Training Program Structure

Training

To provide a comprehensive experience, we strive for balance: balance between training in the hospital and the office; balance between the treatment of acute and chronic medical problems and the application of preventive and health promotion strategies; balance between the traditional biomedical approach and the important psychosocial, spiritual and family aspects of patient care.

We also believe in a balance between patient care, education, and our own personal and family needs. We offer a positive working environment focused on education.

Inpatient Training

The care of hospital patients is taught from two perspectives. First, residents rotate through all the traditional clinical services and have the opportunity to learn directly from specialists in those fields. Fairview Hospital and the Cleveland Clinic have busy clinical services, designed and dedicated for education. Second, residents care for their own patients on the family medicine service at Fairview, under the guidance of our faculty. Residents learn the core principles of family medicine, including continuity, coordination, comprehensiveness and cost-effectiveness of care.

Outpatient Experience

The heart of Family Medicine is ambulatory care. Our model office, the Center for Family Medicine, provides an excellent environment for learning. We see more than 18,000 visits a year. From the beginning of the first year, each resident is an integral member of our healthcare team. The resident provides continuous care for a defined panel of families over the three years of training. Support is given by our behavioral scientist, patient education nurse, family medicine nurse practitioners and other specialty consultants. Our diverse practice population provides experience with patients of all ages and socioeconomic backgrounds.

Residents learn from and with their patients, precepted by an enthusiastic group of full-time faculty, community family physicians and sports medicine fellows. Our office is well-equipped and staffed with sincere, friendly people, who are there to help you. Our program uses the Cleveland Clinic's electronic medical records system, called EPIC. We have access to MyChart, which is a patient portal that allows us to communicate with patients by email. We have an active and constructive quality improvement process. We have an organized, comprehensive patient education program led by our patient education nurse. Residents gain extensive experience in managed care and practice management.

Curriculum

13 Four-Week Block Rotations

*The Population Health curriculum is longitudinal throughout several rotations. There is a significant amount of time on Population Health during your Medicine rotation (2 weeks on Medicine/2 weeks on Pop Health). In addition, one of the two-week Medicine rotations will be on nights.

Clinic Sessions

Wednesday Morning Conferences

• Balint
• Behavioral Science
• Case Conferences
• Computer Skills
• Core Content
• Dermatology (Clinic)
• EKG
• Evidence-Based Medicine
• Geriatrics
• Gynecology
• Office Procedure Skills
• OMT
• Orthopedics
• Patient Education
• Pediatrics
• Perinatology
• Pharmacology
• Practice Management
• Radiology
• Research
• Sports Medicine

Curriculum Highlights

Essentials of Family Medicine Rotation

The depth and breadth of family medicine involves treating the whole person. In the fall of the intern year, there is a dedicated rotation focused on the Essentials of Family Medicine. This rotation is strategically offered a few months into residents' first year to allow focused (and fun) learning, skill building, and team development to enhance patient care and the self of the physician. Some experiential learning, including a tour of Lakewood to provide a better understanding of the community we serve, a procedure workshop (a resident favorite), ACLS/PALS training, Koru Mindfulness classes, a Myers-Briggs personality inventory with interpretation to better understand ourselves and our team, and training in Motivational Interviewing. The didactic component of the Essentials rotation includes classes on well-child visits, office billing and coding, improving office efficiency, video review and coaching, implicit bias modules, and an interprofessional lecture series. Additionally, residents continue to have clinics for patient care.

Health Promotion

Second year residents participate in this rotation to study all areas of health promotion including lifestyle behavior change, evidence-based screening, key health risks, and motivational interviewing. All faculty are involved in teaching this rotation which promotes faculty development and team-building.

