Curriculum

As a first-year resident, you develop knowledge and skills in hospital and outpatient settings. You are setting the foundation for your training. You will also meet and build relationships with your continuity panel at Family Medicine Milton. You will have clinic here at least one half-day a week for most of your rotations, and you will begin to feel a part of the community. Outpatient months have weekends free! There is no call in the PGY1 year.

Highlights for PGY1 residents unique to our program include:

• On most rotations, Wednesdays are protected for PGY1’s to attend didactics and clinic
• Intern “chat” every Wednesday from 1:30-2PM, with faculty to cover basics of clinic and inbox management (Wednesdays are great for class bonding!)
• Balint twice per month to connect with your classmates (facilitated small group support)
• Lots of faculty support in clinic and in the FM inpatient setting
• Graded increase in patient volume (step-wise approach to autonomy)
• TAs/ Preceptors readily available on site with great teaching
• Full patient continuity panels transition from graduating PGY3 to incoming PGY1s with warm handoff
• Patient community is comfortable and familiar with the resident clinic model at MFP
• Allows for continuity of care and management of chronic disease right away for PGY1s!

See a sample PGY-2 schedule below:

Block 1 - Inpatient Pediatrics
Block 2 - Outpatient Surgery/ Cardiology
Block 3 - Urgent Care Center*
Block 4 - OB Days
Block 5 - Family Medicine Service
Block 6 - Community Health Center/Ortho/MSK*
Block 7 - FM Core
Block 8 - Outpatient Pediatrics and Newborn Care*
Block 9 - Medical Intensive Care Center
Block 10 - Continuity Clinic at MFP/ Community Medicine*
Block 11 - Family Medicine Service
Block 12 - Elective*/ Newborn Nursery
Block 13 - OB Days/OB Nights

* Outpatient Rotations

• Cardiology
  • Inpatient, 2-week rotation
  • Wednesdays are protected for didactics (AM) and continuity clinics (PM)
• Community Health Center/ Ortho/ MSK
  • 4-week rotation, mix of continuity clinic, working at CHCB, and working with Orthopedic specialists (including cast tech session, interventional pain, FM procedure clinics and more!)
  • Vacation allowed
• Continuity Clinic/ Community Medicine
  • Time at continuity clinic in Milton
  • Scheduled Community Medicine sessions (examples include Helmets on Heads, Tar Wars, Community Garden)
  • Admin time, as well as dedicated time to work on ABFM modules
  • Vacation allowed
• Elective
  • Self-directed learning. Must include continuity clinics
  • Vacation allowed
• Family Medicine Service Days
  • 6 days/ week, inpatient
  • Wednesdays are protected for didactics (AM) and continuity clinics (PM)
• FM Core
  • Core Family Medicine (back to basics) – covering Family Medicine Service (days), FM OB (days), and continuity clinic. Also includes some admin time.
  • 4-week rotation
• Inpatient Pediatrics
  • Inpatient
  • 1 half days of MFP Clinic per week
  • Attend all Peds lectures and didactics
• Medical Intensive Care Unit
  • Inpatient, 4 weeks
  • Attend Medicine lectures and didactics
  • No continuity clinic (no rushing from hospital to clinic)
• Newborn Nursery
  • 2-week rotation with the Newborn hospitalists, rounding on all hospital babies
  • Dedicated time with IBCLC staff
• OB Days
  • Inpatient, part of the OB team
  • Responsible for FM OB patients
  • Low-risk deliveries
  • Wednesdays are protected for didactics (AM) and continuity clinics (PM)
• OB Nights
  • Inpatient, part of the OB team (night)
  • Responsible for FM OB patients
  • Low risk deliveries
  • Wednesdays are protected for didactics (AM) (sessions available remotely if desired)
• Outpatient Pediatrics
  • At one of two UVM Pediatric clinic sites
  • Vacation allowed
  • One week within the rotation is dedicated to Newborn care - you will work with pediatric hospitalists, as well as lactation consultants.
• Outpatient Surgery
  • 2-week rotation at outpatient surgery clinics
  • Clinics include Colorectal, Breast Care Center (surgical oncology), and Pediatric Surgery
• Urgent Care Center
  • Self-scheduled to maximize options!
  • Will receive criteria and then can create your own schedule!
  • Vacation allowed

