A resident’s perspective on life at the University of Washington Family Medicine Residency

A Letter from A UW Resident to You, the Applicant (with pictures of real residents having real fun)

Hello from the Pacific Northwest! I am a recent graduate from the University of Washington Family Medicine Program.

Three years of residency fly by faster than you think. I remember being in your position wondering which program would be the best fit for me. I applied to mainly university based residency programs because I wanted to train in a rigorous academic environment, develop my skills in evidence-based medicine, work with residents/attendings across different specialties, and pursue teaching opportunities. I was not too sure what I wanted my post residency career to look like so I was also searching for a program that would provide me with the widest breadth of experiences.

At the University of Washington Family Medicine Program there is no shortage of opportunity. If you can think of it, it can happen. Our training spans multiple different sites that provide us with experiences in a wide variety of practice environments. We cover the full spectrum of family medicine. This exposure is definitely reflected in the choices of our graduates. They have gone on to work in rural practices, urban underserved areas, international work, public health, academic medicine, and to pursue fellowships in Research, CDC Epidemiology, Sports Medicine, Obstetrics, Rural Health and Palliative Care.

Our experienced, committed faculty as well as our equally diverse group of residents is a major strength of our program. I have found support and mentorship for my interests. I have developed relationships with people that have continued beyond my three years of residency.

I cannot talk about our program without mentioning our wonderful city. There is more to Seattle than the rain and the rain definitely does not stop us from enjoying what the city has to offer. Seattle has all attributes that come with any major city (the arts, great music scene, wonderful restaurants), packaged in a laid back atmosphere, and set against a stunning backdrop of the Puget Sound, the Olympic and the Cascade Mountain ranges. Seattle is conveniently located three hours away from the Washington Coast, Portland, and Vancouver, Canada. On a clear day, you can see all the way to Mount Rainier from multiple different vantage points in the city. On their off time, residents will go camping, kayaking, get a group together for a movie or a hike, or just meet up for a bite to eat.

I have truly enjoyed my training at this program. I have developed skills in areas that initially inspired me to go into medicine as well as expanded my knowledge in new areas. I am excited and prepared for whatever comes next in my career.

I hope you will take a serious look at our program as you start thinking about your next step.

All the Best,

Kavitha Chunchu, MD

Overview of Our Program

The University of Washington Family Medicine Residency program is one of the premier academic Family Medicine residencies. Our program thrives as an academic, primary care-focused department at a large nationally-recognized medical care center. As residents on our own Family Medicine ward teams, we work in close contact with our faculty to care for our patients. We rotate through a variety of hospitals, alongside residents from Internal Medicine, Pediatrics, Obstetrics, Emergency Medicine, Surgery, and various medical specialties. We have the privilege of leading medical teams in major hospitals, where we are expected to equal our specialized colleagues in skill and knowledge base. We do travel to an array of hospitals scattered about the city of Seattle and beyond, and we experience a truly broad demographic of training opportunities.

Residents who train here are quite adaptable, demonstrating an ability to thrive in many different academic settings. Getting accustomed to different environments can pose its own challenge. However, practicing medicine in a wide variety of clinical settings allows our residents to choose a broad array of practice opportunities upon graduation. We pride ourselves in our varied interests, and our training and practice choices reflect this diversity.

Below, I will briefly discuss the primary training settings in which our residents rotate. I will follow this with a brief overview of each of the 3 years of training. You can also direct yourself to our GoogleMaps listing to see geographically where our residents train. I hope that the following passages will give you a sense of the program and whether it would be a good fit for your training in Family Medicine.

Training Locations- A Resident’s Perspective

University of Washington Medical Center
The “U” or "U-Dub", as we affectionately call it, is a large tertiary care teaching hospital located on the banks of the Montlake Cut between Lake Union and Lake Washington, in the heart of Seattle. It is the site of many of our clinical rotations, including our own inpatient Family Medicine service. The University hospital offers a full spectrum medical facility, with every imaginable specialty. Here, our residents have exposure to cutting edge medical treatments, research, and training.