Sports Medicine

The Family Medicine Residency Program, in collaboration with the Cleveland Clinic Sports Health Department, offers a well-rounded, exceptional education in the field of sports medicine. Residents rotate and work with the team physicians for the Cavaliers and Guardians. They can participate in the medical coverage of multiple sporting events during the year at Cleveland State University, Notre Dame College, John Carroll University, and Baldwin Wallace University as well as at local area high schools. Longitudinal experiences and fellowship didactic lectures are offered for residents interested in pursuing sports medicine. The Primary Care Sports Medicine Fellows also precept at our Family Medicine Clinics, providing the Family Medicine Residency Program with an outstanding educational experience and exposure to the field of sports medicine.

• Learn more about our Sports Medicine Fellowship

Care Enhancement Rotation

Care Enhancement (CE) is an exciting newer educational experience that we piloted successfully in the 2011-2012 academic year and are continuing to shape going forward. The CE resident communicates closely with the Inpatient Team and Center for Family Medicine (CFM) physicians and staff to identify opportunities to prevent hospital admissions and readmissions, enhance quality of life, improve patient and caregiver satisfaction, and prevent adverse outcomes. Contact with patients and families can occur in the home, at the CFM, in the hospital, or in the nursing home or other extended care facility. This rotation occurs following the block the resident was on the Family Medicine inpatient service so the resident is familiar with the patients and families.

Research

Our program promotes evidence-based medicine and provides training in the area of medical informatics. We also encourage scholarly inquiry and provide research support for interested residents. Our program has an experienced fellowship trained research director, Carl C. Tyler, MD, who leads a monthly evidence-based practice seminar. Residents design, conduct and report a short-cycle quality improvement research project as a class during their second year of training. Examples of past topics are: adolescent pregnancy, osteoporosis, acupuncture, asthma, pain management, Raynaud's phenomenon, tension headaches and strep testing. Modest funds are available to residents to foster resident research and scholarly activity without additional burden and time required to obtain external funding.

Integrative Medicine in Residency Track

Our program is the first residency in Ohio to offer the Integrative Medicine in Residency Track sponsored by the University of Arizona Center at Tucson Center for Integrative Medicine. The IMR track is a 180-hour online curriculum that is optional for second and third year residents. Participants devote one or more elective blocks to access the online IMR content, as well as setting up local experiences in Integrative and/or Functional Medicine. Some of their academic funds are used to defray a portion of the tuition expense. Residents who participate are mentored by Ann Rutt, CNP, who has herself completed the two-year faculty fellowship in Integrative Medicine through the Arizona Center.

Osteopathic Recognition

Our residency program has received osteopathic recognition that was granted by the ACGME in 2015 and was dually accredited by AOA and ACGME prior to 2015. We have an osteopathic focused learning environment that spans the length of our educational program. Our program has been nationally recognized for our innovative osteopathic curriculum for both allopathic and osteopathic residents. We teach the osteopathic principles of practice through focused and longitudinal educational experiences. Our 2nd year osteopathic residents lead monthly lectures to teach their peers the foundations of osteopathy. We have multiple osteopathic faculty who routinely practice OMT that teach practical application of OMT to all residents. All interns (DO and MD) attend a two-day OMM Course for All in Columbus early in their PGY-1 year.

Co-Counseling

We provide specialized learning experiences through co-counseling. Residents can provide short-term counseling to their patients by partnering with our Director of Behavioral Science & Wellness Director, Terri Dalton. This provides learning opportunities for caring for patients while learning counseling skills including Cognitive Behavioral Therapy skills, motivational interviewing, and behavioral and supportive therapy strategies to help patients with mood disorders, grief, coping with a health diagnosis, family stress, and addictions. Most visits are integrated visits that include medication management and address comorbid or chronic health conditions.

Ultrasound Curriculum

Dr. John Hanicak directs our primary care ultrasound curriculum. Residents will have didactic lectures and protected time to learn ultrasound and have ultrasound training integrated into their rotations (examples: FAST US on Emergency rotation, fetal presentation, and fluid assessment on OB rotation, etc.). Dedicated faculty from the Emergency Services Institute also act as embedded mentors in point-of-care ultrasound.