During your second year, emphasis is placed on increasing your knowledge, skills, and responsibility in inpatient family medicine, obstetrics, orthopedics, and office-based procedures. The PGY2 year also includes emergency medicine, outpatient gynecology, and geriatric medicine rotations. In addition, there are 10 weeks of elective time and one rotation practicing full time at MFP. Continuity of care expands and strengthens through 3-4 clinic sessions a week, home visits, nursing home rounds, and continued inpatient service. 

Beginning in July 2024, the program is piloting a mostly 2-week rotation schedule. Our goal is to achieve the following benefits:

• Increased continuity clinic experience by having more regular intervals in clinic
• Increased well-being with 2-weeks of inpatient rotations at a time

Our hospital-to-home Back to Bedside discharge clinic.

Originally funded by the ACGME Back to Bedside Grant, now fully sustainable for the future. We were one of only 3 Family Medicine programs to receive this inaugural grant in 2017.

As the PGY2 or PGY3 on our FM inpatient service, you will come to clinic for Back to Bedside (BTB) and see patients on their transition of care visit after hospital discharge

• Our interdisciplinary team includes social work, pharmacy, RN educator, and a dedicated 1:1 faculty preceptor
• Great opportunity to provide in-depth care with complex patients
• Quality improvement at work- with reduced re-admission rate for patients

See a sample PGY-2 schedule below:

Block 1 - FM Procedures/Weekend Nights/ Continuity Clinic at MFP/Dermatology*
Block 2 - FM Procedures/Weekend Nights/ Elective*
Block 3 - Gynecology/ Reproductive Health*/ Family Medicine Service
Block 4 - ​​​​​​​Gynecology/ Reproductive Health*/ Family Medicine Service​​​​​​​
Block 5 - ​​​​​​​Geriatrics*/ OB Nights
Block 6 - Geriatrics*/ OB Nights
Block 7 - FM Core
Block 8 - Continuity Clinic at MFP/Dermatology*/ Family Medicine Service Days
Block 9 - Palliative Care/ Family Medicine Service Nights ​​​​​​​
Block 10 - Elective*
Block 11 - ​​​​​​​Emergency Medicine
Block 12 - Family Medicine Service Days/​​​​​​​ Elective*
Block 13 - Family Medicine Service Nights/ Elective*

* Outpatient Rotations

• Continuity Clinic at MFP/ Dermatology
  • Time at continuity clinic in Milton
  • Dedicated Dermatology clinic sessions
  • Admin time as well as dedicated time to work on ABFM modules
  • Vacation allowed
• Elective
  • Self-directed learning.
  • Vacation allowed
• Emergency Medicine
  • Inpatient
  • Shifts rotate throughout the month to maximize time with Peds EM Attending
  • Protected didactic time
  • See a mix of adult and children
• Family Medicine Service Days
  • 6 days/ week, inpatient
  • Alternate PGY2/ PGY3 to attend Back to Bedside clinic (twice monthly per resident)
• Family Medicine Service Nights
  • Inpatient, 5 nights
  • Include a half day of continuity clinic
• FM Core
  • Core Family Medicine (back to basics) – covering Family Medicine Service (days and nights), FM OB (days and nights), and continuity clinic. Also includes some admin time.
  • 4-week rotation
• FM Procedures/ Weekend Nights
  • Mix of inpatient and outpatient
  • Scheduled procedure clinics with FM faculty
  • Protected didactic session
• Geriatrics 
  • Learn the principles of Geriatrics based on the 5M model that includes focusing on Mind and Mobility, navigating patients' Multi-complex illnesses as well as Medications, all while centering the patient and what Matters Most to them.
  • You will rotate with community partners that may include:
    • Driver’s rehab, home health PT/OT and RN/SW, adult day programs, Geriatric clinic, Falls clinic, as well as spend time caring for sub-acute rehab and long term care patients at Green Mountain Nursing Home
  • Vacation allowed
• Gynecology/ Urology/ Comprehensive Reproductive Care
  • Family Planning self-directed learning/ didactics, as well as clinics
  • Early prenatal ultrasound
  • Options counseling, including termination experience (opt out)
  • Vacation allowed
• OB Nights
  • Inpatient, part of the OB team (night)
  • Responsible for FM OB patients
  • Low risk deliveries
  • Wednesdays are protected for didactics (AM), available remotely
• Palliative Care
  • Division within the department of Family Medicine
  • Inpatient consult service and outpatient/ eHealth components
  • Opportunity to round at the inpatient hospice facility (Vermont Respite House)
  • Faculty nationally known for NIH-funded research on end of life conversations
  • Didactic curriculum for our residents – includes “Talk Vermont”, workshops with standardized patients on serious illness conversations, and symptom management

