Curriculum

An Area of Concentration (AOC) is a framework for family medicine residents who elect to pursue more advanced, in depth training in an area of choosing, with the goal of gaining additional skills and knowledge for future practice or career steps.  It is specifically intended to be a “stretch” goal during normal residency training, NOT additional time or a fellowship, individualized to meet the needs of the resident. 

The concept of focused training has been part of family medicine graduate education for decades.  Many of us have expertise in specific areas of family medicine that we have developed on our own.  This expertise not only can enhance patient care outcomes, but also can lead to sharing of skills and resources with colleagues and learners via teaching or other scholarly work.  

The overall goals are to provide an opportunity to recognize a resident’s extra efforts; encourage and recognize scholarly activity and presentations; encourage resident participation in national meetings; provide a framework to showcase areas of excellence; and help applicant students identify programs that meet their specific needs. 

The requirements for an AOC are: 

• A written program of study designed by the resident with faculty input that identifies the area of study with competency-based goals and objectives and an evaluation component. 
• At least 2 months or 200 hours of training in the AOC, above and beyond RRC requirements. 
• A scholarly project completed in the AOC, which should be presented and evaluated locally. Presentation at the state and/or national level is encouraged. 
• Attendance at a national CME meeting in the AOC. 

• Journal club (critical appraisal) presentation of an article in the chosen area. 
• Quality outcomes must be demonstrated, using case logs with patient outcome data, procedure logs and faculty reviews of resident competency in the AOC. 
• Successful completion of the residency program itself. 

The AOC should be documented through a portfolio of materials that include the above. 

Ideally, an AOC should be identified and started by the R2 year, although development in the early R3 year is acceptable if requirements can still be met by graduation.  The initial steps are to identify an area of interest, and a faculty mentor who agrees to work with the resident in that area.  The resident is responsible for submitting the plan for the AOC in the format attached; developing the portfolio; and completing the requirements.  A certificate will be presented at graduation acknowledging the completion of the AOC, and will be included in summary evaluations of the resident sent to future employers. 

Examples of recent AOCs include: 

• Musculoskeletal Medicine 
• Reproductive Health 
• Sports Medicine 
• Scholarship and Research 

• Clinician Educator 
• Quality Improvement 
• Global Health 

POCUS – Point-of-care ultrasound (POCUS) is a rapidly growing area of interest within primary care and is sometimes referred to as the “stethoscope of the 21stcentury”. When utilized appropriately by a trained clinician, POCUS can answer a specific clinical question or provide immediate diagnostic information in real time, and it has many potential applications. Recognizing thegrowing nationwide momentum of POCUS use in primary care, the UWFMR devised and started a contemporary, longitudinal POCUS curriculum to span the three years of residency training. Skills will be introduced in the first year of residency and expanded upon throughout years two and three. The curriculum includes individual, small group, and large group teaching and workshops. Both the Northgate and Harborview clinic sites have state-of-the-art ultrasound machines both for clinical use as well asthese educational initiatives. This is an area ripe for scholarship and clinical research for interested residents.  

Examples of procedures:  

• Outpatient procedures  

• • Skin: biopsies (punch, shave, excisional biopsies), cryotherapy, dermoscopy, laceration repairs.  
  • Lumps and bumps: I&Ds, lipoma and cyst excisions 
  • MSK: joint injections and aspirations, ultrasound, casting and splinting  
  • Reproductive health: IUD and Nexplanon insertions and removals, terminations (medical and surgical), endometrial biopsies,colposcopies, vasectomies  
  • Newborn: circumcisions   

• • Other: thrombosed external hemorrhoid treatments, tongue tie release, anoscopy 

• Inpatient procedures   

• • Vaginal deliveries   
  • CVC and arterial line placements   
  • Lumbar punctures (adult and pediatric)   

• • Thoracentesis, paracentesis  
  • Fracture reductions   
  • Colonoscopies  
  • C-section assist  
  • Intubations