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Integrative Family Medicine Program

Structured Learning Experiences

Resident Experiences throughout the three years:

During ambulatory teaching sessions, faculty and preceptors encourage residents to:

  • communicate with their patients in a nonjudgmental manner
  • develop balanced relationships with patients where patients are encouraged to take an active part in their medical decision making
  • balance EBM and the art of its application to individual patients

During afternoon report at the FMC, an integrative focus is considered.  A complementary and integrative faculty facilitator or leader or a CAM practitioner is present weekly.

The wellness plan developed during orientation is implemented and reviewed quarterly with advisor.

Integrative medicine case review.  Fellow or Resident presents a case from their patient panel. CAM practitioners from the community representing multiple modalities attend.  Each practitioner contributes his/her perspective regarding diagnosis, communication strategies, treatment options/management and potential integration with conventional care.  Discussion is encouraged.

Grand Rounds presentations include integrative medicine perspectives when appropriate

Residents are encouraged to develop strong doctor/patient relationships through home visits and extended office visits on occasion.

Residents are invited to attend the FMC monthly book group.  The group meets in the evening at the home of one of the participants.  Fiction and nonfiction books with themes related to health and healing are chosen.   

Bi-monthly didactic series on complementary and integrative medicine topics during regularly scheduled teaching conference time.

Didactics/Seminars:
Bi-monthly presentations during regular resident teaching conference time.  These are often co-taught by a family practice faculty member and a CAM provider from the greater Portland community.  Approximately ½ of the session focus on modalities, the other half on integrative approaches to common clinical scenarios.  Goals for the sessions on modalities are to raise awareness of history and use, referral and information resources, available evidence, and clinical applications.  The sessions will also introduce local CAM practitioners and faculty/residents to each other.  The faculty facilitator or a faculty leader will meet or talk with each presenter before the session to ensure that the goals of the project are met.  Each presenter is asked to bring handouts including an outline of their session and a list of resources that would be useful for busy family practitioners (websites, readings, recommended local practitioners and their contact information).

Presentation guidelines include:
Time (approx.)      Component
10 min                                   Overview of history, philosophy, theory of the modality
5 min                                   Interactive component with clinical applications (clinical case scenario, demonstration, or an experience for residents).
10 min                                   Review of evidence – ideally presented by the faculty leader in the corresponding modality
5 min                                      Issues of cost/payment/insurance coverage (especially Medicaid/care) /liability/licensing
10 min                                   Q&A

Faculty facilitator or leaders e-mail abstracts of relevant complementary and integrative medicine articles on a regular basis.

Experiences/Responsibilities PGY-1:
Orientation:
Overview
Introduction to integrative family medicine. Overview of the field as well as the specifics in our program, faculty and resources
Skills in wellness (including nutrition, physical activity and models of behavioral change) and mindfulness for residents and their patients. 

Residents develop a wellness plan for inclusion in their portfolio. This is an opportunity to explore a definition of wellness that is meaningful to each individual.  This may include such themes as relationships, nutrition, exercise, recreation, relaxation, hobbies, spirituality, and/or balance between professional and personal life.  The wellness plan will look different for each resident.  Follow-up at quarterly meetings with advisors.  This is designed to help residents maintain a sense of well being as they move through residency, often a challenging time in their life and career.

Complementary and integrative medicine resources provided for residents


Websites for finding clinical information and patient education. 
Inpatient resources available at MMC.
Local contacts for questions and referral.

Experiences/Responsibilities PGY-2:
Time Management presentation during re-orientation

Community and Integrative Medicine month includes the following sessions (in progress)

·          Video and discussion of Debate between supporter and opponent of integrative medicine.

·          Each resident receives a treatment during the month (approx 1 hr).  We schedule homeopathy, manipulation (chiropractic, osteopathy), acupuncture, massage, energy healing, etc. One-hour at a lunch meeting at the end of the month to share experiences with each other and discuss how to incorporate these ideas into personal wellness and patient interviewing/care.

  • Stories and discussion with community physicians panel/traditional healers panel
  • Scavenger hunt among community grocers, bodegas, health food stores for remedies and traditional medicines followed by discussion
  • Field-trip to community herbalist and botanical gardens
  • Fit for residency
  • Nutrition for the family physician
  • Osteopathic manual medicine skills workshop

Experiences/Responsibilities PGY-3:
2-week block rotation focuses on experience and observation of a wide variety of complementary and integrative medicine therapies, as well as different models of relationship-centered care.  Residents reflect on their personal health and well being practices as well as their approach to patient care.  The rotation can be customized for those residents with a background in complementary or integrative medicine.