Residents rotate on the Family Medicine service (6 weeks as first years, 2 months as second years, and 1 month as third years), where we care for adult medicine patients, obstetrics patients, and newborns. In our downtime when on the Family Medicine Service, we spend time in “Paradise”, our cleverly named call room. While at the UW Medical Center, residents also spend dedicated time on the Obstetrics Labor and Delivery unit for six weeks during the first year where they see a high acuity, complex obstetrical population. Additionally, residents spend 4 weeks in the UW ER, 2 weeks in the Neonatal intensive care unit, working alongside Pediatrics residents, and 4 weeks working alongside Internal Medicine residents in the ICU. In the third year, residents find many elective opportunities scattered amongst the various specialties that are housed at the UWMC. Finally, the UWMC is also the Home of the Department of Family Medicine, which is affiliated with the University of Washington School of Medicine.

Harborview Medical Center
“Harborview”, which is scenically situated overlooking the Puget Sound, downtown Seattle and Elliot Bay, is the only level-one trauma center serving the states of Washington, Alaska, Montana, and Idaho. It is home to the Harborview Family Medicine Clinic and the “Harborview Residency Track.” Like the UW Medical Center, Harborview offers the full array of medical training and teaching facilities, and it is the number one provider of underserved care in the state of Washington. The dedication of the faculty and staff to their patient is reflected in their mission to provide the highest level of care to their patients, regardless of their economic means. It is here that one sees individuals of all socioeconomic strata, from far reaching countries to our city’s own indigent population, come to seek their care. Residents rotate through ward medicine months for at least 4 weeks while they are first years. Two of our eight residents who have their clinic at Harborview also will co-senior Internal Medicine services here, while in their second year of training. All of our residents spend at least 2 weeks in the Harborview ER, working as care providers on the trauma ER service.

Seattle Children's Hospital
“Children's” is the pre-eminent pediatric teaching hospital and tertiary care provider for the state of Washington. Located near the shores of Lake Washington, Children's is located in an idyllic neighborhood in northeast Seattle, just 1 mile from the UW medical center. In addition to housing one of the nation’s top pediatric residency training programs, Children’s is home to many training opportunities for our Family Medicine residents. It is here that Family Medicine residents rotate on ward services for 4 weeks as first year residents. Additionally, our first year residents now spend 4 weeks in the Children’s Emergency Room. Here they gain experience with acute pediatric illnesses and injuries that are frequently seen in a Family Medicine setting. As second years, Family Medicine residents return to Children's to spend another month in the Children’s ER. Our residents often cherish their experiences and memories of training at Children's, which is one of the most efficiently run and vibrant hospitals in the UW system. R2s and R3s additionally can have sub-specialty pediatric rotations in outpatient clinics.

Veteran's Administration Medical Center
The Puget Sound VA in south central Seattle is home to many UW rotations. In fact, residents from Surgery, Internal Medicine, and various subspecialties spend significant time here. Residents who train in the “Roosevelt Track” spend 4 weeks on an Internal Medicine service here during their 1st year. Additionally, Family Medicine residents lead internal medicine ward and ICU services for 1 month as second years. An additional month, for Roosevelt residents during the second year, is spent on the Hospitalist Service. The VA rotations tend to be some of the most intense of our residency program, combining high patient volume with frequent call (and often sleepless nights), night-time cross cover call, and an open ICU, to which the ward service admits patients along with floor patients. Our residents who rotate at the VA find these to be some of the most valuable rotations, where they really earn their chops and gain the clinical confidence to manage nearly any medical problem or emergency. Most importantly, the veterans truly appreciate the care that our residents provide to them, and it is an honor and privilege to work with them.

Group Health Cooperative - Capitol Hill
“Group Health” is situated in the heart of Capitol Hill in Seattle, between UW Medical Center and Harborview Medical Center. This hospital is home to our second year OB rotation. Residents work alongside faculty and residents from the Group Health Family Medicine residency and this rotation provides a more primary care-focused, community obstetrical experience. This rotation reinforces the more complex OB skills obtained during the first year OB rotations at UWMC.

Roosevelt Family Medicine Clinic**
“Roosevelt” is home to the “UW Roosevelt Family Medicine Track.” The administrative home of the residency is housed here, and it will be the site that you first see on your visit to our program during the interview season. The clinic is located approximately one mile from the UW Medical Center in the heart of the University District, one of Seattle’ s distinctive neighborhoods. Eighteen of our 24 residents have their clinics based at Roosevelt. Residents see a wide range of patients at Roosevelt. Proximity to the University provides residents here with patient panels consisting of young families, students, and elderly members of the surrounding communities. Additionally, this clinic serves a large Russian-speaking population. Behavioral scientists, a social worker, a nutritionist, three registered nurses, medical assistants, and patient service representatives, all who serve a crucial role in patient care compliment the clinic faculty and staff. Of note, the Roosevelt Facility is home to an assortment of other UW clinics, including General Internal Medicine, Orthopedics, Pediatrics, Physical Therapy, and Women’s Health. The clinic also has a full service Radiology department and laboratory services on site. Interpreter services are provided in most languages by UWMC and are available at the clinic for our non-English speaking patients. Easy access to and from Harborview and the UW Medical Center is available via the Health Sciences Express, which runs every 15 minutes during business hours.