Dermoscopy

As part of our family medicine, residents' training includes dermoscopy training; this involves using a dermatoscope to further evaluate skin lesions to increase sensitivity in the detection of skin cancer while also minimizing the need for unnecessary biopsies. Family medicine is uniquely positioned to train in dermoscopy principles, given the frequency and breadth of dermatologic presentations encountered in patient care. Our dermoscopy curriculum involves a lecture component and a dermoscopy/ultrasound club that meets monthly. Residents may also use their CME money to purchase a dermatoscope for their practice.

Subspecialty Clinics

Our program has four subspecialty clinics embedded into the Center for Family Medicine (CFM). Residents refer patients from their patient panels and work alongside teaching physicians.

• Child/Adolescent Psychiatry and Adult Psychiatry: We have two psychiatrists integral to our resident’s psychiatric training. They each have a weekly clinic in our office where residents can perform complete psychiatric evaluations with our patients. These clinics allow patients and families to stay within the Center for Family Medicine for their psychiatric care and teaches residents how to best manage common psychiatric conditions, including depression, anxiety, ADHD, and PTSD. After this assessment, patients are usually returned to their Resident PCP for ongoing management.
• Dermatology Clinic: We have a skilled dermatologist who provides teaching and staffs our Dermatology clinic. This clinic is provided monthly as a part of our didactic sessions, where we refer patients with complex dermatological symptoms.
• Integrative Medicine (IM) Clinic: Residents, including those who are in the Integrative Medicine track, can work with an Integrative Medicine Fellowship trained NP and physician in providing IM treatments to our patients.
• Gynecology Clinic: Our monthly GYN clinic provides the opportunity to provide evaluation and women’s health procedures to our patients. Procedures include colposcopy, D & C, and hysteroscopy. We work with a gynecologist who provides women’s health expertise. Additional opportunities for women’s health procedures are available with Drs. Eberlein and Sanyal who both have additional training in gynecology and obstetrics.
• Other Novel Opportunities: This curriculum includes Lean Six Sigma Training, Advocacy Training, and appointments as OU-HCOM Assistant Clinical Faculty as senior residents.

Electives

Cleveland Clinic's Family Medicine Residency Program offers a variety of electives for residents to take advantage of.

Any Medicine Subspecialty Elective

• Allergy
• Endocrinology
• ENT
• Dermatology
• Gastroenterology
• Infectious Diseases
• Nephrology
• Neurology
• Pulmonary
• Rheumatology

Special Electives by Past Residents: An experience created by the resident, tailored to their specific interests.

• Addiction Medicine
• Adolescent Medicine
• Adolescent Psychiatry
• Advocacy/Health Policy
• Allergy
• Anesthesia
• Alternative Medicine
• Clinical Informatics
• Dermatology
• Direct Primary Care
• ENT
• ER/Pediatric ER
• Functional Medicine
• Geriatrics
• Geriatric Psychiatry
• Global Health
• GYN
• Hospital Administration
• Integrative Medicine 
• LGBTQ
• Medical Spanish
• Musculoradiology
• NICU
• Ophthalmology
• Pain Management
• Palliative Medicine
• Pediatrics (Ambulatory)
• Pediatric Cardiology
• Pediatric Dermatology
• Pediatric ER
• Pediatric Pulmonary
• Pharmacy
• Plastic Surgery
• Podiatry
• Population Health Management/SMAs
• Procedures
• Radiology
• Research
• Sleep Medicine
• Sports Medicine
• Stress Tests
• Urgent Care
• Urology

International Health Away Electives by Past Residents

Cleveland Clinic residents and fellows may participate in elective experiences outside of the United States provided appropriate approvals are obtained and the international rotation is felt to provide an experience which cannot be provided at Cleveland Clinic.

Previous approved rotations include trips to:

• Abu Dabi
• Brazil
• Malawi
• Peru
• Rwanda
• Tanzania

Integrative Medicine Track: Sponsored by the University of Arizona Center for Integrative Medicine, this is a 200-hour online course.

