Chief of Department of Family Medicine: Dr. Danielle Manis danielle.manis@nygh.on.ca
Postgraduate Site Director: Dr. Kim Lazare Kimberly.Lazare@nygh.on.ca
Postgraduate Site Assistance: Sally Principio sally.principio@nygh.on.ca
To practice Family Medicine in a realistic setting.
To acquire the knowledge and skills necessary for a Family Physician.
Seeing patients with:
undifferentiated illness
Acute self-limited disease
Chronic illness
Life threatening illness
Screening guidelines for preventative health
To experience continuity of care in a community setting.
To experience patients across their life cycle. Learning appropriate anticipatory guidance and counselling skills.
To gain experience working in an interdisciplinary team.
Your Family Medicine Block schedule must include the following for PGY-1:
6-7 half days per week in your preceptor's office
This includes 1 half day with your OB preceptor if they are not your main preceptor, and 1 half day in-person at the Long Term Care.
1 half day selective per week (optional)
See 'Contacts and Forms' tab for Family Medicine Selective Contacts
Wednesday Morning academic half days. These are mandatory regardless of which rotation you are on.
1 half day protected time for academic/QI project (optional)
1 optional half day per block in either the resident joint injection clinic run by Dr. David Zeldin (the last Thurs afternoon of each month) and/or the resident gyne procedure clinic run by Dr. Kim Lazare on the FMTU (typically Friday afternoon but can vary block to block)
Please fill out the family medicine template (posted at the bottom of this page) and send it to Sally prior to your Family Medicine blocks
Below is an example of a week on FM Block may look like. Remember that selectives and other enrichment half days can be replaced by half days at your FM preceptor's office.
There are three on-call experiences you are responsible for on your Family Medicine blocks:
Long-term care experience: You will take first call for Seniors Health Centre (a long term care facility across the street from NYGH) and Valleyview Nursing Home (near the Branson Hospital). This will be home call for a one-week period, twice per year. Back up will be the staff physicians who also take one week call from Monday to the following Monday. Hours of call will be 5-11pm weeknights and 9am-11pm weekends. You may be required to attend to assess and manage patients or pronounce death, but primarily will be responsible for triaging phone calls from nurses for acute issues. See attachments below for Staff Physician contact list.
You will also be on call with your FM-OB preceptor during the family medicine block and are expected to attend deliveries with them. Your call schedule for OB should be discussed with your preceptor. See below for more information regarding FM-OB.
You are also encouraged to participate in after hours care provision with your preceptors. This may include home visits or after-hours clinic within the FHO. Prior to your scheduled block month, please review their schedules so you are aware of any on call shifts they have during your FM block.
The FM-OB enrichment program assigns each FM resident with an experienced FM-OB preceptor who models the continuity of care thru maternal-child care within family medicine. The main objective is that you will form relationships with a group of obstetrical patients that you will follow in an office setting and be present for their labour, deliver, and post-partum care. As well, you will provide initial newborn care. You should be available (by pager or cell phone) to deliver these patients during your block time. However, there is an option to sign-out to the staff when you have other reasonable obligations. You should follow between 2-4 patients, who are close to term, with the goal of achieving a minimum of 6 deliveries over 2 years. You have the option of following these patients during your clinic half day back and even deliver them during other rotations if practicable.
If your main preceptor does not do OB, you will be assigned a FM-OB preceptor. You will spend (at least) a half day a week in your FM-OB preceptor office, seeing both family medicine and obstetrical patients. Preceptors know to try and schedule visits such that you will see a small group of obstetrical patients near term on a repetitive basis. In cases where FM-OB providers are in the same building or office, you may choose to attend the office for episodic prenatal/postnatal visits throughout the block time.
To help with contacting residents once a patient arrives at the hospital, you should affix your name and pager number on the antenatal 1&2 forms. This will help the triage nurse at the hospital identify you as the resident following the patient. You may also tell your FM-OB preceptor to notify you when there are deliveries. It is prudent that you discuss with your FM-OB preceptor your responsibilities. In some cases, you may be expected to go to L&D, assess the patient, then call the preceptor. In other cases, your preceptor may contact you after the assessment has already been done.
Signing out
It is recognized that being available by pager throughout the month is challenging. If you cannot attend a delivery, then you need to sign-out to your FM-OB preceptor. Tell you preceptor ahead of time that you will be unavailable for the week/weekend/day.
All Family residents are expected to attend two journal club evenings per year. Four journal clubs per year will be held and residents can choose which two they want to attend. Emails of dates will be sent at the beginning of your year. Residents not on block time may still attend the journal club. Critical Appraisal will be taught during Journal Club.
Your block time evaluations will be completed by your FM preceptors, including your FM-OB preceptor. These will be done on POWER. However, in addition your POWER evaluation, you will need to track all Patient Encounters to ensure you have seen a variety of cases. Please see below for instructions for tracking patients. You are also required to obtain Field Notes from you preceptor(s) as another method of assessment.
All patient encounters during your FM block AND clinic half-day backs are required to be logged onto your Resident Practice Profile (RPP) located on Portal. You must log any family medicine encounters at any sites, including deliveries and office based procedures. Once you log onto Portal, click on Practice Profile/Field Note on navigation panel on the left. Click on Resident Practice Profile (Respro). Record your encounter, which entails: age, sex, diagnosis (ICD Code), and procedures (if applicable). See below PDF for instructions.
In addition to the evaluation on POWER, your preceptors know to provide you with formative feedback on an ongoing basis. You are required to have at least 16 Field Notes per academic year. Your preceptors are to fill out the forms online at http://respro.med.utoronto.ca/fieldnotes/
In Family Medicine, follow-ups and continuity of care are essentials of good practice. To learn these skills, you should develop a "mini-practice" within your preceptor's practice. Here are some suggestions on how to assure that you have a strong FM block time experience:
Having patients you have seen return for follow-up when you are available.
Arrange to do periodic health examinations on adults and children.
New patients in the practice may see you first and identify with you as their new doctor.
Make your half days back consistent, so that the booking secretaries know when you will be working.
Visit patients admitted to the hospital from your preceptor’s practice.
Arrange with your preceptor to learn and practice the skill of telephone triage and management.
Use you clinic's EMR to track patient results and reminders to have patients return to see you.