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 Behavioral Science Education |
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Michele A. Reiss, PhD, is the Director of Behavioral Sciences and the Assistant Program Director for St. Margaret's family medicine residency. Dr. Reiss is a certified psychiatric clinical specialist and medical psychotherapist who maintains a part-time private practice in addition to her full-time clinical and administrative responsibilities at UPMC St. Margaret. Patricia McGuire, MD is the Director of Psychiatric Education. Dr. McGuire is board certified in general psychiatry as well as child/adolescent psychiatry, and practices community psychiatry in nearby rural Butler County.
In 1970, the year before we accepted our first residents, the core medical faculty participated in an introductory Balint Seminar, the first of its kind in the United States. This case-centered approach to the psychological aspects of medical practice remains an important part of behavioral science education at UPMC St. Margaret. Today, behavioral sciences are a fundamental part of everyday residency life at UPMC St. Margaret. Over the past two decades, we have evolved a multifaceted, integrated, team approach to behavioral science education. It is incredibly gratifying to participate in the education of such compassionate and highly skilled family physicians. Major components of our behavioral science curriculum include:
* a weekly Balint seminar (co-led by medical and behavioral science faculty), for all first, second, and third year residents
* a monthly Balint seminar for all faculty and training in Balint leadership for family medicine fellows
* a comprehensive and diverse series of core behavioral science lectures
* weekly team (medical/psychiatry) teaching rounds for resident covered inpatient services
* team (medical and behavioral faculty) precepting and psychosocial support services available at the family health centers
* individualized interview skills training using either videotape review or one-on-one precepting experiences
* an available psychiatry "elective" emphasizing advanced interviewing techniques and psychosocial assessment strategies
* a dual advisor system - individual advisor meetings with both medical and behavioral science advisors, to provide residents with ongoing feedback and support
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| Community Medicine Education |
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Our community medicine program reflects UPMC St. Margaret's strong commitment to community health care and community service. Community medicine educational experiences are integrated into both the family medicine residency and fellowship programs. Dr. Sandy Sauereisen is the full-time Director of Community Medicine. Dr. Sauereisen is a board-certified family physician with a master's of public health from Johns Hopkins School of Public Health.
UPMC St. Margaret's community medicine program is multifaceted. Major components of this program include a first year community medicine rotation and a longitudinal community medicine project for second and third year residents. During the first year rotation, residents will be introduced to the special challenges of community health care via a home visitation program, indigent community health centers, and our school health partnership program, as well as exposure to many community agencies and patient/community education principles.
It is our hope that through training in COPC principles and developing strong one-on-one relationships with patients through community-based activities, residents will gain an understanding of the socio-economic, cultural, and family dynamics which characterize our community of patients. By understanding the individual in the context of family and community, the physician can employ more appropriate strategies to alter health behaviors. |
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| Geriatric Education |
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Allegheny County is second in the nation only to Dade County, Florida in its percentage of persons over age 65. In response to meeting the special challenges of this growing population, high priority is placed upon adequately preparing our residents to care for these patients. Many of our faculty members are actively involved in developing new initiatives, insurance products, and serving on CQI committees for the elderly. One of our goals is to encourage residents to continue following patients in long-term care settings upon completion of their residency program.
Geriatric educational experiences are integrated into all three years of our residency curriculum. During the first year, geriatric topics are routinely addressed during daily inpatient teaching and progress rounds. Our noontime conference schedule also includes core lectures specific to geriatric medicine such as cognitive impairments, incontinence, osteoporosis, sensory deprivation, decubitus ulcers, malnutrition, and elder abuse. First year residents will occasionally begin following patients at Seneca Place, a long-term care facility that is part of the UPMC St. Margaret healthcare network. The home visit program brings the first year resident into close contact with community-dwelling, homebound geriatric patients.
During the second year, residents assume continuity care of one or more nursing home patients. Each resident is responsible for history and physicals, required periodic visits, and management of any acute problems that may arise. Our family medicine residency faculty provides supervision and backup. A required third year geriatric block rotation complements this longitudinal experience. During the geriatrics rotation, residents join the team of geriatric specialists at UPMC St. Margaret's Classic Care, one of the few approved geriatric assessment units in western Pennsylvania. Third year residents continue their longitudinal nursing home experiences and make site visits to enhance their awareness of available community resources.