As a third-year resident, you will have the opportunity for advanced practice at Family Medicine Milton. Residents spend four to six half-days per week in the Center to continue to develop their clinical skills. In addition, you will have three rotation blocks to choose electives that match your educational needs and future career plans. Two Chief Residents are elected from the third year class.

Beginning in July 2024, the program is piloting a mostly 2-week rotation schedule. Our goal is to achieve the following benefits:

• Increased continuity clinic experience by having more regular intervals in clinic
• Increased well-being with 2-weeks of inpatient rotations at a time

See a sample PGY-2 schedule below:

Block 1 - Family Medicine Service Days/ Continuity Clinic at MFP*
Block 2 - Family Medicine Service Nights/ Continuity Clinic at MFP*
Block 3 - Family Medicine Service Nights/ Elective*
Block 4 - Family Medicine Service Days/ ​​​​​​​Elective* ​​​​​​​
Block 5 - Ortho/ Sports Medicine*​​​​​​​
Block 6 - Emergency Medicine
Block 7 - FM Core
Block 8 - ​​​​​​​Continuity Clinic at MFP*​​​​​​​
Block 9 - Outpatient Pediatrics*/ Family Medicine Service Days
Block 10 - Elective*
Block 11 - Elective*/ FM Procedures/ Weekend Nights
Block 12 - Outpatient Pediatrics*/ Family Medicine Service Days​​​​​​​
Block 13 - Elective*/ FM Procedures/ Weekend Nights

*Outpatient Rotations

• Continuity Clinic at MFP
  • Time at continuity clinic in Milton
  • Admin time, as well as dedicated time to work on ABFM modules
  • Vacation allowed
• Elective
  • Self-directed learning
  • One block can be away. Second block requires continuity clinic.
  • Vacation allowed
• Emergency Medicine
  • Inpatient
  • Shifts rotate throughout the month to maximize time with Peds EM Attending
  • Protected didactic time
  • See a mix of adult and children
  • Spend 2 days per rotation at a community emergency room in a rural area
• Family Medicine Service Days
  • 6 days/ week, inpatient
  • Alternate PGY2/ PGY3 to attend Back to Bedside clinic
• Family Medicine Service Nights
  • Inpatient, 5 nights
  • Include a half day of continuity clinic
• FM Core
  • Core Family Medicine (back to basics) – covering Family Medicine Service (days and nights), FM OB (days and nights), and continuity clinic. Also includes some admin time.
  • 4-week rotation
• FM Procedures/ Weekend Nights
  • Mix of inpatient and outpatient
  • Scheduled procedure clinics with FM faculty
  • Protected didactic session
• Ortho/ sports Medicine
  • Dedicated procedure/ MSK clinics with fellowship-trained attending
  • High school sideline coverage
  • Scheduled with other Ortho subspecialty providers (i.e. upper extremity, foot and ankle, podiatry)
  • Vacation allowed
• Outpatient Pediatrics
  • At one of two UVM Pediatric clinics
  • Vacation allowed

Outpatient rotations include dedicated community medicine time for experiences and assignments that educate residents about Milton, Burlington, and the surrounding communities, and teach them to understand and advocate for the needs of the underserved.

Residents engage in community building activities starting in their first year of training. They participate in education in the local schools through presentations such as “Helmets on Heads” and “Tar Wars”.

