the three years of training, however, the remaining rotations you will have during your residency will be assigned irrespective of your continuity clinic location.

All of our residents regardless of their assigned continuity clinic will spend an equal amount of time on our hospital services, specialty rotations, electives, etc. Additionally, you will also be scheduled for procedure clinic sessions, perform hospital follow ups, participate in inter-professional clinics and serve as back up at both Portsmouth Family and Ghent Family regardless of where your continuity clinic is located.

Our residency program ensures that your exposure to patients is maintained at both clinical sites despite keeping your continuity panel at one clinic. 

Continuity Clinic Admin Time

During your continuity clinic weeks, our program will make the effort to schedule all residents for at a minimum of 1, and in many cases, up to 2, ‘admin’ sessions per week. These are 4-hour blocks of ‘admin time’ where our residents are allowed time to catch up on their clinic notes, pre-chart for future clinic visits, perform lab and image verifications, call patients, discuss patient cases with their consultant colleagues, etc.

Continuity Clinic Ramp Up

To help prepare our residents for a career in family medicine and to allow learning, our program has developed a gradual ramp up of patients per session during training. In the

PGY1 year, our residents start with two patients per session and gradually work their way up to 6 patients per session towards the end of their first year. PGY2s generally start at 7 patients per session and gradually work their way up to 9 patients per session towards the end of their second year. PGY3s start at 10 patients per session and remain at 10 throughout the PGY3 year.

Continuity Clinic Primary Care Exception

Our residency program participates in the Primary Care Exception, allowing third year residents to bypass direct precepting of new or established level 3 patients.

Continuity Clinic EHR

Our residency program uses Epic as our EHR for both of our continuity clinics.

Curriculum at EVMS FM

PGY1 Year Curriculum

The overall goal of the PGY1 year is to establish the foundational clinical skills for both inpatient medicine and outpatient medicine in addition to being able to understand and treat (or triage if unable to treat) acutely ill adults (including hospital rapid responses) as well as children (including newborns). PGY1s participate in a comprehensive orientation schedule in the first four weeks of their residency – spending time in their assigned continuity clinic for two weeks, as well as a week on each of our inpatient services. During the PGY1 year, faculty and senior residents are always available and always able to help.

• 4 weeks in July for all 16 PGY1s: Clinical Inpatient and Outpatient Orientation
• 13 weeks: Continuity Clinic
• 12 weeks: Inpatient Adult Medicine Days (Norfolk General and Maryview Hospital)
• 4 weeks: Inpatient Adult Medicine Nights (Maryview Hospital)
• 4 weeks: Geriatrics (Hampton Veterans Affairs Medical Center)
• 4 weeks: Labor and Delivery (Sentara Norfolk General)
• 3 weeks: Inpatient Pediatric Medicine (Children’s Hospital of the King’s Daughters)
• 2 weeks: Ambulatory Pediatrics
• 2 weeks: Newborn Nursery
• 2 weeks: ICU
• 1 week: Behavioral Medicine
• 1 week: Ultrasound

PGY2 Year Curriculum

The PGY2 year allows for residents to practice with less supervision and more autonomy especially in the inpatient setting. Residents are also exposed to more critical care medicine via two ER rotations (adults and pediatrics). Additionally, residents are provided with a few core rotations to assist with their future outpatient family medicine practice (cardiology, musculoskeletal, geriatrics, women’s health and practice management).

Residents are also afforded up to 4 weeks of electives and a week of procedural clinic practice. Lastly, residents are expected to grow their continuity clinics and expand their continuity numbers in their PGY2 year.

• 17 weeks: Continuity Clinic 
• 8 weeks: Inpatient Adult Medicine Days (Norfolk General and Maryview Hospital)
• 4 weeks: Inpatient Adult Medicine Nights (Norfolk General and Maryview Hospital)
• 3 weeks: Back Up/Self-Study/Research
• 2 weeks: Adult Emergency Medicine (Maryview Hospital)
• 2 weeks: Pediatric Emergency Medicine (Children’s Hospital of the King’s Daughters)
• 2 weeks: Ambulatory Pediatrics
• 2 weeks: Nephrology/Elective
• 2 weeks: Cardiology
• 2 weeks: Geriatrics
• 2 weeks: Musculoskeletal
• 2 weeks: VA Surgery/VA Elective (Hampton Veterans Affairs Medical Center)
• 2 weeks: Women’s Health
• 1 week: Procedure/Specialty Clinics
• 1 week: Practice Management

PGY3 Year Curriculum

The PGY3 year’s objective is to prepare the resident for autonomous and independent practice. Residents are still asked to do a few core rotations to help improve their critical care medicine skills (adult ER) as well as continued exposure to outpatient pediatrics but are afforded up to 10 weeks of electives targeted towards their goals and objectives.  

• 23 weeks: Continuity Clinic
• 8 weeks: Electives
• 4 weeks: Inpatient Adult Medicine Days (Norfolk General and/or Maryview Hospital)
• 4 weeks: Inpatient Adult Medicine Nights (Norfolk General and Maryview Hospital)
• 4 weeks: Ambulatory Pediatrics
• 3 weeks: Back Up/Self-Study/Research
• 2 weeks: Adult Emergency Medicine (Sentara Leigh Hospital)
• 2 weeks: VA Dermatology/VA Elective (Hampton Veterans Affairs Medical Center)
• 2 weeks: Procedure/Specialty Clinics

Electives

EVMS FM offers our residents a variety of elective options throughout their training. A few of our electives are listed below:

• Addiction Medicine
• Breast Feeding
• Dermatology
• Direct Primary Care
• Endocrinology
• FQHC Community Clinic Rotation
• Geriatrics
• Hospitalist Rotation
• ICU
• Infectious Disease
• Interventional Radiology
• Pain Management
• Palliative Medicine
• Planned Parenthood
• Sleep Medicine
• Sports Medicine

Longitudinal Educational Experiences, Residency Didactics and Grand Rounds

Our residency program offers a variety of longitudinal educational experiences, including scholarly activities (such as case presentations, monthly journal clubs, M&Ms, etc.) as well as workshops and simulation training.

• Continuity Clinical Practice 
• Workshops 
• Practice Management 
• Scholarly Activities (case presentations, monthly journal clubs, quarterly M&Ms, etc) 
• Self-Study 

Didactics and Grand Rounds

• Quarterly Grand Rounds
• Weekly didactics every Wednesday afternoon covering topics including:
  • Hospital medicine and Critical Care Medicine
  • Pediatrics
  • Obstetrics and Gynecology
  • Dermatology
  • Geriatrics and Palliative Care
  • Nephrology
  • Neurology and Sleep Medicine
  • Nutrition
  • Psychiatry
  • Rheumatology
  • Pharmacology
  • Practice Management and Quality Improvement
  • Substance Use Disorders
  • Workshops (EKGs review, skin biopsy procedures and suturing, women’s health/OBGYN procedures) and Code Blue/Rapid Response Training

The Family Medicine Residency offers residents the opportunity to develop their chosen Family Medicine interests with elective time utilization. Many of these tailored experiences have more electives than the available elective months given to residents; this enables the resident to choose which ones will best suit their academic needs. If a resident has an interest in a tailored experience, they should meet with the program director within the first six months of their residency to help establish goals for their residency.