Innovations - 4th Edition

50 YEARS OF DEVELOPING COMPASSIONATE CAREGIVERS

BY LENORE GALLUCCI STEVENSON

For generations, highly skilled health care professionals and support staff at RUHS – Medical Center have provided exceptional, state-of-the-art care to the county’s diverse populations. Our mission is to improve the health and well-being of our patients and communities through our dedication to exceptional and compassionate care, education, and research. One way that RUHS meets this mission is through the residency programs.

During the three-year RUHS/ UCR Family Medicine Residency (FMR) program, residents receive training that prepares them to provide excellent patient care, but the program goes beyond developing just clinical skills. Rather, the residency program offers an environment that focuses on compassionate caregiving and leadership, empowering them to become health advocates within the community and role models to future physicians.

From 1971 to Now

When RUHS became a teaching hospital in the early 1900s, physicians and head nurses worked as instructors.

Then, sometime in the 1930s, the National Youth Administration began training nurses, with the intern training program beginning around 20 years later. This continued to progress for another 20 years, with the community-based FMR Program beginning in 1971.

By 1982, it was one of the first of its kind to gain accreditation in California from the American Academy of Family Physicians (AAFP). The RUHS/UCR Family Medicine Residency program, which is accredited by the Accreditation Council for Graduate Medical Education (ACGME), has proven to be very successful — since its inception, more than 300 family physicians have graduated from the program.

Originally, the program had six resident students at the first-year, second-year, and third-year levels. In 2010, the program grew to 12 residents per year at each level. Today, the program functions with a Family Medicine Chair and Vice Chair. Along with a program director, FMR has a program coordinator with two assistant coordinators, 10 full-time faculty and a full-time clinical psychologist.

10 FOURTH EDITION

“Many changes have happened in the past 14 years that I have had the privilege of working with residency program,” said former program director Dr. Parastou Farhadian. “Mostly a lot has been changed fromthe time the FMR program started. There have been medical center location changes, academic sponsorship changes, the name of the program changed, we’ve had several program directors, we’ve expanded the faculty complement, and the curriculum has changed. But something that has never changed is the mission of our program, because we live by our mission.”

Addressing Ethnic and Racial Inequities

When Dr. Adolfo Aguilera began his tenure as program director in 2010, he sought to recruit more underrepresented minorities (URM) to “help fill the gap of ethnic and racial inequities that existed within our health care system.” As a result, the program held a 30–40% rate of URM. According to Dr. Aguilera, “this representation really helped serve our large Latino and African American population in a more culturally sensitive and linguistic appropriate manner. This was further solidified by our high rates of placing our graduating residents in areas of unmet need.” In fact, 75% of graduating residents stayed in Southern California and 50% stayed within the Inland Empire.

Today, the RUHS/UCR Family Medicine Residency Program still strives to train family physicians who come from diverse backgrounds, helping these learners become competent independent family physicians who are highly skilled at providing comprehensive and patient-centered care. “Our Program aims to produce Family Physicians who are proficient community leaders and healthcare advocates for all patients and their families, most especially the underserved communities,” said Farhadian.

Clinic First Model

Traditionally, residents spend one to three half-days per week in a family medicine clinic and rotate between outpatient and in-patient care monthly. This model makes it difficult to train physicians to provide comprehensive and patient-centered care.

Alternatively with the Clinic First Model, which the RUHS FMR program follows, residents rotate on one- to twoweek mini-blocks. This way, residents can avoid being absent from the continuity clinic for long periods of time, giving them the opportunity to book most patients with the same primary care physician resident and the same primary care team.

Thus far, the response to the Clinic First Model has been excellent. Residents have expressed increased wellness due to better ability to provide continuity of care and better control of their schedules outside of the clinic and hospital. Our patients are happy to have a long-term relationship

with their primary care physician, and better access to care.

Research Projects

As a component of our curriculum, the residency program requires residents to actively participate in scholarly activities. While it is expected that residents will participate in research throughout their three years of residency, they begin a formal research project on an approved topic during their second year of residency. All residents are required to complete and present their original research project at the end of their third year at both the UCLA Research Day Conference and the Inland Research Forum. Residents are also encouraged to submit their projects for presentation and or publication at professional regional and national meetings or in peer-reviewed journals.

In the past few years, research projects have included clinical projects, health care systems research, patient education research, case reports, and quality improvement projects. Several residents have presented their research at the Inland Empire FMR Exchange. During the past five years, these projects and presentations have won awards at this annual research forum. Last year our residents took first place at our own RUHS research symposium and placed top 3 in our regional PREMIER research forum. And some go on to present at state and national conferences.

“We trigger curiosity within our residents through research and scholarly work,” says Dr. Aguilera. “It has always been an essential part of our program. Not only does research align with part of our mission statement, it also helps form investigation to further our minds and approach to patient care. Being at the forefront of medicine and creating resourceful physicians that will integrate their work into their practices will benefit our institution and impact our community in a positive manner.”

“We cherish diversity, we believe in inclusion and cultural sensitivity, and we live it in our program,” says Dr. Aguilera. “In our work family, we all come from different backgrounds, different schools, and even different countries. Last time I counted, we share over 20 different languages and many of us our bi-cultural and/or bilingual. Our faculty also bring unique expertise to the program — from Sports Medicine, Palliative Medicine, Geriatric Medicine, Community Medicine, Wellness, Addiction Medicine, to Population Health and Quality Improvement.” All of this allows not only for a rich learning environment, but an opportunity to connect deeply with our patients and a legacy for future residents.”

RUHS INNOVATIONS11