St. John Family Medicine Residency Program

Kenneth W. Bollin, MD
Chief, Department of Family Medicine

Mark Paschall, MD
Vice-Chief and Program Director

Barry Scofield, MD
Assistant Program Director

Patricia West, Ph.D, RN
Director of Behavioral Sciences
and Community Medicine

Chandrika Iyer, MD
Clinical Instructor

Rachel O'Byrne, MD
Clinical Instructor

Veena Panthangi, MD
Clinical Instructor

Nicholas Urbanczyk, DO
Clinical Instructor

St. John Health System is an ideal setting for Family Medicine. It has the resources to provide excellent training for residents and to give comprehensive, continuing care for both medical and behavioral problems. The SJH&MC Family Medicine Residency trains its residents to be specialists in breadth, allowing them to treat the whole patient and the whole family. The thrust of the family medicine resident's training is the ambulatory care of families, but inpatient hospital care is also emphasized, drawing upon the teaching of the Family Medicine faculty as well as the part-time and full-time physicians in the other specialty departments within the St. John Health System.

The Family Medicine resident is introduced to ambulatory Family Medicine patients from the first day of the residency. Since 80-90% of practice in the future will be spent in the outpatient setting, the emphasis of teaching will be ambulatory care. The first-year Family Medicine resident spends one to two half-days per week in the Family Medical Center. The resident will see approximately four or five patients per half-day session. The resident discusses all patients with the supervising preceptor. The emphasis for the first year resident will be how to efficiently function in the ambulatory setting, utilizing the proper amount of time, laboratory, consultants and community resources.

The second-year Family Medicine resident spends two to three half-days per week in the Family Medical Center. The resident will see approximately six or seven patients per half-day session. The resident reviews important aspects of all cases with the supervising preceptor. The emphasis for the second year resident is increasing efficiency in utilization of office personnel for physician assistance, an increasing awareness of office finances and management, and increasing sophistication in the management of ambulatory patient problems.

The third-year Family Medicine resident spends four or five half-days per week in the Family Medical Center. The third-year resident sees approximately eight or nine patients per half-day session, and reviews all cases with the supervising preceptor. During the resident's third year, there will be guidelines to increase efficiency to ensure financial success aain future practice and didactic sessions on managing common business problems.

The Family Medicine Department is located in a spacious and brightly decorated building only minutes north of St. John Hospital and Medical Center and easily accessible to patients off I-94 and Ten Mile Road. The facilities include X-ray and lab, a large conference/library room for residents, special procedure rooms and all modern equipment, including a flexible sigmoidoscope, colposcope, and nasopharyngoscope.

While the Family Medicine residents are in the model unit, there are one or more supervising Family Medicine faculty immediately available for consultation. A PhD behavioral scientist is present for added expertise in any behavioral or social problems. She reviews with residents the videotapes of patient interviews that they have performed to aid them in interviewing and counseling skills.

The hospital has a broad spectrum of education conferences available to residents and attending staff. The Family Medicine Department has resident-oriented conferences two or three times weekly. An additional combined resident/attending conference is held on Friday mornings. There are also monthly procedural workshops and testing sessions.

As the St. John Health System expands its reputation for excellence in Southeast Michigan, opportunities for resident education continue to emerge. We currently have experiences in both urban and rural medicine built into our residency and also offer rural electives for second and third year residents.

Core Curriculum In Internal Medicine

Family Medicine residents are assigned to four months of Internal Medicine during the first year of training. These months are divided between the Internal Medicine service and the Inpatient Family Medicine service. This also includes experience in the Medical Intensive Care Unit. During the second year, the residents have four months of Internal Medicine on the Family Medicine Inpatient service. In the second and third years, residents are required to take medicine subspecialties in Cardiology and Dermatology. While on Inpatient Internal Medicine, they are assigned to one of three geographical teaching units. On teaching units, they are full members of the resident staff consisting of three first-year residents and two second-year residents. There is one full-time board-certified internist in charge of the teaching on each unit. The Family Medicine team consists of three to four residents under the direction of faculty family physicians and attendings.

Core Curriculum In Pediatrics

Family Medicine residents are assigned to three months of pediatrics in their first year plus one month in their second year. The curriculum includes inpatient pediatrics, outpatient clinic, newborn nursery, neonatal intensive care experience and a month of pediatric ER.

Core Curriculum In Obstetrics And Gynecology

Family Medicine residents spend 2 months on OB during their first year of training. The obstetrical service at SJH&MC is one of the largest in the state, averaging approximately 300 deliveries per month. A family-centered LDRP unit provides a state-of-the-art setting.

The objective of training in obstetrics and gynecology is to teach residents the management of normal obstetrics and to identify potential problems. The importance of family-centered obstetrics is stressed, with the emphasis on prenatal education for parents, natural delivery and bonding. In the OB clinic, the residents are expected to evaluate and conduct normal prenatal care for expectant mothers, follow postpartum patients, and assist in the management of high-risk patients.

