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
Four 13-Week Block Rotations
| PG-Y 1 Year | |||
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| Akron Children’s ER | 1 block |
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| Emergency Medicine (Fairview) | 1 block |
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| Essentials of Family Medicine | 1 block |
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| Family Medicine Service (Fairview) | 1 block |
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| Family Medicine/Medicine (MetroHealth) | 1 block |
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| Medicine Service (Fairview)/Population Health* | 3 blocks | ||
| Obstetrics (Fairview) | 2 blocks | ||
| Pediatrics (MetroHealth) | 1 block |
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| Surgery Inpatient (Fairview) | 1 block |
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| Surgery Outpatient | 1 block |
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| PG-Y 2 Year | |||
|---|---|---|---|
| Ambulatory Pediatrics | 1 block | ||
| Behavioral Science | 1 block |
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| Cardiology | 1 block |
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| Coronary Care Unit | 1 block |
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| Dermatology | 1 block |
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| Elective | 1 block |
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| Family Medicine Service | 1 block |
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| Geriatrics | 1 block |
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| Gynecology | 1 block |
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| Health Promotion | 1 block |
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| Pediatric Inpatient (Fairview) | 1 block |
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| Management of Health Care Systems | 1 block |
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| Sports Medicine (CCF) | 1 block |
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| PG-Y 3 Year | |||
|---|---|---|---|
| Allergy/ENT | 1 block | ||
| Care Enhancement | 2 blocks | ||
| Community Medicine | 1 block | ||
| Elective | 4 blocks | ||
| Emergency Medicine | 1 block | ||
| Family Medicine Service | 2 blocks | ||
| EYE/GU | 1 block | ||
| Orthopedics | 1 block | ||
*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).
Clinic Sessions
| PGY-1 Year | 1 half day per week |
| PGY-2 Year | 3 half days per week |
| PGY-3 Year | 4 half days per week |
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
This rotation consists of lectures and activities that lay the foundations of family medicine as well as team building activities. The intern class completes this rotation all together during their 4th block of residency.
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 Indians. 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.
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 is currently in 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. Dr. Katie Jones DO, a graduate of our program who routinely practices OMT, also teaches practical application of OMT to all residents.
Co-Counseling
Residents have the opportunity to schedule counseling sessions with our behavioral science director, the patient and their resident physician. These sessions allow residents to connect with their patients and experience a valuable part of mental healthcare.
GYN Clinic
Once a month, an OBGYN physician comes to our clinic to teach resident outpatient gynecological procedures. This clinic includes colposcopy, endometrial biopsies and other more complicated gynecologic cases.
Dermatology Clinic
Residents are encouraged to refer difficult or interesting dermatology cases to our Dermatology Clinic. Dr. Anthony comes to didactic sessions and sees these patients with the residents. This allows for differential diagnosis discussions as well as treatment plans and easy access to Dermatology for our patients.
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
- Addiction Medicine
- Adolescent Medicine
- Adolescent Psychiatry
- Advocacy/Health Policy
- Anesthesia
- Alternative Medicine
- Clinical Informatics
- Dermatology
- Direct Primary Care
- ER/Pediatric ER
- Functional Medicine
- Geriatrics
- Geriatric Psychiatry
- GYN
- Hospital Administration
- Integrative Medicine
- International Health (Workshops or conferences)
- LGBTQ
- Maternity/Paternity Electives (Usually a research project)
- Medical Spanish
- Musculoradiology
- NICU
- 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
Special Elective: An experience created by the resident, tailored to their specific interests.
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 course is 200 hours online.
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. Our curriculum highlights community, racial equity and advocacy. The four vulnerable populations we serve are the Homeless, LGBTQ+ patients, Adult patients with Intellectual or Developmental Disabilities (IDD) and School-Aged Children and Adolescents.
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 is a resource for residents and faculty who have patients exhibiting concerning behaviors or who are clinically complex. Residents have the opportunity to be on this committee as well.
- Doctors on the Street (DOTS):Residents will work with residents from MetroHealth and 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.
- Frontline: Residents work with physicians, psychologists, community nurses and case workers to address the mental health, preventive and acute care needs of the homeless and the indigent suffering from mental illness, trauma and abuse. In this experience, our trainees are exposed to the complex and interlocking systemic issues that can perpetuate disparities in these at-risk populations.
- IDD Education and Advocacy:Residents will have the opportunity to learn about the care of patients with intellectual and developmental disabilities through experience with the DDPBRN (Developmental Disabilities Practice-Based Research Network), Gigi’s Playhouse and Upside of Down’s centers. They also will continue to learn from Dr. Tyler, who specializes in care for patients with developmental disabilities.
- 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.
- Shared Medical Appointments (SMA):Our residents lead yearly 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.
- Strengthening Teams in the Advanced Management of Populations (STAMP): STAMP 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 teams.
- Urgent Dispatch: Residents get to ride along with this innovative team. Patients who are at high risk for re-admission or are high utilizers of emergency services can be referred to this service 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 at the patient’s home to assess if they can be treated at that point or should be referred to the ER. Staff are also able to assess the home environment to see if it is contributing to the patient’s morbidity and health status.
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, Racial Equity Training, and appointments as OU-HCOM Assistant Clinical Faculty as senior residents.
