1. Kaiser Permanente Napa-Solano Family Medicine Residency Sherry Fung-Sakita, MD Patrick Lowerre, MD

2. Think back on your family medicine rotation…. Where did you go to medical school? Where was your family medicine rotation? Who was your preceptor? What did you learn? How did the rotation affect your career path? If you could go back…… What would you change about your FM rotation? How would you improve the rotation?

3. Agenda for the next 20 minutes Overview of our clerkship 5 core principles: Orientation & EHR Patient Education Evidence Based Medicine Community Health Mentorship Your own innovations

4. CLERKSHIP OVERVIEW - “ Kaiser really impressed me--the way the docs work with their support staff is like I have seen nowhere else.” “Kaiser is doing so many things right, and is rightfully praised as innovative.” “Really enjoyed getting to spend time in a variety of settings during my rotation and get to see so many different parts of the hospital.” “Confirmed the family medicine is the right path for me!” “Loved my experience and became very interested in the residency itself.”

7. Full Spectrum Family Medicine Adult Medicine Women’s Health Labor & Delivery HBS Department Overview Procedures Pediatrics Prenatal Newborn Nursery ER

8. Our Students 3 rd Year family medicine clerkships Subinternships

9. Student Schedules Overview 4-8 week rotations 2-3 main preceptors who work across departments MSIIIs: M-F, 8:30-5:30, full scope outpatient MSIVs: Varies; some weekends and nights; inpatient and oupatient

10. Student Schedule - Orientation

11. Student Schedule - Clinic

12. Student Schedule - Didactics

13. Student Schedule - Projects

14. ORIENTATION AND EHR TRAINING Core Principle I: - “ Kaiser really impressed me--the way the docs work with their support staff is like I have seen nowhere else.” “Kaiser is doing so many things right, and is rightfully praised as innovative.” “Really enjoyed getting to spend time in a variety of settings during my rotation and get to see so many different parts of the hospital.” “Confirmed the family medicine is the right path for me!” “Loved my experience and became very interested in the residency itself.”

15. Student Schedule - Orientation

16. Schedule and Clinic overview Feedback Expectations Student Schedule – Orientation Walk around

17. Web Based Flexible schedule 30-40 minutes Student Schedule – EHR Training

18. Lesson 1: Getting started Lesson 2: Schedule Lesson 3: Chart Review Lesson 4: Pend Orders, Write Note, Forward Encounter Lesson 5: In Basket Lesson 6: Patient Lists Summary

19. Student Schedule – EHR Training

23. PATIENT EDUCATION TRAINING Core Principle II: Learned a lot how to deal with "non-medical" issues like a patient wanting for access to him. It was great to watch him do motivational interviewing and offer anticipatory guidance

24. Student Schedule - Didactics

25. Residency Didactics – Thursday afternoons CME lectures Evening Lectures – Napa Specialty Lectures Student Schedule - Didactics Department lectures -med in the am, super Tuesday

26. Student Schedule – Patient Education Diabetes Basics: If you are newly diagnosed with diabetes, or if you need to learn to use your glucose meter, this class is for you. Learn the basics of managing type 2 diabetes, how to use your blood glucose meter and learn your blood sugar targets. Please bring your meter to class. Two hours. No Fee* Congestive Heart Failure Education Provided: ▪Causes and symptoms of heart failure ▪How to accurately take and record daily weight ▪Guidelines for healthy and low sodium eating ▪Importance of balancing activity with rest ▪Importance of regular exercise and guidelines to follow ▪Medication compliance and medication for heart failure ▪Side effects of medication to watch out for ▪Importance of Advanced Directives ▪How to make an action plan for self-care Managing Your Weight Learn how making healthy lifestyle choices—like eating well, getting regular exercise, and maintaining a positive attitude—can help you lose weight and keep it off. Taking Control of Stress Learn more about what stress is, how it affects your body, and how you can use the mind-body connection to control it. You’ll find out about various self-care tools and other treatments for managing your symptoms. You’ll also get information about other stress-reduction classes and resources available through Kaiser Permanente.

27. Student Schedule – Patient Education In room precepting – observe preceptor; active patient education with immediate feedback

28. EVIDENCE BASED MEDICINE TRAINING Core Principle III: I now know the importance of looking into programs that define a high caliber of patient care that is comprehensive, evidence-based, and driven by self-analytical data. I was encouraged to think critically about patients and their problems I was able to see evidence base medicine being used to answer clinical questions.

29. Evidence Based Medicine Daily Practice Forming clinical questions Quick search (Dynamed, UpToDate) Evidence based medicine project EBM project mentor Develop a clinical question Literature search Meta-analyses, Cochrane Reviews Answer question with supporting evidence 10-15 minute presentation Feedback

30. Student Schedule - Projects

31. EBM Project Examples Are antibiotics indicated in treatment of bacterial conjunctivitis? Is screening for OSA warranted duiring well child checks? Among those with migraines, is osteopathic manipulative treatment (OMT) more efficacious than pharmacologic treatment? Do the benefits of long term use of PPIs outweigh the risks in refractory GERD leading to non- dysplastic Barrett’s Esophagus? Do e-cigarettes help people to quit smoking tobacco? Which fractures indicate potential child abuse on radiographic imaging? Are steroid effective in treating lateral epicondylitis Pedometer use in Pre Diabetics: Physical Activity and Outcomes Is fall risk a contraindication to anticoagulant use in elderly populations? Does intense glycemic control decrease cardiovascular risk?

