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  UPMC St Margaret - Family Medicine Residency Program
  • Behavioral Science Education
  • Community Medicine Education
  • Geriatric Education
  • Medical Informatics
  • Obstetric Education
  • Pediatric Education
  • Pharmacotherapy Education
  • School Health Education
  • Sports Medicine Education
    bullet point  Behavioral Science Education
    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 monthly 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 monthly support group for all residents
    * 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, direct observation, patient simulations, 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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    bullet point  Community Medicine Education
    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 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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    bullet point  Geriatric Education
    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.

    Geriatric Patient
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    bullet point  Medical Informatics
    Medical Technologies at UPMC St. Margaret

    Medical Technologies education at UPMC St. Margaret is constantly evolving to keep up with the newest innovations for providing efficient, safe, evidence-based patient care. The successful 21st century family physician must be facile in all of these tools, and the UPMC St. Margaret faculty is committed to providing a thorough education for all residents in these technologies. Currently, faculty member Dr. Nil Das leads the Medical Technologies education team at UPMC St. Margaret.

    Electronic Health Records (EHR) & Physician Computerized Order Entry (PCOE)
    UPMC has been a leader in implementing innovative medical technologies for patients, and UPMC St. Margaret has been a leader within that system regarding the implementation of Electronic Health Records and Physician Computerized Order Entry.

    The EHR system for UPMC St. Margaret Memorial Hospital is Cerner. The hospital has transitioned to a fully electronic and paperless system, and most functions necessary for physicians have already been available for the past 7-8 years – electronic documentation and charting, lab and micro reporting, radiology image review, and physician computerized order entry.

    The EHR system for the UPMC St. Margaret Family Health Centers is EpicCare. All outpatient clinical documentation is done using this platform. UPMC also supports patient web portal access using HealthTrak to many EpicCare functions including laboratory results review, appointment scheduling, and refill requests. ePrescribing is available for all interested patients, eliminating the need for paper prescriptions and reducing patients’ wait time in the pharmacy. Also using HealthTrak, patients may electronically contact the office with questions or issues instead of using the telephone during busy office hours. These sophisticated communication tools allow for efficient, asynchronous, patient-centered communication that is convenient for patients, physicians, and staff. A new addition has been the arrival of eVisits, which, for a limited number of appropriate chief complaints, allow patients to describe their medical problem via an automated patient history program; the physician then responds back electronically to the patient with recommended treatment plan along with an ePrescribed medication if necessary.

    All residents receive intensive training and ongoing support to facilitate their mastery of these EHRs.

    All incoming residents receive a stipend to purchase a smartphone. A variety of approved models is provided to permit residents to work within their existing cell/data carrier if they desire, and the list is updated on a yearly basis. Residents receive training in the use their smartphones to access medical resources at the point-of-care.

    Medical Decision Making (MDM) curriculum
    The weekly MDM curriculum includes dedicated time for residents to practice using online and handheld evidence-based resources to rapidly find guidance to clinical questions.

    For fifteen minutes during the Thursday CCS (Core Curriulum Series) conferences, rotating St. Margaret faculty host a TechBYTE teaching session. These brief sessions offer highly practical tips and tricks for using the EHRs, smartphones, and online electronic resources.

    1-on-1 shadowing and support
    All interns receive intensive 1-on-1 teaching and support from residency faculty in learning the nuances of the outpatient EpicCare system. Additionally, all residents may request additional 1-on-1 sessions at any point during their residency.
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    bullet point  Obstetric Education
    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 10,000 deliveries per year. During this initial rotation, our first year resident functions as an intern in the labor and delivery suite, assuming full care of all family medicine patients in triage and labor & delivery. Our residents also evaluate private OB attending patients in triage and participate in their labor and delivery as well.

    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 high risk obstetrics. High volume obstetric experiences are also available in various locations across the country. ALSO (Advanced Life Support Obstetrics) is a requirement for all residents as a part of their family medicine training.
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    bullet point  Pediatric Education
    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 the newly opened Children's Hospital of Pittsburgh (CHP), one of the best pediatric hospitals in the world, conveniently located near two of our family health centers. The newborn nursery rotation is at UPMC Magee Woman’s Hospital with over 10,000 deliveries a year.

