Family Medicine Residency Seneca - Curriculum

Residents will have dedicated time throughout the orientation process to obtain their office based opioid treatment (OBOT) waivers to be able to prescribe Suboxone and Subutex. Residents will work with faculty and local facilities including Anderson Oconee Behavioral Health Services to better understand and treat addiction as a chronic disease. We believe it is imperative that primary care physicians have the skillset to care for patients struggling with substance use disorders and provide care in the context of a primary care home. You will gain experience treating complications associated with substance use disorder such as hepatitis C and managing prenatal patients with substance use disorder as well alongside maternal fetal medicine.

Our Family Medicine Teaching Service (FMTS) at Oconee Memorial Hospital serves all admitted adult patients of the Center for Family Medicine-Oconee as well as patients in the community who don’t have a primary care provider.  We can then follow-up with these patients in our clinic and give them a medical home!  Residents will not be lacking exposure to pathology during their time in the hospital and will learn how to care for patients independently and in cooperation with available subspecialties both locally and through tele-consults.  Our Critical Care Unit is an open 12-bed unit and residents will follow their patients in and out of the unit as their level of care warrants.

Our daily rounding schedule is done with the entire inpatient team (adults, pediatrics and OB) which allows residents to get the family medicine perspective on inpatient care.  The FMTS resident presents complicated or interesting cases from the previous 24 hours and the team atmosphere allows for self-directed and team-based learning.  All faculty participate in some form of bedside teaching rounds to give residents a more hands-on opportunity to model physical exam skills or see interesting physical findings.  Bedside point-of-care ultrasound is available as well as the opportunity to learn inpatient procedures like lumbar punctures and paracentesis.

Residents will feel comfortable taking care of hospitalized patients and be ready to incorporate that care into their practices upon graduation.  Extra time for inpatient medicine electives is available either with the FMTS or with the local hospitalist group.

The longitudinal experience in behavioral health teaches residents to recognize, initiate treatment for, and utilize appropriate referrals for mental health disorders to optimize patient care. Our clinic has an embedded mental health professionals and we also offer substance use disorder treatment.

The bulk of our behavioral health curriculum is involvement in the integrated behavioral health model through residents’ continuity clinic and through a dedicated behavioral health experience where residents shadow our behavioral health curriculum director as she sees patients for therapy. 

Additionally, our residents benefit from  regularly structured didactic lectures on mental health issues, emotional aspects of illness, motivational interviewing, and other communication skills. Residents also have access to mental health precepting in the clinic and through video by the behavioral health curriculum director to address biopsychosocial factors affecting patient health and resident communication with patients.

We are modeling the future of integration between behavioral health and primary care so that you will be ready for future practice.

Residents obtain a structured clinical experience in Cardiology at Oconee Memorial Hospital and South Carolina Cardiology Consultants, the only cardiology practice in Seneca. These rotations are typically in two-week blocks, as the focus of the curriculum is on the “clinic first” model.  Residents round with cardiologists in the hospital, see new consults and other hospitalized cardiac patients and present directly to the cardiology attending. Residents participate in cardiovascular stress testing, catheterization labs procedures and other scheduled cardiovascular procedures. When the residents are not rounding with the cardiology service or engaged in their continuity clinic, they participate in outpatient care at the South Carolina Cardiology Consultants office, where they see patients with the cardiologists, participate treadmill stress tests and tilt table testing.

The goal of the cardiology curriculum is for our residents to become comfortable diagnosing and managing common cardiovascular conditions, understand how to coordinate care with cardiology colleagues, become comfortable interpreting EKGs, and gaining proficiency in overseeing and interpreting treadmill stress tests. Residents become comfortable managing a variety of cardiovascular conditions including but not limited to syncope, risk factor modification, post MI care, CHF, CAD/ACS/Angina, arrhythmias, valvular disease, pericardial disease, and vascular disease.