Postgraduate education boasts an accredited geriatric fellowship. This is one of the few family medicine-based geriatric fellowships in the country. Two fellowship positions are available at UPMC St. Margaret. This is an intense, clinical fellowship with multiple teaching and learning opportunities. Each fellow is encouraged to participate in faculty development and research activities.
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| Medical Informatics |
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St. Margaret is a leading center for medical informatics, the discipline that encompasses the broad range of applications of information technology in medicine. Medical informatics activities involve the participation of all health care providers including residents, faculty and nursing staff, and include the following:
* Education
UPMC St. Margaret is very much involved in educating physicians and other health care professionals in the use of information technologies. All new interns attend an introductory course in computer applications including information retrieval, communication, data management, and office/presentation software. This education extends to family medicine fellows and faculty. Expertise in teaching medical informatics, furthermore, has allowed UPMC St. Margaret to extend educational programs to other residencies within the UPMC consortium. Faculty and fellows at UPMC St. Margaret are involved in teaching clinical computing to community-based family physicians through continuing medical education programs and in private offices. Demand for such educational programs is growing rapidly, and UPMC St. Margaret is expected to remain a leader in medical informatics education.
* St. Margaret Clinical Medicine Guidelines Database
Clinical medicine guidelines are playing an increasingly important role in the practice of medicine. Education about them, therefore, is crucial at the residency level. The UPMC St. Margaret clinical medicine guidelines database project is an effort to teach family medicine residents how to retrieve, critically appraise, and utilize clinical medicine guidelines. Residents select and contribute guidelines to an online database on a regular basis. The database is growing rapidly and is used by physicians all over the country. A unique and practical approach to educating residents about clinical medicine guidelines within the context of medical informatics, the project was recently the focus of a presentation at the national Society of Teachers of Family Medicine conference.
* Handheld Computing Initiative
UPMC St. Margaret has launched an initiative to provide systematic training in the use of handheld technology to our residents, fellows, and faculty. All residents will complete four training modules designed to provide them with the skills needed to use this rapidly growing and exciting technology resource in the clinical setting. While many residency programs distribute handheld computers to their residents, ours is unique in making a commitment to training, development and selection of special applications and research.
* Integration of Medical Informatics and EBM
Our weekly Journal Club series serves as a focal point for integrating Evidence Based Medicine into every day clinical medicine. Resident-led discussions with faculty center on making EBM principles useful. Our popular biostatician, Dr. Frank D’Amico, demonstrates the practicality of good statistical methods. Faculty member Dr. Goutham Rao has recent co-authored an AAFP monograph on evidence based medicine, and our residency faculty and fellows are frequent contributors to the Journal of Family Medicine Journal Clubs POEMS (Patient Oriented Evidence that Matters).
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| Obstetric Education |
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Obstetric and gynecologic education at UPMC St. Margaret involves a series of block rotations in obstetrics, a longitudinal experience in obstetrics, and a case-based discussion series, as well as an optional obstetric track. In the first year, a month is spent at Magee-Women's Hospital (MWH), which is the largest obstetrical hospital in Pittsburgh. Magee has a very large service with approximately 7,000 deliveries per year. During this initial rotation, our first year resident functions as an intern in the labor and delivery suite, assuming a full and equal responsibility with the Magee intern on the labor and delivery rotation. As a full member of the L&D team, our resident participates in all activities of the team including initial evaluation and supervision of private attending patients as well as delivery of clinic patients.
In addition to these block rotations, residents follow their own family health center patients through pregnancy, labor, delivery and the post-partum period. Residents deliver their family health center (FHC) patients at Magee-Womens Hospital's new birthing center. There, a team of family physicians with obstetrical training and interest supervise our deliveries. Our residency program has developed an optional obstetrical track for those interested in practicing family medicine obstetrics upon graduation. The obstetrics track offers additional experiences in neonatology, including newborn resuscitation, ultrasound and ALSO (Advanced Life Support Obstetrics). High volume obstetric experiences are available in various locations such as Colorado, New Mexico, Alaska or in California. |
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| Pediatric Education |
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Pediatrics is an important and stimulating part of family medicine. Dr. Maryellen Schroeder and Dr. Donald Middleton coordinate the pediatric educational program at UPMC St. Margaret. Both Dr. Middleton, certified in Medicine and Pediatrics, and Dr. Schroeder, a certified PALS instructor, are full-time family medicine faculty. They both have a special interest in the care of children and enjoy caring for a large number of children within a family medicine setting.