    Pediatric ConsultationAt the family health centers, outpatient management of pediatric issues is stressed. Over 25% of our patients are under 13 years of age. Residents develop expertise in well-child care (Dr. Middleton and Dr. Schroeder edit the American Board of Family Medicine review guide, Well-Child Care), immunizations (Dr. Richard Zimmerman at the University of Pittsburgh served as the American Academy of Family Physician's representative to the Advisory Committee on Immunization Practices of the Centers for Disease Control in Atlanta), and 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. In the Summer, residents can experience the role of being a camp physician. 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, etc.) is available. Residents are expected to be certified in Pediatric Advanced Life Support (PALS) with courses being offered each year at UPMC St. Margaret.

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    bullet point  Pharmacotherapy Education
    Pharmacotherapy education at UPMC St. Margaret is accomplished through a variety of means and media. Drs. Klatt, Farrah, Sakely, and Broders are members of the family medicine faculty and are involved in both inpatient and outpatient teaching services. The UPMC St. Margaret Pharmacy Residency Program was established in 2003, and has grown to include 4 PGY-1 Pharmacy Practice Residents and 2 PGY-2 Family Medicine Pharmacy Residents. In addition, clinical pharmacist specialists participate in rounds on all inpatient teaching services. The major components of our pharmacotherapy educational curriculum include:

    * Morning Rounds
    Inpatient clinical pharmacist specialists are an integral part of each of the inpatient teaching services 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.

    * Core Content Series
    Core pharmacotherapy lectures and drug updates are provided on a monthly basis for all residents. These conferences are given by a combination of pharmacist faculty members and residents.

    * Precepting and patient care at the New Kensington, Bloomfield-Garfield and Lawrenceville Family Health Centers
    Drs. Klatt, Farrah, and Broders spend time between the three health centers where they see patients in the Medication Management office sessions and are regularly available to precept residents regarding patients' drug therapy. In addition to the block Medication Management Rotation that is required as a part of our PGY-2 curriculum, residents doing their Outpatient FHC rotation spend time regularly seeing patients with members of our pharmacy team learning how to optimize patients’ medication therapies. The pharmacy residents divide their time between the three family health centers as well.

    * Inpatient and Outpatient Consults
    Both the inpatient and outpatient pharmacists are available for formal medication management consults on hospitalized patients as well as family health center outpatients, either to assist with the management of patients' drug therapy or for teaching about a specific medication or disease state. In addition, they are available for informal consultations.

    * Medication Management Rotation
    Second year residents during their medication management rotation work with Drs. Klatt, Farrah, and Broders and the pharmacy residents in the medication management service. Four half-day sessions are devoted to managing patient medication specific issues on the areas of anticoagulation, diabetes, hypertension, hyperlipidemia, asthma, and polypharmacy management.

    * Complimentary and Alternative Medicine Elective
    Second and third year residents have the opportunity to choose a complementary 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.
    Contact Information
    Michele Hilty
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    bullet point  School Health Education
    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, Pittsburgh Montessori, Arsenal Elementary, Woolslair, and the Urban League of Greater Pittsburgh Charter elementary schools and The Neighborhood Academy 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. 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. Several faculty members provided updated second editions published in June, 2010. 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 elements of these classes during “All About Me” classes 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. Dr. Klatt, the American Respiratory Alliance, and the residents teach students and school personnel to improve asthma recognition and self-management, beginning with the 1996-1997 school year. 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. A series of residents have provided sports physicals and shadowing experiences for grades 8-12 at The Neighborhood Academy and are gearing up for healthy cooking classes. Fitwits School research (2008) and the resulting fun 1-hour fifth grade program stimulate thinking about obesity prevention, associated diseases, exercise, nutrition, and portion sizes. The program uses didactics, hands-on and visual learning demonstrations, and memory and trivia games, resulting in an engaging program complemented by Fitwits MD in the physician office and research with parents in the community.

    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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    bullet point  Sports Medicine Education
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