During this combination longitudinal and block experience, residents identify population health needs and health disparities in Oconee County and the surrounding areas, assess social determinants of health, learn panel management with a focus on individual and practice productivity, and engage in the community to identify partners and resources for patient care. Residents accomplish these goals through structured didactics, participation in Journal Clubs, rotating at community sites, and dedicated teaching time on identifying individual and practice patterns with EMR data. Residents start their experience in their first year so they can use knowledge gained throughout residency to help guide patient care and quality improvement initiatives, and perform regular individual practice assessments. Community site rotations include Access Health Mountain Lakes (a community network whose goal is to strengthen healthcare delivery for the uninsured), Anderson-Oconee Behavioral Health Services, South Carolina Vocational Rehab, Foothills YMCA, Oconee Memorial Hospital’s Wellness Center and Cardiac Rehab, Golden Corner Food Pantry, and more.

This curriculum will prepare residents for independent practice and leadership roles by providing a thorough understanding of patient registries and of EMR data use, the ability to assess and manage a given patient population, practice addressing inequities in their individual patient panels, and the skills needed to identify and partner with community resources to advance population health in any community.

We hope to provide a robust didactic curriculum that is subject based, comprehensive for mastering the ABFM family medicine boards and prepares residents for full spectrum family medicine. Residents are provided protected time for a scheduled half day of didactics on a weekly basis. Didactics include a variety of teaching learning modules anywhere from power point lectures, to group discussions and debates, to simulated learning, journal clubs and wellness groups. The curriculum has been designed to be subject based so that each afternoon if committed to one subspecialty of family medicine: pediatrics, women’s health, cardiology, respiratory, gastroenterology, etc. Residents have shared lectures with the Greenville and Greer program to enhance their learning by utilizing resources available at these other programs. On a monthly basis, residents will travel to Greenville to participate in “Sim Center” workshops including point of care ultrasound, suturing skills, ALSO training, ACLS training, and many more. Residents will participate in teaching components of the curriculum, including journal clubs, statistical analysis, Morbidity-Mortality (M&M rounds), and Grand Rounds. Residents’ wellness is of the utmost importance at CFM-Oconee. We are committed to a wellness curriculum which is included in the weekly didactics on a regular basis and includes three to four afternoons per year that are purely dedicated to the wellness and mental health of our residents.

We offer a wide range of electives and ample time within the longitudinal curriculum to allow residents the opportunity to focus their training on areas of interest or clinical passions. Local elective experiences include neurology, hematology/oncology, hospice/palliative care, dermatology, pediatrics, LGBTQ, research, wound care, pain management, allergy/immunology, nephrology, pulmonology, OB/GYN, ophthalmology, orthopedics and sports medicine. If not available locally, residents are able to rotate at other Prisma Health sites in the Upstate including rheumatology and pediatric subspecialists.

Residents obtain a comprehensive clinical experience in gynecology through Blue Ridge Women’s Center, Center for Family Medicine – Oconee and Prisma Health Oconee Memorial Hospital. Residents work directly with our community OBGYN’s at their outpatient clinic, Blue Ridge Women’s Center, seeing routine gynecological complaints and participating in office procedures. Residents scrub into gynecological surgeries at Oconee Memorial Hospital with Blue Ridge Women’s gynecologists. Residents also perform routine gynecological exams and procedures in their continuity clinics under the guidance and supervision of CFM-Oconee attendings. Procedural opportunities include women’s wellness exams, pap smears, colposcopies, endometrial biopsies, and placement of long acting reversible contraception devices. There is a variety of learning provided through on the fly teaching by Blue Ridge Women’s OBGYNs as well as OB/GYN subject based lectures covered during the Wednesday didactic curriculum.

The goal of the gynecology learning experience is to become proficient in managing a wide variety of women’s healthcare needs including well woman exams, sexual dysfunction, pelvic pain, abnormal uterine bleeding, hormone guided therapy, birth control, preconception counseling, and other common conditions. Residents will develop a good understanding of which medical conditions can be appropriately managed by a primary care provider and when to refer.

Obstetrical care is a fundamental component of full spectrum family medicine and for that reason is a core rotation in our longitudinal curriculum. Residents rotate on inpatient obstetrics at Prisma Health Oconee Memorial Hospital on average every 6 weeks, for one week at a time. During this OB rotation, residents round on patients admitted to the labor and delivery unit, assess triages, participate in vaginal and C-section deliveries, and manage postpartum patients. Residents are directly supervised by a variety of faculty including CFM-Oconee Family Medicine attendings, community family medicine attendings and obstetricians with Prisma Health Blue Ridge Women’s Center OBGYNs. These providers engage residents in case-based didactics and procedural skills as the opportunity arises, as well as structured OB lecture curriculum.

