Curriculum

ST MARKS FAMILY MEDICINE CLINIC (SMFM)

At the heart of family medicine is continuity of care for your own panel of patients. Most residency programs start with minimal clinic exposure and significant time in the hospital. Our program puts a major emphasis on your personal clinic experience, the foundation of becoming a successful family physician. Our trademarked program is called Clinic Every Day™. During all three years of residency, you will see patients at SMFM five days per week in half-day clinic sessions (with some exceptions during inpatient and away rotations), just like you would in independent practice. Your patient load gradually increases throughout residency, starting with one patient per half-day and building to three by the end of intern year, then progressively increasing to eight patients per half-day by the end of R3, preparing you for independent practice.

Being in clinic on a daily basis means:

  1. When your patients call, the receptionist can tell them you'll be available today or tomorrow, not next week or month as in a traditional program.

  2. When lab results return, you'll review them promptly and take appropriate action.

  3. When you see a very ill patient who needs follow-up tomorrow, you'll see your own patient rather than having them follow up with a colleague they've never met.

SMFM is located in the community we serve. We see approximately 15,000 patient visits per year.

NOON CONFERENCE DIDACTICS

Every weekday, residents attend a noon conference with lunch from the physicians’ lounge. Topics range from ECG interpretation to Balint groups, where residents reflect on patient interactions in a faculty-free setting. Speakers include residency faculty, rotation directors, residents, and outside experts. Residents help schedule and select lectures, ensuring we cover the topics we want to learn.

ROTATIONS

Family Medicine Hospital Service (FMS)
Patients are admitted from our Family Medicine Clinic (SMFM) and the community. Our inpatient team consists of one FM intern, one podiatry intern, one senior FM resident, one FM attending physician, and an inpatient pharmacist.

Unlike traditional inpatient services that admit patients throughout the week, our service front-loads admissions from the Emergency Department on Mondays until reaching our service cap. For the remainder of the week, we primarily manage and discharge existing patients, admitting only patients from our clinic. This allows our inpatient census to gradually decrease throughout the week, providing more time for continuity clinic while maintaining valuable inpatient experience.

Details:

  • R1 patient load averages 6-8 patients/day, decreasing toward the weekend

  • Daily pharmacy rounds with our team

  • Clinic continues during FMS: interns attend Monday morning clinic, while both interns and seniors attend afternoon clinic Wednesday-Friday as the inpatient census decreases

Rotation Length:

  • R1: 3 months (one month, then two-week blocks)

  • R2: 2 months (two-week blocks)

  • R3: 1 month (two-week blocks)

General Schedule:

  • R1: 7 AM-9 PM Monday (general admissions); 7 AM-7 PM Tuesday-Friday; Saturday off; Sunday morning rounds*

  • Interns manage the service with attending supervision on Monday mornings and Tuesday afternoons

  • Attendings and senior residents not on service are always available for guidance

  • R2/R3: Noon Monday-noon Tuesday (24-hour shift including Monday night call); 7 AM-7 PM Wednesday-Friday; Saturday morning rounds*; Sunday off

  • *Weekend morning rounds are typically brief, as the inpatient census is usually at its lowest by the end of the week. Once you've seen and staffed your patients, completed your to-dos, and signed out to the covering resident, you're free to enjoy the rest of your day!


Call Schedule

Home Call (7 PM–7 AM): Residents who live within a 30-minute radius of the hospital can take call from home. Call includes managing questions about hospitalized patients on our inpatient service and answering after-hours calls from clinic patients. You are only required to come into the hospital for new admissions from our clinic or if a hospitalized patient becomes unstable. Home call allows for better work-life balance. We do not have any night-float rotations!

  • R1: No overnight call

  • R2 and R3: Home call covering hospitalized patients, admissions from our clinic, and after-hours clinic phone calls. Call is shared among our eight senior residents, averaging q8 weekdays and q8 weekends.


Obstetrics/Gynecology:
Residents complete three months of OB/GYN training over three years.

  • Minimum delivery requirements: 30 non-continuity deliveries and 10 continuity deliveries

  • Opportunities for additional deliveries based on resident interest (see the OB Track tab)

  • Deliveries take place at St. Mark's Hospital, where residents work closely with community OB/GYN physicians and OB hospitalists

  • All continuity deliveries are supervised by our fellowship-trained family medicine obstetrics faculty member, Dr. Maryana Boulos

  • Time is split between OB clinic and labor & delivery (~20hrs a week), and continuity clinic

  • Advanced Life Support in Obstetrics (ALSO) training is provided during R1

  • Residents work one-on-one with community attendings in general gynecology, gynecologic oncology, and pelvic pain clinics


Surgery: 
Residents work with St. Mark's general surgeons during their surgery rotation.