Residents at UPMC St. Margaret are well-trained in all aspects of pediatric care. Five months of required full-time pediatric rotations are broken down as follows:
* one month - Inpatient
* one month - Outpatient Clinic and Newborn Nursery
* three months - Urgent Care and Emergency Room
Four of these rotations are at Children's Hospital of Pittsburgh (CHP), one of the best pediatric hospitals in the world.
Additionally, each resident has two months of further, albeit less intense, inpatient pediatric responsibility as part of the family health center rotations. This family medicine-oriented service enables the resident to see first hand how family physicians in private practice deal with pediatric inpatients. Residents also follow their own pediatric patients in-house at UPMC St. Margaret.
 At the family health centers, outpatient management of pediatric issues is stressed. Over 25% of patients are under 13 years of age. Residents develop expertise in well-child care (Dr. Middleton and Dr. Schroeder edit the ABFP review guide on Well-Child Care), immunizations (Dr. Richard Zimmerman at the University of Pittsburgh serves at the AAFP's liaison to the ACIP of the Centers for Disease Control in Atlanta), as well as developmental and adolescent issues (Dr. Michele Reiss has extensive experience in these arenas). All residents rotate through a school health experience providing school health education, including puberty, sexual education, violence prevention and nutrition, to various Pittsburgh grade school students. A core lecture series on pediatric topics is scheduled each year at UPMC St. Margaret.
In addition to the above required rotations, many excellent electives are available to those with interest. Virtually any pediatric subspecialty rotation (cardiology, infectious disease, nephrology, neurology, NICU) is available. Residents are expected to be certified in Pediatric Advanced Life Support (PALS), as well as Neonatal Advanced Life Support (NALS), with both courses being offered each year at UPMC St. Margaret.
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| Pharmacotherapy Education |
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Pharmacotherapy education at St. Margaret is accomplished through a variety of means and media. Dr. Klatt is a member of the family medicine faculty and is involved in both in- and outpatient teaching services along with a pharmacy resident. UPMC St. Margaret Pharmacy Residency Program was established in 2003. In addition, hospital pharmacists participate in the inpatient teaching services. The major components of our pharmacotherapy educational curriculum include:
* Morning Rounds
Once a week on each of the inpatient units at UPMC St. Margaret, morning floor rounds include case-related discussions of relevant pharmacotherapy concerns such as drug choice, dosing requirements, mechanisms or action, side effects and drug interactions.
* Noon Conference Series
Core pharmacotherapy lectures are provided on a monthly basis for all residents. These conferences are either given by Dr. Klatt, the pharmacy resident, or by a visiting professor.
* Precepting at the New Kensington, Bloomfield-Garfield and Lawrenceville Family Health Centers
Dr. Klatt divides her time between the three health centers where she is regularly available to precept residents regarding patients' drug therapy. The pharmacy resident divides his/her time between two of the health centers as well.
* Inpatient and Outpatient Consults
Dr. Klatt and the pharmacy resident are available for formal medication management consults on hospitalized patients, either to assist with the management of patients' drug therapy or for teaching about a specific drug. In addition, they are available at the health centers for either formal or informal consultations.
* Medication Management Rotation
Second year residents during their medication management rotation work with Dr. Klatt and the pharmacy resident in the medication management service. Three half-day sessions are devoted to managing patient medication specific issues on the areas of anticoagulation, diabetes, hypertension, hyperlipidemia, asthma, and polypharmacy management. The resident also actively teaches in diabetes group education.
* Complimentary and Alternative Medicine Elective
Second and third year residents have the opportunity to choose a complimentary and alternative medicine elective. During this elective, residents will meet with a variety of practitioners including acupuncturists, chiropractors, dietitians, herbal specialists, pharmacists, and family practitioners who integrate complimentary medicine into their practices. Learning takes place via direct patient care, observation, case discussions and presentations.
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| School Health Education |
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Our school health program is a vital part of UPMC St. Margaret's commitment to children and to the community. Our school-linked partnerships with Fort Pitt, Friendship, McCleary, Woolslair, and the Urban League Charter elementary schools overlap the same communities and families served by our family health centers. In the best public health sense, this enables us to fashion preventive health care for young students and their teachers based on community observations.