Residents have several opportunities to provide continuity prenatal care via several different experiences, including their own routine clinics. They also participate in Centering Pregnancy group prenatal care via Blue Ridge Women’s Center. Additionally, residents provide prenatal care for patients at the Walhalla Women’s clinic in collaboration with the Clemson Sullivan Center, which is a clinic committed to providing high quality, evidence-based care for underserved women in Oconee country.

The goal of obstetrical residency experience is to become proficient at managing health care needs of pregnant women including prenatal, intrapartum, post-partum care, and care of chronic health problems during pregnancy. Our goal is for our residents to become familiar with the clinical skills required to safely delivery babies, manage obstetrical emergencies, and know when to refer/transfer patients to a higher level of care based on risk and resource assessments.

You will spend time with our DO faculty not only practicing OMT but learning the ins and outs of how to incorporate this into your daily clinic. Both MDs and DOs alike will gain hands-on experience by working in half-day OMT clinics as part of the outpatient and inpatient experience; additionally, you will learn appropriate coding, billing, and documentation and gain the skills to practice OMT once you graduate.

Most family doctors spend the majority of their careers in an outpatient clinic setting, so we want to make sure that our teaching clinic prepares you for this part of your job. Center for Family Medicine – Oconee (CFM-Oconee) is a high-functioning patient-centered medical home providing excellent care to our patients and excellent training for our residents.

Our robust pediatric curriculum will expose you to well child care and the acute management of common inpatient conditions including sick and well newborns. The pediatric experience encompasses inpatient and outpatient longitudinal rotations.

During the outpatient experience, you will see newborn and pediatric patients at the Center for Family Medicine – Oconee for well child/preventative care, acute care sick visits and management of common chronic conditions like asthma and ADHD. Residents will have the opportunity to work with pediatricians during designated pediatric clinic sessions. Additional outpatient exposure includes rotations at local private community pediatric practices.

Our pediatric hospitalist service serves all pediatric and newborn patients who are admitted to Prisma Health Oconee Memorial Hospital. You will receive high-quality teaching and mentoring from pediatric hospitalists and family medicine core faculty. During the inpatient longitudinal experience, residents will be exposed to a wide variety of cases and will learn how to care for patients independently.

Specific inpatient experiences include:

• Delivery attendance
• Neonatal resuscitation
• Well newborn care, including late preterm infants
• Admission and management of acutely ill pediatric patients from birth to 17 years
• ER consultation for pediatric patients to guide admission decisions

Our daily rounding schedule is done with the entire inpatient team (adults, pediatrics and OB) which allows residents to get the family medicine perspective on inpatient care. The inpatient pediatric and OB residents will present mom-baby dyads.

The team atmosphere allows for self-directed and team-based learning. All faculty participate in bedside teaching rounds to give residents a more hands-on opportunity to model physical exam skills or see interesting physical findings. Bedside point-of-care ultrasound is available as well as the opportunity to learn inpatient procedures like lumbar punctures and incision and drainage of abscesses.

Residents will graduate feeling comfortable taking care of acutely ill pediatric patients as well as newborns and well child preventative care. Extra time for pediatric electives is available with local pediatric practices, our pediatric hospitalist service or at the tertiary center with a variety of pediatric subspecialists.

We offer you many opportunities to become competent at a wide range of inpatient and outpatient procedures and train you in the use of office-based point-of-care ultrasound. Some highlights include joint and soft tissue injections, skin biopsies and excisions, colposcopy, contraceptive device management, lumbar puncture, circumcision and central line placement.

POCUS is quickly becoming the new stethoscope – with advances in ultrasound probe size and utility, it will be a necessary skill in the not distant future. You will gain both inpatient and outpatient experience and comfort with point of care ultrasound techniques including but not limited to abdominal scans, cardiac assessment, pulmonary exams, obstetrics (including early dating), musculoskeletal assessment, and more. You will gain comfort with Butterfly iQ (portable) probes as well as the Sonosite X-porte and will learn how to utilize these to improve procedural accuracy. Learning will be done in real-time as well as in our simulation lab in Greenville, SC and with standardized patients.