The residents will follow patients they see in the Family Medical Center through their prenatal course, assist the mothers during birth, follow their postpartum course and care for the newborns. Four full-time family physicians in the department are available for OB supervision in the office and in the labor and delivery suite. Consultation with OB specialists is available when needed. Family Medicine residents will also have the opportunity to care for high-risk obstetrical patients in the High-Risk Obstetrical Clinic under the direction of the Chief Obstetrical Resident and full-time obstetrical staff.

During the second year, a block month is devoted to GYN under the direction of a precepting gynecologist. While on the gynecology service, residents learn to evaluate GYN patients in the office and on preoperative admissions. The residents assist on minor gynecological surgeries and procedures such as D&C’s, biopsies and colposcopies. Residents will also assist on some major gynecological surgeries. Family Medicine residents are actively involved with the management of emergency gynecological patients.

For residents who wish to make obstetrics and gynecology a significant part of their future practice, an additional three months of experience in this department is recommended and easily obtained through electives available.

Core Curriculum In Surgery

 Two months of the Family Medicine curriculum are spent in general surgery. The first month is a preceptorship with a busy general surgery practice at River District Hospital. This affords the resident a full spectrum surgical experience, including pre-operative diagnosis and preparation intra-operative skills and postoperative management and follow-up. They are also exposed to an environment where Family Medicine Physicians are routinely involved in the surgical procedures for their patients.

The second surgical month is an ambulatory experience. Residents work with general and specialty surgeons in their offices performing minor surgical procedures. The experiences focus on those problems that the FM would encounter in their future practice and the procedures that they may perform.

During PGY III, residents have an optional procedure-based elective rotation that includes OR experience, endoscopy experience and casting work.

Core Curriculum In Behavioral Science/Psychiatry

Family Medicine residents spend one month in psychiatry during the second year of training. The rotation is designed around the Psychiatric-Medical Unit and the Psychiatric Consultation Liaison Service at SJH&MC. Residents learn to diagnose and manage a variety of psychiatric problems under the guidance of staff psychiatrists and psychologists. The teaching focus is on differential diagnosis, treatment formulation and psycho-pharmacology. Behavioral science is an on-going curriculum dealing with the psycho-social factors affecting the health of the individual and family. The methodology includes didactic lectures, videotaping and individual precepting with the behavioral scientist.

Electives Offered

The Family Medicine resident will have a total of four months of elective time in the second and third years. The resident has the option of either inpatient or outpatient electives. All electives are selected by the residents with prior approval of the program director and the participating physician on the elective. Available electives include: allergy, cardiovascular disease, community medicine, emergency medicine, endocrinology, gastroenterology, hematology, industrial medicine, infectious diseases, medical ethics, nephrology, obstetrics and gynecology, oncology, oral surgery, pathology, pediatrics, physical medicine, plastic surgery, psychiatry, pulmonary diseases, rheumatology, podiatry, rural preceptorships, and sports medicine.

Call Schedule

While serving on inpatient rotations, residents have call approximately every 4th night. While on outpatient rotations, they share in covering the FM inpatient service. This translates into call for PGY I - PGY III as listed below: PGY I 1 call every 5 days (-70 calls) PGY II 2-3 calls per month (-30 calls) PGY III 2 calls per month (24 calls)

St. John Hospital adheres closely to the recently instituted ACGME Resident Duty Hours, and this is monitored on a monthly basis.

Core Schedule

PGY I

• Orientation — 1 month
• IM floor (SJH&MC) — 2 months
• MICU floor (SJH&MC) — 1 month
• FM floor (SJH&MC) — 1 month
• IP Peds (SJH&MC) — 1 month
• OB (SJH&MC) — 2 months
• NICU (SJH&MC) — 1 month
• Orthopedics (SJH&MC) — 1 month
• ER SJH&MC (Adult) — 1 month
• Outpatient Peds/NBN — 1 month

PGY II

• FM floor (SJH&MC) — 4 months
• GYN — 1 month
• ER SJH&MC (Peds) — 1 month
• Cardiology (SJH&MC) — 1 month
• rural FM (RDH) — 1 month
• General Surgery (RDH) — 1 month
• OP Surgery (SJH&MC) — 1 month
• Elective — 1 month
• Psychiatry — 1 month

PGY III

• Community Medicine — 1 month
• Occupational Med — 1 month
• Ophth/ENT — 1 month
• Urol/Practice Management — 1 month
• Derm — 1 month
• Family Medicine (Team Leader) — 1 month
• Orthopedics — 1 month
• Electives — 5 months

For more information or an application you can write to the following address,
call (313) 343-3875, or visit us on the Web at http://stjohn.org/physicianresources.cfm.

Medical Education Department
St. John Hospital and Medical Center
22101 Moross Road
Detroit, Michigan 48236