We are piloting a web-based botanical module intervention.  This involves the consenting resident taking a pre-test, completing the approximately 12-hour online module, and then completing a post-test. 

Description of the general organization of the rotation:
The rotation takes place at the Family Medicine Centers and in the offices of CAM providers in the greater Portland community. This experiential rotation including complementary therapy treatments and observation of patient care and provider/patient interactions with community CAM providers in mind/body medicine, homeopathy, manual therapies, acupuncture, and botanical medicine is complemented by required reading and resource work.  Exploring videos and websites provides a broad overview of complementary and integrative approaches to medicine.  There are opportunities for discussion with complementary and integrative medicine providers.

Time is allocated for physician wellness, reading and reflection.  Residents meet with the faculty facilitator at the beginning of the rotation to discuss learning goals and opportunities during the month.  Residents also update their personal wellness plans.

Residents see patients with community alternative, complementary and integrative providers.  Within our Family Medicine Centers residents see patients along with Ralph Thieme, DO, LAc. for experiences in osteopathic manual medicine and acupuncture as well as in integrative medicine consultation with Craig Schneider, MD and Integrative Medicine Fellow.  Residents are encouraged to develop an integrative treatment plan for one of the patients seen.

Timeframe:
Approximately 4-5 half-days/week for 2 weeks PGY3.

Learning Resources: (work in progress)

Community and Integrative Medicine month includes the following sessions (in progress)

·          Video and discussion of Debate between supporter and opponent of integrative medicine.

·          Each resident receives a treatment during the month (approx 1 hr).  We schedule homeopathy, manipulation (chiropractic, osteopathy), acupuncture, massage, energy healing, etc. One-hour at a lunch meeting at the end of the month to share experiences with each other and discuss how to incorporate these ideas into personal wellness and patient interviewing/care.

  • Stories and discussion with community physicians panel/traditional healers panel
  • Scavenger hunt among community grocers, bodegas, health food stores for remedies and traditional medicines followed by discussion
  • Field-trip to community herbalist and botanical gardens
  • Fit for residency
  • Nutrition for the family physician
  • Osteopathic manual medicine skills workshop

Experiences/Responsibilities PGY-3:
2-week block rotation focuses on experience and observation of a wide variety of complementary and integrative medicine therapies, as well as different models of relationship-centered care.  Residents reflect on their personal health and well being practices as well as their approach to patient care.  The rotation can be customized for those residents with a background in complementary or integrative medicine.

We are piloting a web-based botanical module intervention.  This involves the consenting resident taking a pre-test, completing the approximately 12-hour online module, and then completing a post-test. 

Description of the general organization of the rotation:
The rotation takes place at the Family Medicine Centers and in the offices of CAM providers in the greater Portland community. This experiential rotation including complementary therapy treatments and observation of patient care and provider/patient interactions with community CAM providers in mind/body medicine, homeopathy, manual therapies, acupuncture, and botanical medicine is complemented by required reading and resource work.  Exploring videos and websites provides a broad overview of complementary and integrative approaches to medicine.  There are opportunities for discussion with complementary and integrative medicine providers.

Time is allocated for physician wellness, reading and reflection.  Residents meet with the faculty facilitator at the beginning of the rotation to discuss learning goals and opportunities during the month.  Residents also update their personal wellness plans.

Residents see patients with community alternative, complementary and integrative providers.  Within our Family Medicine Centers residents see patients along with Ralph Thieme, DO, LAc. for experiences in osteopathic manual medicine and acupuncture as well as in integrative medicine consultation with Craig Schneider, MD and Integrative Medicine Fellow.  Residents are encouraged to develop an integrative treatment plan for one of the patients seen.

Timeframe:
Approximately 4-5 half-days/week for 2 weeks PGY3.

Learning Resources: (work in progress)

Community and Integrative Medicine month includes the following sessions (in progress)

·          Video and discussion of Debate between supporter and opponent of integrative medicine.

·          Each resident receives a treatment during the month (approx 1 hr).  We schedule homeopathy, manipulation (chiropractic, osteopathy), acupuncture, massage, energy healing, etc. One-hour at a lunch meeting at the end of the month to share experiences with each other and discuss how to incorporate these ideas into personal wellness and patient interviewing/care.