32. COMMUNITY MEDICINE Core Principle IV: The rotation further solidified my decision to go into Family Medicine and demonstrated to me that community medicine should be an important factor in ranking a residency program (at least for me). Gave me a better idea of how family medicine can function within a community and not just as an isolated health care service. The community health rotation specifically taught me to consider our broader role as family physicians in community management and population health, as well as strategies to assess and counteract influences on our patients’ health beyond the clinic walls. I was already committed to family medicine before my rotation began, but my experience at KP helped me narrow down my residency preference to unopposed community-based programs.

33. Embedding Community Medicine within the Clerkship Challenge: Create a longitudinal project Utilize community partnerships Maximize students’ efforts Allow for independent interests Contributes to a common goal

34. Vallejo, CA Former California State Capitol – 1852 and 1853 Bankrupt in 2008 Largest Employers – Kaiser Permanente – Six Flags – Vallejo School District – Sutter Health Population ~120,000 32.8% White 22.6% Latino 22.1% African American 21.1% Filipino 1.1% Pacific Islander

35. Jesse M. Bethel High School Local high school – 1,758 students Kaiser Permanente school based clinic Jesse M. Bethel High School Accountability Report Card 2014-15

36. Jesse M. Bethel High School Accountability Report Card 2014-15.

37. Science is a weakness Jesse Bethel High School Accountability Report Card 2014-15.

38. High Dropout, Low Graduation Rates Jesse M. Bethel High School Accountability Report Card 2014-15.

39. Not meeting UC or CSU admission requirements

40. BioMed Academy at Jesse Bethel One of many academies created to reduce drop-out rate Green, Law, International Finance, Multimedia, Visual and Performing Arts 200-300 students grades 9-12 Students take 1-2 courses/year focused on biomedical topics 10 th grade: Biomedical Science 11 th grade: Human Body Systems 12 th grade: Medical Interventions, Biomedical Innovations

41. Creating a Pipeline Program Grumbach et al, Univ of California, 2003

42. Kaiser Medical Scholars Program Link local hospital, family medicine residency program, medical schools and high school students Goals of Program: Math and science enrichment College preparation (e.g., SATs) Volunteer opportunities Research opportunities Healthcare career awareness

43. Kaiser Medical Scholars Program Inception 2015-2016 14 students applied and accepted motivated individuals with strong interest in health care Multidimensional 2-year program Sophomore and junior years Most important years of high school Curriculum designed and taught by 3 rd year medical students UCSF and Touro Univerisity allows for mentorship, building social capital

44. Freshman Sophomore Junior Sept Oct NovDecJanFeb MarApr MayJuneJuly Aug Application released Application deadline Introduction, college requirements, career opportunities, medical school process, networking (10 sessions) Diabetes training program (8 sessions) Diabetes training program (8 sessions) Study Skills, test taking skills, time management, (6 sessions) Summer youth Employment program Community/school Project, health disparities, suturing/hands-on workshop (6 sessions) Community/school Project, health disparities, suturing/hands-on workshop (6 sessions) SAT Prep (6 sessions) Financial Aid, choosing the right college, Personal statement, (6 sessions) Poster Presentation at Kaiser Permanente Structured Volunteering at Kaiser Permanente Medical School / College trips Structured Volunteer at Kaiser Permanente Career Exposure at Kaiser Permanente Peer Tutoring / individualized academic plan geared at UC acceptance Interviews Program Timeline

45. Medical Scholars Curriculum Career Day Personal Statement workshop Suturing Workshop Health Coach Training Mental Health First Aid Disaster Preparedness UC/CSU Course Requirements SAT preparation Networking Research opportunities Shadowing Resume building

46. MENTORSHIP Core Principle V: Efficient, really team based, very organized. Great person to learn time-mgmt skills from. Loved all my time spent with [my attending]. From physical exam moves, to ways of dealing with difficult patients, he is a great preceptor. An incredible doc. He is so loving of all of his patients.. I was unbelievably impressed by the high quality of faculty who truly cared about teaching.

47. Multiple Preceptors Across specialties FM roles across departments Mentors across levels of training Mentorship

48. Student Schedule - Clinic

49. Teaching Clinic Schedule Regular Clinic Schedule Changes Student Schedule – Clinic

50. INNOVATING YOUR CLERKSHIPS - “ Kaiser really impressed me--the way the docs work with their support staff is like I have seen nowhere else.” “Kaiser is doing so many things right, and is rightfully praised as innovative.” “Really enjoyed getting to spend time in a variety of settings during my rotation and get to see so many different parts of the hospital.” “Confirmed the family medicine is the right path for me!” “Loved my experience and became very interested in the residency itself.”

51. Redefining Family Medicine Clerkship Are your students prepared to work and learn in your clinic? Are you practicing EBM? Mentorship Community Medicine Things to think about Evaluation process Incorporate Feedback Allow yourself time to teach

52. Questions? Comments? - “ Kaiser really impressed me--the way the docs work with their support staff is like I have seen nowhere else.” “Kaiser is doing so many things right, and is rightfully praised as innovative.” “Really enjoyed getting to spend time in a variety of settings during my rotation and get to see so many different parts of the hospital.” “Confirmed the family medicine is the right path for me!” “Loved my experience and became very interested in the residency itself.”