The behavioral health curriculum, led by our psychologist Dr. Bill Gunn, is integrated into all three years. In the first year, residents participate in Balint group and are introduced to family systems during two weeks of systems-based training. The most formal behavioral training occurs in the second year. Residents meet with Dr. Gunn twice a month for didactic sessions. Continuing into the third year, residents work with Dr. Gunn reviewing video of patient encounters, in addition to working with a psychiatrist one-half day a week during the Family Health Center rotation.

The Community Oriented Primary Care (COPC) rotation provides community experiences to promote the development of basic skills related to a COPC approach to practice. Community Education Initiative Coordinator Tina Kenyon, ACSW, works with residents and their advisors to identify projects that will provide enriching experiences. Projects begin in the second year and continue through the third year, culminating in a presentation at our annual project fair.

Dermatology, ophthalmology, otolaryngology, and urology are combined into a five-week rotation in the third year. Residents work with a variety of specialists in these fields, gaining the skills and exposure to appropriately diagnose, manage or refer for common issues that typically present to family physicians. There is a weekly, high-volume dermatology clinic at the VA, which is staffed by a resident and faculty.

The geriatrics rotation is a six or seven-week rotation completed in the third year. During the rotation, residents work with geriatrician Dr. BJ Entwisle for broad and intense exposure to elderly patients in a variety of settings. The rotation is designed to expand and deepen the knowledge previously acquired through visits to nursing homes and patient homes. Residents obtain the necessary skills to manage all aspects of providing care to the elderly. They work with geropsychiatrists, nutritionists, hospice staff, and mid-level physical, occupational and speech therapists.

The emergency medicine/community medicine rotation is a six-week rotation completed in the first year. During the rotation, experience in evaluating and treating a variety of urgent and emergent situations in an emergency department setting is obtained. Residents work with several board-certified emergency medicine physicians. There is didactic teaching to promote acquisition of skills required to diagnose, stabilize, and provide initial or definitive treatment for urgent or emergent problems. Community medicine is well integrated into residents’ training. Residents obtain hands on experience with various hospital and community based ancillary services that will increase practical health care knowledge and skills.

The intensive care unit (ICU) rotation is a six-week rotation in the first year. Because NHDFPR is an unopposed residency, residents work directly with pulmonologists. The rotation is structured to allow for maximum exposure to teaching and allows for continuity of care and management of patients. Residents work in the ICU for four continuous weeks; have a week of vacation and a week of continuity clinic.

The inpatient internal medicine rotations occur in each year of residency. The medicine team typically consists of two first-year residents, two senior residents, and one family practice attending. Residents admit and provide medical management for adult patients with a wide variation of medical problems. During rotations on this service, residents will acquire necessary skills in many areas, including how to manage the complicated patient, learn alternatives to inpatient care, and become competent in procedures such as venupuncture, paracentesis, and lumbar puncture.

The surgical curriculum is designed to provide first year family practice residents with the clinical experience and supervision necessary to provide primary care management of outpatient surgical conditions; evaluate and diagnose conditions requiring surgical specialty referral; and develop patient-physician relationships that bridge the surgical intervention. Residents participate in a weekly case review, manage surgical patients and act as first assistants on common surgical problems, including appendicitis, cholecystitis, injuries to the head and neck, and blunt injuries to the chest and abdomen.

Our program combines nursery, pediatrics and obstetrics using family physicians as attendings and role models. Additionally, we have two pediatricians and two obstetricians/gynecologists who are integral to this rotation and provide coverage for the service. There are daily didactics on this rotation, typically one lecture by a family physician and another by either a pediatrician or obstetrician. First year residents work directly with Dr. Conway in OB clinic and senior residents attend high risk OB case review on a weekly basis. In addition to the MCH service, residents provide prenatal care in their continuity clinic.

Another component of inpatient medicine is night float. First year residents complete two three-week blocks of night float. During the rotation, the night float resident runs the medicine service from 6 pm to 8am, four nights a week and the senior resident supervises all admissions. While the family medicine attending is not in-house, they are available by telephone and will come in when needed.

The occupational health rotation is a two-week rotation completed in the third year. Residents learn to diagnose and manage common occupational or environmental illnesses/injuries by working with directly with occupational therapists in the Concord, NH area.

This is a mandatory two-week event that combines practical information and training with social events. Activities range from baseline skills testing and how to read a call schedule to a welcome lunch and the annual skit presentation by residents and faculty.

The orthopaedic rotation is a four-week rotation in the second and third years. Residents work with orthopaedists in inpatient and outpatient settings. They learn physical exam techniques specific to orthopaedics, how to diagnose and manage common musculoskeletal problems, gain proficiency in splinting and casting, and serve as first assistants on same day surgeries. Residents are also required to spend a Saturday or Sunday at Loon Ski Mountain evaluating acute injuries with on-site orthopaedic attendings.

In the third year, residents participate in a two-week surgery rotation. Residents observe and participate in the care of surgical patients in the office of the surgeons. The residents will understand the information needed by the surgeon during the office consult. They will also gain understanding of the pre-operative counseling and instructions prior to surgery. There is also the opportunity to work in the Concord Hospital Wound Healing Center and learn about different options to prevent and reduce complications of non-healing wounds.

This outpatient rotation occurs in both the second and third years. Residents in both years participate in a weekly teen clinic run by our pediatric faculty. Residents also see their own continuity patients within the context of a well child clinic. The WCC features an integrated, team approach, including family physicians, pediatricians, nutritionists, dental hygienists and developmental specialists. Another feature is resident participation in school clinics and attending summer camps.

In the second year, residents work independently at a local pediatric office, supervised and precepted by a pediatrician. As a third year, residents work with pediatric sub-specialists. Specialty sessions include pediatric cardiology, allergy, ophthalmology, and gastroenterology.

This is a unique four-week rotation, which is split into two 2 week segments in the first year. The curriculum focuses on self-development and learning about the various healthcare, family and information systems.

This rotation is designed to teach a comprehensive approach to women’s issues. Residents learn to diagnose, manage, educate, and consult, when appropriate, in the care of common female health problems. Residents also gain an understanding of the female life cycle, emphasizing preventative, behavioral and procedural skills. Clinical opportunities include, working with Dr. Mary Danca in her GYN clinic, weekly GYN clinics at the VA, experience in the OR and attendance at the Feminist Health Center and the Breast Care Center.