In 1989, UPMC St. Margaret developed the first operational school health partnership in the Pittsburgh area. Our specific goals included on-site screening physicals for entry, second, and fourth grade students with parent permission; priority treatment at the health centers if requested by school personnel and parents; and educational programs for the schools. We work closely with the school nurses in evaluating and following students.
Beginning in 1990, we had faculty in-service programs on first aid and common illnesses in school-age children. Our First Aid Guide has been given to all the parochial and public school nurses in the Pittsburgh district and has been used by residents to teach small group meetings and day camp students. In 1991, our residency piloted courses for fifth graders on expected puberty changes, followed by classes on human sexuality, relationships, family life, and sexual health risks. Drs. McGaffey and Schroeder published What About Me: Puberty Education for Preteens (1994) and Learning About Sexuality Is Like Learning How to Swim (1993) to use in the classroom and as a home resource. Our violence and conflict resolution class "Peacemakers" (April 1996) is taught to fourth graders each winter. Advocacy of nonsmoking for third graders, "Kids Say Don't Smoke," accompanies the Great American Smoke Out (debuted November 1995). Residents also can teach a series of these classes to East End fifth and sixth graders in community settings.
Each year of this community partnership has brought innovations. During spring 1995, UPMC St. Margaret's nurses and residents partnered with Fort Pitt school, Carnegie Mellon University, and various community groups on Dare to Share Day, erecting a safe and attractive playground for inner city youth. "Pleeze Don't Wheeze" asthma education for students, teachers, and residents commenced during the 1996-1997 school year. Dr. Klatt, the American Respiratory Association, and the residents teach students and school personnel to improve asthma recognition and self-management. Our summer 1997 pilot on nutrition and exercise, "Too Much, Too Little, Just Right," captivated day camp children thanks to a video and small station activities brainstormed by residents and fellows. Camp Kon-O-Kwee invited us to help the camp nurses evaluate and treat campers every summer. In 2003, residents acquainted kindergartners with medical exams during a Teddy Bear Clinic. Improved nutrition and exercise programs were given to second graders in 2004.
UPMC St. Margaret family medicine residents play an active role in our school health program. First year residents spend one day per week with the school health program during their community medicine rotation. Senior residents have multiple opportunities to continue their involvement with this exciting and innovative program. |
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| Sports Medicine Education |
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UPMC St. Margaret is renowned for its orthopedic excellence. The UPMC Sports Medicine Center, an 11,000 square foot facility, is on site and features outstanding physical therapy and the latest equipment, including a Swim-ex swimming machine. The attending physicians for the center are team physicians for local high schools and colleges, as well as for the Pittsburgh Penguins and Steelers.
Education in sports medicine is lead by Dr. Anne Boyd, a full-time faculty member who is also Director of the UPMC St. Margaret Primary Care Sports Medicine Fellowship. Prior to coming to UPMC St. Margaret, Dr. Boyd was in private practice in New Hampshire and then completed a sports medicine fellowship at Kaiser in California. Residents have two rotations, emphasizing primary care sports medicine and orthopedics. During these rotations, residents work in the offices of orthopedic surgeons and primary care sports medicine physicians. The Lawrenceville and Bloomfield-Garfield Family Health Centers have separate primary care sports medicine clinics staffed by an attending and our sports medicine fellow. Rotating residents learn diagnostic, radiographic, and procedural skills necessary to manage musculoskeletal problems after residency.
Didactic lectures are held monthly and include medical issues and focused sessions on specific joint examinations. There are teaching opportunities for first year residents and medical students during these rotations. For those with a strong interest, there are opportunities to spend elective time in a variety of sports medicine experiences.
For those who want additional sports medicine experience or who are considering fellowship after residency, UPMC St. Margaret has one of the region’s finest Sports Medicine Fellowships. In collaboration with Dr. Freddie Fu, Chairman of Orthopedics and head team physician for the University of Pittsburgh, the fellow works with Pitt's football, men’s soccer, men’s basketball, and wrestling teams and serves as the team physician for Shaler Area High School. Our fellow rotates weekly with Dr. James Bradley, head team physician for the Pittsburgh Steelers. During the year, residents have numerous opportunities to receive first hand experience along side our fellow at preparticipation physical examinations for local high schools and in medical coverage for the Pittsburgh Marathon and other local sporting events. |
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