** The Roosevelt Family Medicine Clinic will close approximately March of 2012 and a new larger facility will be opened at Thornton Place in the Northgate area of Seattle under the direction of UW Medicine and it’s primary care arm, the University of Washington Neighborhood Clinics (UWNC). Thel neighborhood is ideal with many opportunities to create ties to the community and lend to more pediatric and obstetrical patients. The clinic will be a free standing clinic so we will not have a need to compete with other UWMC clinics. We hope to develop a referral clinic for other North Seattle primary care clinics who do not provide the broad spectrum of care and procedures provided at the UW Family Medicine Residency. Free parking will be available for those who drive and the Northgate Metro transit center is located 1 block away where 1,000 buses traverse each day and the future Northgate light rail transit station will be developed. Thornton place currently attracts 1.4 million people a year to its other services and recreation.

Harborview Family Medicine Clinic
Harborview’s Family Medicine Clinic is now located in a new facility called the Pat Steele Building that is three blocks away from Harborview Medical Center. HMC is home to a group of vibrant clinicians, faculty, staff, and residents; all of whom have a true passion and mission for providing comprehensive care to our population of urban underserved patients Six of our twenty four residents call the Harborview Clinic their home and see a broad array of patients from many sociocultural backgrounds. The clinic, additionally, serves large Somali, Eritrean, Ethiopian, and Vietnamese populations situated around and near Harborview Medical Center. Interpreter services,provided by HMC, are often a vital component of patient care for the Harborview Family Medicine Clinic. Growing interest is forming to align what is currently the Harborview FMC with a community health center and form a Teaching Health Center. Discussion is in very early stages at this time with no immediate plans for a change in location.

Away Rotations
Residents spend 1 to 2 months at sites away from the UW system, in more rural settings scattered across Washington, Montana, and beyond. Most residents find these “away” rotations to be rewarding, as a way of getting away from the university setting and practicing family medicine in a smaller community. Below are a few available rotations, however, residents can set up their own away experiences as well.

Popular Community Practice Sites:
Sequim: Situated approximately 3 hours from Seattle on Washington’s Olympic Peninsula, the Sequim rotation provides residents a truly rewarding and diverse community family medicine experience amongst the Olympic Mountains and the Pacific Coast Line. Residents spend mornings managing an inpatient service, followed by a day of clinic. Call is infrequent, giving residents a chance to explore the dramatic and beautiful environments surrounding this community. The Jamestown S’Klallam Indian Tribe funds the clinic in Sequim, and residents have the unique opportunity to become involved in tribal activities, such as health fairs and community social events. Residents who rotate here are provided with accommodations. Residents work with a wonderfully dedicated staff of physicians who, together, provide comprehensive care to the community.

Libby, Montana: Located near Glacier National Park and Montana’s Western border, the Libby Montana site offers residents a chance to work as a family physician in a small rural community, with easy access to bountiful recreational activities, including skiing. Both inpatient and outpatient experiences are provided as part of the experience. The clinic provides housing for residents who choose to rotate in Libby.

Othello, WA: Located in the Columbia River Basin about 180 miles away from Seattle, 100 miles southwest of Spokane. Residents have the opportunity to work closely with full spectrum community physicians to provide medical services to a large Spanish speaking population. There are numerous opportunities for camping, visiting the Columbia River National Wildlife Refuge, and participating in local life through fairs, festivals, etc. Housing is provided to residents.