Population Health

Family Physicians can no longer care for their patients only in the walls of the office or hospital. They must be prepared to focus on quality goals and identifying the social determinants of health that impact the populations they serve. To this end, we have created a robust Population Health Curriculum that provides longitudinal educational and clinical experiences for residents across their residency training. We provide dedicated time for reviewing your patient panel’s electronic medical record and for directly contacting your patients to discuss their health care. In addition, many educational opportunities prepare our residents for practice in a value-based care environment.

During the population health rotation and on ½ day sessions in select rotations, residents will have protected time to engage in various population health activities.

PGY-1 

Focus: Introduce the resident to their patient panel and specific quality metrics and population health initiatives. Learn how to use our EMR for data management of their patient panel and attend community-based learning experiences.

PGY-2

Focus: Population panel review, patient engagement to close gaps in care and to help meet quality metrics in chronic disease management. Continuation of immersive community-based learning experiences.

PGY-3

Focus: Population panel review, patient engagement and community-based learning experiences.

As trainees progress from PGY-1 to PGY-3, our longitudinal curriculum prepares them to evolve their mindset towards caring for both the individual patients in their office and the community as a whole.

Population Health Learning Experiences

• Collaborative Care School Based Mental Health Clinic: In collaboration with Child and Adolescent Psychiatry, Family Medicine residents work with FM Faculty to provide initial assessments and follow-up care for children of Lakewood City Schools with a variety of mental health conditions. Real time consultation with a Child/Adolescent Psychiatrist is available for complex cases. The goal is to have residents gain familiarity and comfort with indications and use of psychotropic medications in children and adolescents. This prevents patients staying on a waiting list while trying to access care and improves function, enhances school performance and attendance.
• Controlled Substance Committee: Our clinic has a Controlled Substance Committee that monitors all patients on controlled substances. This committee comprised of physicians, behavioral health, and nursing staff, is a resource for residents and faculty who have patients exhibiting concerning behaviors or who are clinically complex. Patients who are on Medication Assisted Treatment for Opioid Use Disorder are also discussed.
• Doctors on the Street (DOTS): Residents will work with students from Ohio University College of Osteopathic Medicine to staff Doctors on the Street. This clinic provides free health care to the homeless population of Cleveland.
• Gathering Place: Residents visit this community organization to learn more about services available to cancer patients, caregivers, and their families as they navigate diagnosis, treatment, and survivorship.
• High Risk Transitions in Care (HRTIC)/Urgent Dispatch Program: Residents get to ride along with these innovative teams to care for patients in their homes. Patients who are at high risk for re-admission or are high utilizers of emergency services can be referred to Urgent Dispatch so a team of professionals can see them at their home and prevent a potential hospitalization. Residents along with APPs in the program provide assessment to see if they can be treated at that point or should be referred to the ER. Patients in the HRTIC program are visited at home to help their transition back to the community after a hospitalization. Staff are also able to assess the home environment to see if it is contributing to the patient’s morbidity and health status.
• IDD Education and Advocacy: Residents will have the opportunity to learn about best practices in healthcare for patients with intellectual and developmental disabilities (IDD) through immersive learning experiences with the Developmental Disabilities Practice-Based Research Network (DD-PBRN), GiGi’s Playhouse, Special Olympics, United Cerebral Palsy of Greater Cleveland, and other community organizations. Dr. Tyler, who specializes in care for patients with developmental disabilities, provides instruction in IDD care topics along with clinical guidance regarding patients with IDD under each resident's care.
• Lakewood School Clinic: We partner with the Lakewood City School District to staff the in-school medical clinic. This clinic allows students to receive medical care without missing too much school for appointments. These visits consist of sports physicals & injuries, well child checks, contraception and mental health evaluations.
• LGBTQ+ Health: Lakewood has a vibrant LGBTQ+ community, and the Lakewood Family Health Center is home to the Cleveland Clinic’s Center for LBGTQ+ Care. Residents will learn how to care for this population in a sensitive manner and also about specific health issues such as PrEP and gender identity.
• Nursing Home: We are fortunate to do our nursing home training at O’Neill Bradley Bay, where faculty physician, Dr. Carl Tyler, is the Medical Director. Residents provide care to our nursing home patients on Tuesday mornings with Dr. Tyler. These are patients of our practice, and residents have the opportunity to provide longitudinal care to their patients.
• Refugee Health: Cleveland is home to a growing refugee population, with large groups from Southeast Asia and the Middle East. This vulnerable population often have complex health needs including their mental health. Residents get to work with Family Physicians at a FQHC to learn about these patients and how to help them navigate their health in a new environment.
• Shared Medical Appointments (SMA): Our residents lead SMAs for patients with chronic conditions, allowing them to provide targeted disease management to larger groups of patients at one time. Residents have the opportunity to choose the focus of the SMA, as well as help run these sessions. Past SMAs have been held regarding hypertension, diabetes and Obesity.
• Supporting Practices in Achieving Reliability in Quality (SPARQ): SPARQ teams review recent hospital discharges to help prevent re-admission and also review patients with chronic conditions or missed screenings to help close healthcare gaps. They bring together Medicine, Nursing and Social Work to collaborate in interdisciplinary team.
• Malachi House: Residents visit the Malachi House to learn about the services offered to homeless individuals who may be dying under bridges, in cars, deserted buildings and other unsuitable places within the city. 
• Bright Beginnings: Residents join in on a meeting with staff from Bright Beginnings which provides services that promote the health and development of young children, so they start school healthy and ready to learn.
• Health Barriers Assessment Project: Residents gather, analyze and assess data collected to identify responses they might make if they entered practice in the studied community.

