Finding the Right Program

During residency fairs and the interview season it is very important that you are able to ask intelligent and useful questions that will allow you to determine the unique and important aspects of any potential residency program.  These questions were developed for medical students looking into Family Medicine residency training programs in order to help them find distinguishing features, which will make their individual selection of programs for interviews more streamlined and better-suited to their needs and trajectory in life.

What is the nature of the program?

  • It is critically important to know if the residency is a community-based or university-based program, since this will determine the spectrum availability of your residency experience.
  • In addition, it is important to discover if the program is “opposed” (other resident specialties besides the Family Medicine residents in the same clinical setting) or “unopposed” (Family Medicine residents are alone in their training experiences). This will determine if there will be other residents competing with the Family Medicine residents for patients, procedures, and rotational experiences.
  • It is also useful to determine what sort of practice settings that the graduates of a particular program tend to practice in, since this indicates the broadness of training and the level of comfort of their graduates.
  • Via Christi’s nature
    • We are a community-based program with a very strong emphasis on procedural OB training which will prepare our graduates to comfortably practice in any setting (rural, suburban, urban, or overseas) with confidence and competence.
    • Our residency is unopposed having no OB, Pediatrics, or Internal Medicine residents competing for our core training population.
    • We serve a large and diverse population of patients affording our residents broad opportunities to learn all aspects of Family Medicine, from the delivery room to the operating room, and even the ICU.
    • Our graduates are comfortable practicing all over the world; from rural Kansas, throughout the Midwest, as well as in some overseas locations.

 

What is the character and personality of the residents/faculty within the program?

  • One of the strongest aspects of a good residency are the residents that it attracts, since they reflect the strength and reputation of the program among the community physicians, consultants, patients, hospital system, and community.
  • If the residency has skilled and competent residents, then the attending physicians of other disciplines (and the local Family Medicine physicians as well) will be more likely to entrust the care of their patients to those residents (and the procedures they may require as well, such as deliveries).
  • The personality and philosophy of the program is largely a reflection of the residents within the program. There may be many different personalities among the people there, but there is generally an overall attitude or perspective of practice, confidence (or lack thereof), and lifestyle that should match yours.
  • Look for a program where you feel comfortable and which reflects your values, ethics, and philosophy of living. The individuals within that program will be your “family” for the next three years, and many will remain your friends (and sometimes partners) for a lifetime.
  • The faculty members of the particular program should be individuals whom you want to learn from, be around, and be mentored by, knowing that they are competent role-models of Family Physicians.
  • Via Christi’s character
    • Our residents are considered very strong and capable physicians who came to Via Christi because of the unique training opportunities offered here.
    • They chose to come to the Midwest from all over the country for a short 3-year period in order to get the kind of training they desire, and for training that is hard to find anywhere else in such a comprehensive setting.
    • The overall personality of our program is one of being “hard-working yet laid back.” We value life outside of medicine and strive to encourage proper priorities in living that will best suite our residents in “the real world.”
    • We strive to be compassionate, hardworking, and teachable, since we believe that these qualities are the foundation of a good physician. We look for these when we interview students as well.
    • Our residents are diverse (coming from many locations throughout the United States) and yet they are similar in many ways.
    • Issues of faith are very important to a majority of the faculty and residents, and the religious philosophy of our residency and hospital system allows and encourages us to care for “the whole person” (body, mind, and spirit), the underserved, and those experiencing crisis pregnancies.
    • Most important, we try to have fun with many social activities with other residents, faculty, and their families. We don’t just work together.

 

What is the nature of the Obstetrical experience?