In the summertime, residents participate in the community garden with children from a nearby daycare. Residents discuss the importance of healthy eating and the benefits of various fruits and vegetables.

Previous community projects that the residents were involved with include a farm share distribution project and The Rocking Chair Project.

Residents also have the opportunity to interact with the community by participating in a variety of events from the Activities Fair, the Safety Fair, the community Fun Run- in Color and more!

Dedicated inpatient pharmacist who rounds with the Family Medicine Service team.

Embedded pharmacologist within clinic for additional teaching and patient co-management if desired.

Pharmacy residents co-rotate at MFP for shared learning experiences.

Dedicated pharmacy didactic sessions.

Our residents all participate in at least one Quality Improvement Project throughout their training. Dedicated time is spent with one of our core faculty where residents learn about SMART Goals, PDSA Cycles, and all of the basic tenants of quality improvement in the clinical setting.

Residents are supported with QI and research projects that look at health outcomes improvement through PDSA cycles, population management through registry management, as well as self-directed projects. Additionally, residents participate in monthly audits, including the OB Audit, Cervical Cancer Screening Audit, etc…

Residents come away with life-long skills in quality improvement that they can apply to their own clinical practice after graduation.

Home Visits

Residents are scheduled for Home Visits while on their Geriatrics rotation, as well as some continuity clinic rotations. Residents have the ability to identify patients in need, and have a dedicated faculty member who will attend the visits with them.

Nursing Home Care

During the second and third years, residents participate in regular Nursing Home rounds. Dedicated Family Medicine faculty attend these half day sessions.

The University of Vermont Family Medicine department has been an integral part of the State of Vermont’s response to the Opioid Crisis. As a department, we participate in a Hub and Spoke model, providing office-based medication for opioid use disorder (MOUD) with buprenorphine.  In the residency practice, second and third-year residents follow a panel of 8-10 patients with opioid use disorder for two years in a team-based clinic.  The MOUD clinic care team includes an attending physician, two resident physicians, a registered nurse, and a licensed social worker.

A longitudinal addiction curriculum spans all three years of residency to ensure residents are comfortable treating the full variety of substance use disorders.  This curriculum includes planned educational sessions and clinical education both in the continuity clinic and in the hospital.

Residents have the option to choose an addiction elective experience, which includes working with the UVM Addiction Treatment Center, the Emergency Room (involvement in initiation of buprenorphine or methadone), the local opioid treatment program Chittenden clinic (methadone), and Turning Point Center (local peer support group.)

• The behavioral health portion of the Family Medicine Residency program provides both didactic and hands on experience with psychiatric aspects of Family Medicine.
• Didactic sessions focus on:
  • Evaluation and treatment of psychiatric symptoms and illness
  • Evaluation of suicide risk
  • Substance abuse
  • Psychiatric emergencies in inpatient medicine
  • Psychopharmacology
  • Participation in Balint groups twice monthly for reflection on the emotional aspects of the practice of Family Medicine
• Additional resources now available at the continuity clinic site:
  • Pediatric mental health case manager
  • Two master’s level therapists specializing in CBT and substance abuse therapy
  • Monthly behavioral health case conferences held via Zoom
  • Primary care consultative service, in collaboration with psychiatry

Dedicated didactic curriculum with topics including:

• Voice therapy for gender affirmation
• Hormone therapy
• Fertility preservation and assisted reproduction
• Transgender mental health concerns
• Continuity clinic care at Milton Family Practice of transgender and gender queer patients
• Focused Gender-Affirming Care sessions with one of our local community providers

• Our Global Health curriculum includes a longitudinal series of education sessions and Grand Rounds with multidisciplinary faculty, and community resources with expertise in areas such as malnutrition, immunizations, infectious diseases, and maternal-child health.
• Longitudinal global health/ alternative culture curriculum includes time at the CHCB where residents gain experience caring for immigrant and refugee populations and the underserved.
• Residents also care for the Community Health Center patients on our inpatient hospital service as well as labor and delivery allowing for a richness of diversity in their clinical practice.
• Elective international health rotations are currently just starting to open up again in light of the COVID-19 pandemic. Residency safety is paramount and residents will only be allowed to rotate abroad if it is safe for them to do so.