  • Stories and discussion with community physicians panel/traditional healers panel
  • Scavenger hunt among community grocers, bodegas, health food stores for remedies and traditional medicines followed by discussion
  • Field-trip to community herbalist and botanical gardens
  • Fit for residency
  • Nutrition for the family physician
  • Osteopathic manual medicine skills workshop

Experiences/Responsibilities PGY-3:
2-week block rotation focuses on experience and observation of a wide variety of complementary and integrative medicine therapies, as well as different models of relationship-centered care.  Residents reflect on their personal health and well being practices as well as their approach to patient care.  The rotation can be customized for those residents with a background in complementary or integrative medicine.

We are piloting a web-based botanical module intervention.  This involves the consenting resident taking a pre-test, completing the approximately 12-hour online module, and then completing a post-test. 

Description of the general organization of the rotation:
The rotation takes place at the Family Medicine Centers and in the offices of CAM providers in the greater Portland community. This experiential rotation including complementary therapy treatments and observation of patient care and provider/patient interactions with community CAM providers in mind/body medicine, homeopathy, manual therapies, acupuncture, and botanical medicine is complemented by required reading and resource work.  Exploring videos and websites provides a broad overview of complementary and integrative approaches to medicine.  There are opportunities for discussion with complementary and integrative medicine providers.

Time is allocated for physician wellness, reading and reflection.  Residents meet with the faculty facilitator at the beginning of the rotation to discuss learning goals and opportunities during the month.  Residents also update their personal wellness plans.

Residents see patients with community alternative, complementary and integrative providers.  Within our Family Medicine Centers residents see patients along with Ralph Thieme, DO, LAc. for experiences in osteopathic manual medicine and acupuncture as well as in integrative medicine consultation with Craig Schneider, MD and Integrative Medicine Fellow.  Residents are encouraged to develop an integrative treatment plan for one of the patients seen.

Timeframe:
Approximately 4-5 half-days/week for 2 weeks PGY3.

Learning Resources: (work in progress)

Community and Integrative Medicine month includes the following sessions (in progress)

·          Video and discussion of Debate between supporter and opponent of integrative medicine.

·          Each resident receives a treatment during the month (approx 1 hr).  We schedule homeopathy, manipulation (chiropractic, osteopathy), acupuncture, massage, energy healing, etc. One-hour at a lunch meeting at the end of the month to share experiences with each other and discuss how to incorporate these ideas into personal wellness and patient interviewing/care.

  • Stories and discussion with community physicians panel/traditional healers panel
  • Scavenger hunt among community grocers, bodegas, health food stores for remedies and traditional medicines followed by discussion
  • Field-trip to community herbalist and botanical gardens
  • Fit for residency
  • Nutrition for the family physician
  • Osteopathic manual medicine skills workshop

Experiences/Responsibilities PGY-3:
2-week block rotation focuses on experience and observation of a wide variety of complementary and integrative medicine therapies, as well as different models of relationship-centered care.  Residents reflect on their personal health and well being practices as well as their approach to patient care.  The rotation can be customized for those residents with a background in complementary or integrative medicine.

We are piloting a web-based botanical module intervention.  This involves the consenting resident taking a pre-test, completing the approximately 12-hour online module, and then completing a post-test. 

Description of the general organization of the rotation:
The rotation takes place at the Family Medicine Centers and in the offices of CAM providers in the greater Portland community. This experiential rotation including complementary therapy treatments and observation of patient care and provider/patient interactions with community CAM providers in mind/body medicine, homeopathy, manual therapies, acupuncture, and botanical medicine is complemented by required reading and resource work.  Exploring videos and websites provides a broad overview of complementary and integrative approaches to medicine.  There are opportunities for discussion with complementary and integrative medicine providers.

Time is allocated for physician wellness, reading and reflection.  Residents meet with the faculty facilitator at the beginning of the rotation to discuss learning goals and opportunities during the month.  Residents also update their personal wellness plans.

Residents see patients with community alternative, complementary and integrative providers.  Within our Family Medicine Centers residents see patients along with Ralph Thieme, DO, LAc. for experiences in osteopathic manual medicine and acupuncture as well as in integrative medicine consultation with Craig Schneider, MD and Integrative Medicine Fellow.  Residents are encouraged to develop an integrative treatment plan for one of the patients seen.

Timeframe:
Approximately 4-5 half-days/week for 2 weeks PGY3.

Learning Resources: (work in progress)

Community and Integrative Medicine month includes the following sessions (in progress)

·          Video and discussion of Debate between supporter and opponent of integrative medicine.

·          Each resident receives a treatment during the month (approx 1 hr).  We schedule homeopathy, manipulation (chiropractic, osteopathy), acupuncture, massage, energy healing, etc. One-hour at a lunch meeting at the end of the month to share experiences with each other and discuss how to incorporate these ideas into personal wellness and patient interviewing/care.