  • OB numbers (spontaneous vaginal and surgical deliveries) are very important, since they will determine your ability to obtain practice privileges, as well as your comfort and competence in delivering excellent OB care to your patients. Beware of the statement, “if you work real hard, you can get good numbers.” This generally means that the skills you desire are hard to come by.
  • Try to determine the overall numbers of deliveries per month for the hospital (a more clear representation of OB volume), as well as the range, average, and maximum delivery numbers of the residents in the program - and whether these numbers apply to all the residents within the required OB curriculum and continuity experience, or instead require additional elective experiences to obtain.
  • Also try to determine who manages the complex cases, as well as the emergent C-sections, forceps, and vacuum extractions. This will determine the degree of training as well as the skill and competence of the residents within that program.
  • Some residents may not desire to do OB in their eventual practices, but a broad training in OB lends itself very well to many other areas pertinent to Family Medicine (gynecology and women’s health).
  • Surveys have shown that Family Physicians offering OB care in their practices are happier with their careers and are better compensated for their time. In addition, doing OB keeps a practice young with continual incoming young families who are easier to care for over time.
  • Via Christi’s OB experience
    • Our residents are the only OB residents on our very busy OB service (around 240-250 deliveries monthly), and are expected to be involved in every delivery and with every inpatient. When the RRC recently evaluated our program, our OB volume would have placed us at the 15th percentile compared with all OB/GYN residency training programs in the country (not Family Medicine programs)! So you see we have a lot of OB opportunity.
    • We work closely with the OB attendings while on the OB service and have ample opportunity to obtain additional experience in laparoscopic and operative OB/GYN care.
    • In addition to the OB service experience, our residents have ongoing continuity care for their own OB patients throughout the year and also have cross-coverage experience on OB call so as to continue to maintain and enhance their OB experience and skills throughout their time here.
    • Our residents are the primary surgeons on C-sections. Gaining valuable experience that allows the attainment of C-section privileges after residency training.
    • Our residents finish residency with OB numbers that compare with many OB fellowships (averaging around 240-250 deliveries with 40-60 C-sections as the primary surgeon, not as the second assistant).
    • Our residents are given ample opportunity to become competent in OB ultrasound, and other fetal assessment skills.
    • In a nutshell, our OB experience is unsurpassed by any other Family Medicine residency program in the country.

 

How much are the faculty actually available for individual consultation, supervision, mentoring, teaching, and clinical questions?

  • Many faculty salaries are based upon their personal clinical numbers of patients seen and revenue generated (which funds their salaries indirectly). The more that they are in their own personal clinics seeing their own patients, the less time that they are available for you.
  • Look for a program that emphasizes faculty availability not just good faculty-resident ratios.
  • Determine the percentage distribution of the faculty duties, which reflects the availability of the faculty for consultation, clinical questions, lecture preparation, mentoring, and overall teaching. Much of what the faculty does is related to just being available for questions and fellowship.
  • Via Christi’s faculty
    • Our faculty members are paid to teach! This may seem like a ‘no-brainer,’ but most training programs pay their faculty a set salary, and then expect them to generate their salary in patient care. As a result, they are obligated to see their own clinical population, and thus, they are not available to the residents at that time.
    • Our faculty members are available for clinical outpatient and inpatient supervision and mentoring from 75-83% of their time, seeing patients only 1-2 half day clinics per week. As a result they are available for our residents for clinical questions, advice, and mentoring, and our resident-faculty ratio is an outstanding 3:1.
    • Our faculty members come from diverse practice settings, and bring broad teaching experiences to the residency, and they are encouraged to develop new procedural skills in order to pass these on to the residents.

 

What is the spectrum of procedural training that is available to the residents?

  • Procedural training should be at the heart of a good Family Medicine residency program, since it reflects the spectrum of training opportunities available to the residents, as well as the competence of the faculty.
  • Broad opportunities allow the resident to determine their future practice scope rather than it being determined by the limitations of their training and the inability to obtain privileges for those desired procedural skills.
  • Most programs offer the standard procedures of skin surgery, simple orthopedics, and flexible sigmoidoscopy (which is falling out of favor as a useful screening procedure and whom many consider “a procedure of antiquity”). Consider looking for a program that easily offers adequate numbers of more useful procedural skills.
  • EGD and colonoscopy training, along with OB ultrasound, colposcopy and LEEP training, closed reduction of fractures, enhanced ER skills (tubes, lines, and pacer issues), ICU skills (ventilator care), and exercise stress testing should be sought after since these skills are greatly needed with the typical Family Medicine practice population.
  • Via Christi’s spectrum
    • All of our residents should finish residency with adequate numbers to apply for privileges to perform EGDs, colonoscopies, and EKG stress-testing. In addition, our program gives ample opportunities to learn and become competent at OB ultrasound, colposcopy, and LEEP.
    • In addition, we have frequent opportunities to manage many patients in the Intensive Care Units  of our hospital system(averaging 1-3 admits/night, both pediatric and adult), as well as manage all adult code blues at our East Harry hospital, and all pediatric code blues at our hospitals on East Harry and St. Francis.
    • Our program is like a “cafeteria” with a wide array of choices. It is up to you to determine your training in procedural skills based upon your future practice desires.