The longitudinal experience in quality Improvement and patient safety teaches residents basic QI methodology, how to develop, implement, and analyze a QI project, and the basics of patient safety event reporting and analysis. Residents will conduct their own quality improvement projects both individually and with a multidisciplinary team. At least one quality improvement project will focus on addressing health disparities at the Center for Family Medicine – Oconee, with the goal of improving health equity in our patient population and providing quality care for all.

Through structured didactics, simulations, and clinical experiences, residents will learn about common patient safety events and contributing system factors, as well as how to disclose safety events to patients and families. Residents will conduct root cause analyses (RCA) and present regular morbidity and mortality reports. To supplement their training in quality improvement and patient safety, residents will complete web-based modules through the Institute of Healthcare Improvement’s (IHI) Open School.

This experience will provide residents the tools to succeed in independent practice and as healthcare leaders by providing a thorough foundation in quality improvement work and practice working with multidisciplinary teams to advance clinic and patient goals. With dedicated time throughout their three years of residency to participate in and lead long-term projects, residents will learn to apply a quality improvement approach to their everyday practice.

Sports medicine at Seneca Family Medicine Residency is a robust 3-year experience that will prepare you to comfortably handle the vast majority of acute and chronic musculoskeletal injuries and issues you will encounter in your future practice. During these experiences, you will spend time seeing patients with fellowship-trained sports medicine physicians and orthopedic surgeons working at Prisma Health’s Blue Ridge Orthopedics offices. Our residents also have the opportunity to work with athletes at Southern Wesleyan University (in nearby Central, South Carolina) and local high schools, visiting training rooms and acting as a sideline team physician at games. Point-of-care ultrasound is rapidly becoming the standard of care, and you will be trained in the use of this powerful tool in the care of athletes and other patients. You will have an opportunity to develop skills in performing musculoskeletal procedures such as injections, casting, and splinting.

PGY-1 – 2 weeks

PGY-2 – 2 weeks

PGY-3 – 4 weeks

Sports medicine track and sports medicine electives – available.

Mission statement

The Seneca Family Medicine Residency Program is committed to maintaining a culture that encourages our residents to grow in all aspects of their lives: professionally, physically, spiritually, emotionally, financially, and socially. We believe that the knowledge, skills, and attitudes vital to experiencing joy during training are an essential foundation for future success and sustainability in the practice of family medicine.

Curriculum

Wellness is a huge priority to our program. We know all too well the stress and rigors of residency and its impact on learners. As a result, it is a priority of our behavioral health curriculum director, Melicia Tanner, to ensure that our wellness program is robust and meets the needs of our residents, equipping them with lifelong skills to assess and maintain their wellness throughout their career.

The objectives for our wellness program are to:

• Create a culture of confidential, safe disclosure for burnout, depression, suicidal ideation, and impairment:
  • Behavioral health curriculum director will have weekly office hours for residents to come in and for routine “mental health check-ins”.
  • Behavioral health curriculum director will have weekly office hours for faculty do the same. This will be a help to faculty wellness and reduce stigma for residents to utilize this resource.
  • Residents will be encouraged to utilize the Employee Assistance Program as a part of their training.
• Develop and maintain a didactics-based wellness curriculum focused on all aspects of wellness: physical, emotional, occupational, social/spiritual, and financial.
• Provide concrete resources and be an ally and advocate in allowing residents to address their wellness:
  • Residents have been given a steeply discounted membership at the YMCA on campus.
  • Residents will be given a list of primary care physicians and therapists in the area covered by insurance plan.
  • Behavioral health curriculum director will be utilized as an aide and advocate both in securing care and in securing time off to seek care
• Schedule time to reflect:
  • Arrange for Employee Assistance to provide “critical incident” debriefing after stressful patient situations, (e.g. patient death, adverse obstetric outcome) to reduce distress and self‐blame.
  • Reflective writing/narrative medicine.
  • Balint groups.
  • Individual wellness plans.
  • Monthly clinic-wide “Wellness Times.”
• Schedule and support time to connect with colleagues and mentors:
  • Retreats.
  • Team-building events.
  • Social events including families.
  • Assigning residents a “wellness buddy” in their own cohort to provide encouragement and accountability.
  • Assigning residents a mentee in a cohort below them.
  • Community engagement.
  • Advocacy projects.