  • Stories and discussion with community physicians panel/traditional healers panel
  • Scavenger hunt among community grocers, bodegas, health food stores for remedies and traditional medicines followed by discussion
  • Field-trip to community herbalist and botanical gardens
  • Fit for residency
  • Nutrition for the family physician
  • Osteopathic manual medicine skills workshop

Experiences/Responsibilities PGY-3:
2-week block rotation focuses on experience and observation of a wide variety of complementary and integrative medicine therapies, as well as different models of relationship-centered care.  Residents reflect on their personal health and well being practices as well as their approach to patient care.  The rotation can be customized for those residents with a background in complementary or integrative medicine.

We are piloting a web-based botanical module intervention.  This involves the consenting resident taking a pre-test, completing the approximately 12-hour online module, and then completing a post-test. 

Description of the general organization of the rotation:
The rotation takes place at the Family Medicine Centers and in the offices of CAM providers in the greater Portland community. This experiential rotation including complementary therapy treatments and observation of patient care and provider/patient interactions with community CAM providers in mind/body medicine, homeopathy, manual therapies, acupuncture, and botanical medicine is complemented by required reading and resource work.  Exploring videos and websites provides a broad overview of complementary and integrative approaches to medicine.  There are opportunities for discussion with complementary and integrative medicine providers.

Time is allocated for physician wellness, reading and reflection.  Residents meet with the faculty facilitator at the beginning of the rotation to discuss learning goals and opportunities during the month.  Residents also update their personal wellness plans.

Residents see patients with community alternative, complementary and integrative providers.  Within our Family Medicine Centers residents see patients along with Ralph Thieme, DO, LAc. for experiences in osteopathic manual medicine and acupuncture as well as in integrative medicine consultation with Craig Schneider, MD and Integrative Medicine Fellow.  Residents are encouraged to develop an integrative treatment plan for one of the patients seen.

Timeframe:
Approximately 4-5 half-days/week for 2 weeks PGY3.

Learning Resources: (work in progress)

Community and Integrative Medicine month includes the following sessions (in progress)

·          Video and discussion of Debate between supporter and opponent of integrative medicine.

·          Each resident receives a treatment during the month (approx 1 hr).  We schedule homeopathy, manipulation (chiropractic, osteopathy), acupuncture, massage, energy healing, etc. One-hour at a lunch meeting at the end of the month to share experiences with each other and discuss how to incorporate these ideas into personal wellness and patient interviewing/care.

  • Stories and discussion with community physicians panel/traditional healers panel
  • Scavenger hunt among community grocers, bodegas, health food stores for remedies and traditional medicines followed by discussion
  • Field-trip to community herbalist and botanical gardens
  • Fit for residency
  • Nutrition for the family physician
  • Osteopathic manual medicine skills workshop

Experiences/Responsibilities PGY-3:
2-week block rotation focuses on experience and observation of a wide variety of complementary and integrative medicine therapies, as well as different models of relationship-centered care.  Residents reflect on their personal health and well being practices as well as their approach to patient care.  The rotation can be customized for those residents with a background in complementary or integrative medicine.

We are piloting a web-based botanical module intervention.  This involves the consenting resident taking a pre-test, completing the approximately 12-hour online module, and then completing a post-test. 

Description of the general organization of the rotation:
The rotation takes place at the Family Medicine Centers and in the offices of CAM providers in the greater Portland community. This experiential rotation including complementary therapy treatments and observation of patient care and provider/patient interactions with community CAM providers in mind/body medicine, homeopathy, manual therapies, acupuncture, and botanical medicine is complemented by required reading and resource work.  Exploring videos and websites provides a broad overview of complementary and integrative approaches to medicine.  There are opportunities for discussion with complementary and integrative medicine providers.

Time is allocated for physician wellness, reading and reflection.  Residents meet with the faculty facilitator at the beginning of the rotation to discuss learning goals and opportunities during the month.  Residents also update their personal wellness plans.

Residents see patients with community alternative, complementary and integrative providers.  Within our Family Medicine Centers residents see patients along with Ralph Thieme, DO, LAc. for experiences in osteopathic manual medicine and acupuncture as well as in integrative medicine consultation with Craig Schneider, MD and Integrative Medicine Fellow.  Residents are encouraged to develop an integrative treatment plan for one of the patients seen.

Timeframe:
Approximately 4-5 half-days/week for 2 weeks PGY3.

Learning Resources: (work in progress)

 
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