The Duke Family Medicine Residency is a unique program designed to train leaders, innovators, and advocates in the field of family medicine. Our foundation is built upon high quality clinical education, with residents rotating in a variety of practice settings. From Day 1, residents experience life as a true family physician with their own patient panel, continuity deliveries for our pregnant patients, and longitudinal training experiences. These experiences include an integrated population health curriculum and capstone community engagement project (PHIT), CenteringPregnancy® prenatal care, leadership training, panel management education, and annual quality improvement projects.
There is significant support for residents to attend conferences, present, and publish their ongoing scholarship, take local and national leadership positions, and develop the non-clinical skills needed to improve the field of family medicine.
Residents have up to 18 weeks of elective time during the course of residency to explore all aspects of professional development and the field of family medicine. Typically, 6 weeks are taken in the second year and 12 weeks in the third year. Elective time can be used to explore educational interests locally and abroad, and may focus on clinical medicine, advocacy, leadership development, and more.
With the start of our Family Medicine inpatient service in 2020, our home call is now covered by the in-house residents to protect as much personal time outside of work as possible for our residents. The on-service residents are responsible for responding to after-hours pages for our Duke Family Medicine patients, with faculty backup available as needed.
The on-service residents are also first-call for obstetrics calls. When a patient from one of our CenteringPregnancy® groups is admitted for labor, other members of the CenteringPregnancy® group are notified so they can be present during the delivery too.
The Family Medicine Inpatient Service is a dedicated rotation, with both the senior residents and interns working 6 days a week. A senior resident will cover a 24-hour call period from Saturday morning to Sunday morning while the other residents are off. Residents can expect to have approximately six total 24-hour calls during each of their second and third years of residency.
Residents meet every Tuesday afternoon for faculty-led didactic sessions. A list of ABFM core topics is used to create an 18-month rotating curriculum that includes lectures, workshops, and modules. Each month, residents will participate in a population health session, journal club, a resident case presentation, behavioral medicine didactics, dedicated geriatrics teaching, and wellness time with our program behavioralist Dr. Andrada Neacsiu. Speakers are both DFM faculty and outside presenters recruited for their passion and expertise in a particular topic.
In addition to Tuesday afternoon didactics, residents will also participate in departmental grand rounds, primary care grand rounds, and an outpatient didactic series. The focus of the outpatient didactic series (held at the Duke Family Medicine Center on Wednesday and Thursday mornings) is on clinical outpatient family medicine through small-group, discussion-based, and case-based learning with participation by residents, faculty, and students.
Additionally, we will launch the Clinic Didactics Series beginning July 2021. This series will take place every Wednesday and Thursday morning from 8:00 – 8:50 and will be attended by residents on outpatient rotations and residency core faculty. The series will focus primarily on outpatient family medicine, will be small-group oriented, and will cover clinical, practice management, and psychosocial topics.
OB: The standard model of prenatal care offered at the Duke Family Medicine Center is CenteringPregnancy®, a group-based model of care. All residents receive training and are certified to be CenteringPregnancy facilitators. In addition to CenteringPregnancy, a smaller portion of patients receive traditional prenatal care through one-on-one visits. Residents spend 8 weeks on Labor and Delivery (4 weeks in first year, 4 weeks in second year), in addition to continuity deliveries of their CenteringPregnancy patients.
Geriatrics: In addition to seeing geriatric patients in clinic, residents have a panel of continuity patients at a local nursing home and participate in home visits through the Just For Us program. There is an additional required 3-week rotation in geriatrics that includes exposure to geriatric outpatient specialty care, inpatient consult service, and transition of care to nursing facilities.
Pediatrics: Residents rotate 1 month on inpatient pediatrics, 2 weeks in the newborn nursery, and 2 months on outpatient pediatrics in addition to seeing pediatric continuity patients at the Duke Family Medicine clinic.
Residents can also choose to do electives in particular areas of OB, pediatrics, or geriatrics.
There are multiple opportunities for clinic-based procedural training. The DFMC offers gynecology, sports medicine, and dermatology procedural clinics that residents rotate through each year. Gynecology procedures include colposcopy, endometrial biopsy, Nexplanon insertion/removal, and IUD insertion/removal. Sports medicine procedures include ultrasound-guided joint injections and aspirations. Dermatology procedures include punch, shave, and elliptical biopsies, cyst removals, and toenail removals. There is also a new opportunity in clinic for vasectomies. During residents’ clinic schedules, they may perform foreign body removal, joint injections, cryotherapy, cerumen impaction removal, I&Ds, anoscopy, management of thrombosed hemorrhoids, laceration repair, and splinting.
There are annual resident skills workshops focusing on the procedures listed above, as well as suturing, ultrasound training, circumcision, cervical exams, fetal scalp electrode and IUPC placement, and perineum laceration repairs. There are also growing opportunities for clinic-based ultrasound training including MSK, joint injections, and OB. Lastly, there are numerous opportunities to gain hands-on procedural training while on off-service rotations.
All residents will have two months of dedicated procedure training. During this time, they will be the procedure resident at Duke Regional Emergency Department, spend time in the benign anorectal clinic gaining expertise on common anorectal procedures, and work at the Duke Family Medicine dermatology and gynecology procedures clinics.
Additionally, a third year gynecology rotation allows for an immersive experience at the Durham County Health Department and local Planned Parenthood locations. Residents have the option to gain experience in providing medical or surgical abortion, or can instead focus on long-acting reversible contraception like IUD and Nexplanon placement and removal instead.
Residents in good standing in January of the second year of training are eligible for moonlighting privileges with program approval. Current opportunities include the emergency department observation unit.