Unique Learning Experiences

• Ultrasound Curriculum: Dr. John Hanicak directs our primary care ultrasound curriculum. Residents will have didactic lectures and protected time to learn ultrasound and have ultrasound training integrated into their rotations (examples: FAST US on Emergency rotation, fetal presentation and fluid assessment on OB rotation, etc.). Dedicated faculty from the Emergency Services Institute also act as embedded mentors in point-of-care ultrasound.
• Co-counseling: Residents have the unique opportunity offer patients with health behavior or psychiatric concerns co-counseling sessions. In a joint visit with our Director of Behavioral Science, Terri Dalton, a patient’s primary care physician can provide short-term psychotherapy and behavioral strategies to help patients tackle challenges regarding their mental and physical health and recognize maladaptive behavioral patterns. Residents have used this service for mood disorders, family stress, smoking cessation and substance abuse among others.
• Subspecialty Clinics: Our program has three subspecialty clinics embedded into the Center for Family Medicine. Residents refer patients from their patient panels and work alongside teaching physicians.
• Child/Adolescent Psychiatry and Adult Psychiatry: We have two psychiatrists integral to our resident’s psychiatric training. They each have a weekly clinic in our office where residents can perform complete psychiatric evaluations with our patients. These clinics allow patients and families to stay within the Center for Family Medicine for their Psychiatric care and teaches residents how to best manage common psychiatric conditions, including depression, anxiety, ADHD, and PTSD. After this assessment, patients are usually returned to their Resident PCP for ongoing management.
• Gynecology Clinic:  Our monthly GYN clinic provides the opportunity to provide evaluation and women’s health procedures to our patients. Procedures include colposcopy, D & C, and hysteroscopy. We work with a gynecologist who provides women’s health expertise. Additional opportunities for women’s health procedures are available with Drs. Eberlein and Sanyal who both have additional training in gynecology and obstetrics.
• Dermatology Clinic:  We have a skilled dermatologist who provides teaching and staffs our Dermatology clinic. This clinic is provided monthly as a part of our didactic sessions, where we refer patients with complex dermatological symptoms.
• Other Novel Opportunities: This curriculum includes Lean Six Sigma Training, Advocacy Training, and appointments as OU-HCOM Assistant Clinical Faculty as senior residents.