 

How are the Family Medicine residents treated within the community, hospital system, and the various clinical settings where they train?

  • Today’s Family Physicians are looked upon as the most cost-effective and efficient specialties within primary care for the majority of the US population. In private practice, most specialists recognize the worth and skill of a Family Physician, and expect to maintain cordial and cooperative medical relationships with them. The lifeblood of their practice depends upon the Family Physicians of their community.
  • It is not unrealistic to expect that the Family medicine residents also be regarded as a vital component of the health care of that community, and deserving of respect and confidence.
  • Look for a program where the residents are viewed as competent, qualified doctors who are fully capable of caring for the sickest of patients (not necessarily just those patients who are indigent, but also those within other social strata and income levels).
  • How Via Christi’s residents are treated
    • Our residents are treated as colleagues, respected as Family Physicians, and given great autonomy in the care of their patients, as well as the patients of our private attending physicians.
    • Wichita is very “Family Medicine-friendly”, and our patients expect to be cared for by our residents.

 

Are there any unique opportunities available to the residents of the program?

  • Determine what types of training opportunities are available to the residents within the program, which may afford them added exposure and experience in unusual settings, which can make them better physicians.
  • Look for international opportunities, unique community-based settings, such as crisis pregnancy medical clinics, indigent health care clinics, diverse populations and language groups, varied moonlighting opportunities (ER and minor emergency centers). In addition, look for a program that will try to grant special requests for possible unique opportunities (such as overseas experiences or international rotations) that might pertain to your future practice plans and career.
  • Via Christi’s opportunities
    • It is possible to embark on an international medicine experience for one month in either the second or third year of training instead of the required rural training month.
    • In addition, we offer an International Family Medicine Fellowship (for additional training abroad for those so inclined).
    • Community Health experiences that afford our residents the opportunity to rotate through and care for a large population of crisis pregnancy patients at the Choices Medical Clinic (www.choicesme.org), training in state-of-the-art 3-D OB ultrasound and the unique aspects of crisis pregnancy care, including Perinatal Hospice for families facing lethal anomalies.
    • Other Community Health opportunities that allows us to care for a large and diverse Hispanic population through the Guadalupe Health Center.
    • Sports Medicine plays a large role in our training and affords many opportunities for broad training and experience in this area. In addition, we have a Sports Medicine Fellowship for those desiring further skills and certification in Sports Medicine.
    • We have our own Osteopathic Manipulation Clinic allowing our osteopathic residents and faculty to utilize and improve their skills, and we are also a dually-accredited Allopathic and Osteopathic Family Medicine Residency Program, allowing residency training sufficient for either background, as well as entry through either matching program (ACGME or AOA).

 

Lastly, is the program attempting to remain “cutting edge” in their training of residents, and willing to advance with the times, or is it stuck in the past, fearful of trying new things?

  • Are they involved with Electronic Health Records, which all future family physicians will want to incorporate into their future practices.
  • Are they “looking at the horizon” (forward thinking) or stuck in the past?
  • Via Christi’s technology
    • Our institution has a full range of information technology to include office-based EMR, computerized inpatient hospital records, digital radiology and lab, mobile tablet computers (for each resident) and wireless networking.

 

Here is a helpful worksheet to compare residency programs:
Family Medicine Program Comparison Worksheet