The Maternal-Child health curriculum provides the knowledge and skill to care for families from preconception counseling through pregnancy, childbirth, and to well-child care. This includes didactic training from Family Medicine physicians with a commitment to Maternal-Child health.

Our residents rotate with various faculty in “Maternal-Child Health” clinics. During these clinics, patients are predominantly either prenatal, postpartum, or newborn.

This opportunity allows our residents to develop relationships with pregnant patients, with the goal of being present for continuity delivery experiences.

• Our program includes 3 FM-OB rotations: 1.5 daytime rotations, and 1.5 nighttime rotations.
• We currently have 10 Family Medicine faculty practicing OB
• We have a strong collaboration with our OB residency counterparts
• There is the opportunity for high volume low risk deliveries
• For those interested, there are elective options for maternal-fetal medicine and/or high risk delivery care

Recognizing the power of Point of Care Ultrasound in patient diagnosis, in 2022, the ACGME mandated that all Family Medicine residencies incorporate POCUS into their curricula.  Leading up to this announcement our residency worked hard to take this challenge head on, requiring an investment in software, hardware and personnel.

Our POCUS training starts at the beginning of the PGY1 year with a 2-day bootcamp held with the Emergency Medicine residency.  The longitudinal curriculum then intersperses POCUS training into existing rotations, using a combination of online modules and hands-on scanning.  Some of the hands-on scanning happens in the simulation center during structured workshops, but most happens during patient care.  Each resident exam is then reviewed and evaluated by fellowship trained POCUS faculty member, with feedback provided.  Didactics are focused more on image interpretation and pathology.  Additional workshops are available for POCUS based procedures.  There have even been a few “POCUS Parties” at the homes of faculty. 

We use Butterfly Enterprise software to store all POCUS images.  This software allows us to maintain a “proficiency dashboard” to track each resident's POCUS progress.  We have Butterfly IQ3 and cart-based machines available for use on both the inpatient and outpatient sides of care. 

Our expectation is that residents arrive without significant POCUS experience.  Yet, we strive to allow each resident to pursue POCUS training to the level that is right for them, be it answering questions correctly on board exams or graduating residency ready to apply for POCUS credentials at their next institution. 

• Residents are paired with FM faculty with dedicated procedure clinics
• Occur during various rotations (i.e. Gynecology, Sports Medicine, weekend Nights, plus additional elective time if desired)
• Hands-on experience doing office-based procedures including:
  • Cryotherapy
  • Skin biopsy
  • Joint injection and aspiration
  • Incision and drainage
  • Splinting and Casting
  • Vasectomy
  • Gynecologic procedures (IUD, Nexplanon, endometrial biopsy, colposcopy, etc…)
  • POCUS opportunities

• Original RHEDI site, now self-sustained and able to run in perpetuity
• Includes options-counseling training
• Long-term contraception training and gynecologic procedure training is embedded in the Family Medicine medical homes
• Ultrasound training
• Opt-out termination training

• Rural rotation can be completed as close as 45 minutes from the hospital and as far as the farthest reaches of the state!
• Can include full-spectrum rural Family Medicine
• Housing may be arranged, if scheduled in advance
• Great opportunity for immersion in true rural Family Medicine experience!
• New experience being offered in collaboration with Maine and New Hampshire to offer rural rotations in northern Maine.

• Two dedicated rotations in Orthopedics/ Sports Medicine
• Curriculum includes monthly didactics, as well as MSK and injection workshops
• Fellowship-trained sports medicine doctor is a core faculty member at our residency clinic site, and provides training in ultrasound-guided injections
• Sideline sports coverage includes Milton High School sports. Additional optional sideline sports coverage can include UVM Division 1 sports, St. Michael’s College Division 2 sports, and mass sporting events (Vermont City Marathon)
• Sports Medicine electives are available and include a schedule for those looking for more experience, as well as a dedicated schedule for those interested in pursuing a Sports medicine fellowship