The UW Family Medicine Curriculum- A Resident’s Perspective

R1 Curriculum
The first year of training in the UW program is probably the most intense of the 3 years. Residents find themselves in a variety of clinical settings, and need to be ready to adapt to new services and regularly varying hospitals. The first year of training certainly emphasizes adaptability. Rotations in the first year include inpatient medicine, inpatient pediatrics, ER, trauma/ surgery, neonatal intensive care, adult intensive care, OB, orthopedics/sports medicine and our Family Medicine service. Residents additionally find themselves in clinic for 1-2 half days per week. During paired months, 2 residents essentially split the load of one, which provides a nice break in the otherwise intensive inpatient-heavy R1 schedule. Another built-in break in the R1 curriculum is the Core Skills two weeks in July/August and the Home Focus month, beginning in mid-October. During Home Focus month, residents concentrate and develop their clinical skills, while attending frequent didactic sessions with Family Medicine faculty. R1 residents to get to know one another, interact with faculty, and enjoy some free time while the weather still cooperates. Despite the heavy inpatient curriculum of the first year, interns still find time to enjoy themselves. The residency does acknowledge and embrace the balance of training and life outside of medicine.

R2 Curriculum
The second year of residency, like the R1 year, focuses heavily on inpatient and hospital medicine, while bringing residents into the outpatient clinic setting more often. In the R2 year, residents pursue further OB and ER training. Organizational and leadership skills are developed while leading our family medicine service for 6 weeks and co-leading internal medicine services for 2 months. More time in the curriculum is dedicated to outpatient-focused rotations, such as gynecology and sports medicine. Our gynecology curriculum allows time for residents to learn medical and surgical pregnancy termination in an “opt out” arrangement. Residents typically attend their continuity clinic 2 half-days per week during their R2 year.
Also built into the R2 year is 4 weeks of night float, in which an R2 runs the family medicine service, with faculty back up at night. Residents develop clinical confidence and independent thinking and action in the medical setting. In the Medical Home month residents have the opportunity to learn advanced medical and communication skills to care for complex patients. Finally, two dedicated weeks of elective time is built into the second year, allowing residents to begin focusing and furthering their personal interests.

R3 Curriculum
Hooray, we’ve made it to the R3 year! This year embraces the modern Family Medicine model of outpatient-focused practice with interspersed call nights. R3’s take approximately 16-17 calls, scattered through the R3 year, all on our UWMC Family Medicine service. The remainder of time finds residents at clinic or in various elective or specialty opportunities. R3’s typically attend their continuity clinic 4 half days per week in their respective FMCs. The remainder of time is dedicated to developing skills useful in the outpatient family medicine setting. Residents become proficient in colposcopy, dermatologic procedures, vasectomy, IUD placement, and a variety of other techniques such as flexible sigmoidoscopy. Furthermore, Wednesday mornings in the R3 year are dedicated to advanced behavioral science training, R3 Balint group development and extensive practice management topics, designed to aid residents in making a smooth transition to life after residency. Residents in the R3 year are often found enjoying their lighter work load, while also focusing their energy towards research projects, clinic managerial and leadership roles, and educative extracurricular activities such as being team physician for local high school sports teams, organizing various interest groups, teaching medical students, or coordinating other resident activities. Throwing parties has not been unheard of either! Furthermore, nearly 3 months of the R3 year is dedicated elective time, allowing residents to pursue personal interests and goals. The R3 year also allows residents travel time for job search pursuits, and nearly all have jobs awaiting them on completion of their training here!

Longitudinal Curriculum
In an effort to broaden their scope of knowledge, the program requires residents to attend a weekly didactic session on Wednesday afternoons when clinically able. The didactic curriculum, which runs over an 18-month cycle, focuses on important Family Medicine topics. Primarily, faculty provide lectures and teaching modules, though resident presentations are also frequently given. The longitudinal curriculum incorporates resident-developed talks and presentations, which occur alongside morning reports on Wednesdays and Fridays, along with a Monday afternoon report. Faculty liaisons to each rotation have been working on adding supplemental reading materials as a rotation adjunct to our new online course module called “Anytime Courses.”
Residents also have the opportunity (more so during R2, R3 years) to develop clinical Areas of Concentration (AOC) or an area of Academic Focus. Residents can pursue educational toward an MPH or other graduate degree. With a clinical AOC, residents work on increasing their fund of knowledge in specific patient care areas with a focus on developing a scholarly project. Examples are Dermatology, Integrative Medicine, Global Health, and Reproductive Health. In addition, three Academic Focus pathways are available, electively, to increase skills in the areas of Health Policy/ Advocacy, Teaching/ Education, and Research/ Scholarly Writing. Residents work in concert with their faculty advisors and other faculty mentors to develop these AOC or Academic Focus projects.