Experience includes preoperative diagnosis, intubation, suturing, surgical assisting, postoperative management, and ambulatory surgical procedures. Residents may also spend time in surgical clinics or with the wound care team.


Behavioral Medicine: 
Residents work with inpatient psychiatrists at St. Mark’s Behavioral Health Unit and outpatient psychiatrists in the community.
Residents perform a reflective session annually during noon conference, and behavioral medicine is addressed 2-3 times per month in noon conference

Dermatology:
Residents work with clinicians in the community, including those performing Moh’s surgery

Sports Medicine/Orthopedics:
Residents work with clinicians at St. Mark's and in the community.

  • Rotate with our sports medicine fellowship-trained faculty member, Dr. Emily Miro

  • Complete a winter ski clinic rotation during R2, treating a variety of sports-related injuries

  • Gain experience in casting, splinting, joint aspirations, point-of-care ultrasound (POCUS), and injections

  • Opportunities to perform pre-participation sports physicals and provide medical coverage for local sports teams and events


Cardiology:
Residents work with Cardiologists at St. Mark’s renowned Heart Center in their clinic and on the inpatient service. 

Emergency Department:
Residents work in St. Mark's Emergency Department for a total of two months (200 hours)

  • Residents also complete a dedicated pediatric emergency medicine rotation at Primary Children's Hospital

  • St. Mark's Hospital Emergency Department sees approximately 40,000 visits annually and is part of a Level II Trauma Center

  • ACLS certification during R1

  • Optional ATLS training funded through CME benefits

Pediatrics:
Residents train on a Family Medicine inpatient team at Primary Children's Hospital during the busy winter months.

Residents also care for newborns in the nursery while on the Obstetrics/Gynecology service.

  • R1: One month of outpatient pediatrics with a community general pediatrician or pediatric specialist, plus one month of inpatient pediatrics at Primary Children's Hospital

  • R2/R3: One month of pediatric emergency medicine at Primary Children's Hospital and one month of outpatient pediatrics or NICU at St. Mark's Hospital under staff neonatologist supervision

  • PALS and NRP certifications are provided during R1


ICU:
One month in the second year with one-on-one training with the intensivist physicians at St. Mark's Hospital
Opportunity to learn many aspects of critical care, including intubation, ventilator and pressor settings, arterial and central line placement, and pulmonology procedures

Community Medicine/Population Health:
Residents explore community resources, such as the county health department, poison control, community health clinics (i.e., Maliheh Free Clinic), an HIV clinic, AA meetings, and an occupational medicine facility. Residents may also work on their research and QI projects during this month

Geriatrics:     
Residents follow 5-6 long term nursing facility patients during R2 and R3 years. Home visits and hospice visits completed during this rotation

Preceptorship:
This very important rotation gives the resident a chance to experience potential future practice opportunities. Options available include rural, suburban, and academic practices. 

Practice Management: 
Residents spend a month honing their business in medicine skills. Residents need to learn the business side of medicine, and this is the rotation to do it. Residents also attend a hospital committee through residency to further their understanding of hospital management. Coding and billing is taught throughout residency, including didactics from our in-house coding staff.

Radiology:
The radiologists at St. Mark's Hospital teach our residents about plain films, CT, MRI, mammography, ultrasound, and nuclear medicine. Residents read the X-rays in the FPC on their own patients, and then the films are over-read by a radiologist for teaching and quality control. 

Lifestyle Medicine:
St. Mark's Family Medicine is committed to training future physicians in the principles of Lifestyle Medicine, equipping residents with the skills to promote health and wellness through evidence-based lifestyle interventions. With a focus on nutrition, physical activity, stress management, and other key areas, our residents gain comprehensive training to address the root causes of chronic disease and improve patient outcomes. 

Elective Rotations:
Some of the options available include but are not limited to: pulmonology, ophthalmology, GI, ENT, plastic surgery, a procedures clinic, podiatry, endocrinology, rheumatology, allergy, sports medicine, urgent care, and numerous pediatric subspecialties, or even a rotation abroad. 

ANNUAL RETREAT

Part of our curriculum is having fun. Each year, our program hosts a retreat at an off-site location. In recent years, we've held retreats in Park City and at Solitude Resort.

Procedures:

We gain experience with a wide variety of procedures, both in the clinic and during our rotations.