The Tulane Internal Medicine Residency Program places a strong emphasis on outpatient medicine for all residents, whether they are categorical or primary care. All residents will complete more than 200 clinic sessions over a three-year residency, far exceeding the 150 required by the ACGME. They will also have over 25, three-hour "Ambulatory School" conferences devoted to topics in ambulatory medicine. For these reasons, the primary care track does not focus on providing additional clinic time or additional time to learn outpatient medical knowledge. Instead, it focuses on providing residents with additional skills in panel management, practice management and community engagement. In short, the Tulane Internal Medicine Primary Care Track is designed to create primary care leaders, developing the management, communication, and leadership skills requisite for running a patient-centered medical home upon their graduation. Whether in academic or community-based primary care clinics, it's no wonder that Tulane graduates go on to leadership positions in primary care.
Primary Care Track Basics
As opposed to other residency programs where primary care residents are in parallel to the remainder of the residency program, the Tulane Internal Medicine Primary Care Track residents are integrally involved with all residents in the program. All interns in the primary care track do the same rotations as their non-primary care track colleagues. We believe this is important because it establishes a strong foundation in general internal medicine, and enables the primary care residents to appreciate the intricacies central to understanding successful transitions-of-care between the inpatient and outpatient environments.
Compared to categorical residents, primary care residents have one less elective month in their second and third year as well as one less CCU/ICU/Moondog rotation over the final two years. Those slots are filled with ambulatory-based rotations. In addition to the standard rotations, primary care residents (both interns and upper levels) have an exclusive specially-crafted ambulatory-based rotation we affectionately call Ziggy. Complement to the Ziggy rotation is a second ambulatory rotation called Stardust. Stardust is open to all residents though one of the places where primary care track residents have growing opportunity for leadership. More details about how these ambulatory rotations fit into the primary care track curriculum will be coming up shortly.
Obviously becoming a great primary care physician and leader involves more than just excellent clinical exposure. The primary care track residents have additional learning opportunities in a number of venues. One of those is a primary care journal club (which occurs in addition to the all-program journal clubs). The primary care journal clubs are a relaxed learning environment (usually held over potluck dinner at a resident’s home) where the material is resident-selected and resident-taught. Guest speakers and seminars also add to the hands-on primary care curriculum of the Ziggy rotation. Though these additional activities are often held “after-hours,” they are well-attended for their social-support value as much as the learning opportunity. They provide a “home within a home” in the residency program, allowing residents interested in primary care to have additional opportunities to gather around their future career path.
Developing Clinical Skills
As noted previously, the Tulane Internal Medicine Primary Care Track runs in parallel with the remainder of the residency program. The “4+1” system is the key. Under the “4+1” system, the residency program is divided into five firms. Each week, one of the five firms devotes its time to primary care continuity clinics (the “+1 weeks”); the other four firms staff the standard inpatient ward, ICU, ER and elective rotations. During these "+1" continuity clinic weeks (ten clinic weeks per year), all residents have protected time to devote to the care of their primary care patients without the distraction of ward or elective duties. Importantly, this system enables patients to schedule clinic appointments with their primary care provider anytime within the clinic weeks, removing the guess-work that is a feature of the standard system where resident clinics are only one half day per week and frequently cancelled or moved due to post-call, on-call or ICU/ER duties.
But what happens in the four weeks that intervene between a firm’s primary care “+1” week?
The answer is Stardust, an ambulatory rotation including one resident from each of the four firms not on their “+1” week. The role of the Stardust residents is to act as partner providers for their colleagues whose patients need care in the interim between their primary care visits. These visits are generally directed towards specific tasks such as hospital discharge follow-up, blood pressure checks, or acute complaints. Though currently not a rotation exclusive to Tulane’s Primary Care Track, Stardust is one of the many places primary care track residents have the opportunity for leadership. There is usually one primary care track resident rotating on Stardust at any given time, and that resident acts as the “Primary Care Director” for his or her firm and the program overall. A leadership role that will continue to grow for the primary care track residents, the Primary Care Director serves as a resource person for colleagues, easing the transitions between inpatient and outpatient settings. In addition to being a point person for questions about transitions of care, the Primary Care Director resident is someone with whom clinic staff can communicate regarding newly arising needs for patients and patient education.
Primary care track residents get additional ambulatory education and exposure to round-out their skills with the Ziggy rotation.
This specially-designed rotation is available only to primary care track residents (and is always filled by one of them) and is intended to further skills in several realms. Dedicated time for quality improvement and research helps residents increase skills managing disease registries and provides opportunity to look at health on a larger or policy-based level. Hands-on experience with procedural-based fields such as dermatology and physical medicine & rehabilitation are included to increase resident comfort and independence with biopsies and joint injections. Precepting at the medical student-run Fleur de Vie clinic provides residents a chance to work on their teaching skills in a community-based health care environment. Primary care residents also get the chance to explore other patient populations and interests with time in the Rebuild Center homeless clinic, adolescent clinics, and open-days for each resident to use in an area of his or her own interest.
Another key feature of the primary care track is that the residents have part of their continuity clinics at the Ruth U. Fertel/Tulane University Community Health Center. This NCQA-certified level 3 patient-centered medical home is at the heart of community health and primary care in New Orleans offering traditional primary care health services as well as behavioral health and HIV care. Innovative services include guided grocery shopping trips to help teach diabetics, multidisciplinary chronic disease counseling, and soon the clinic will be home to a unique teaching kitchen. In addition to continuity clinics, this center serves as a sort of home base for many of the activities specific to the primary care track, including individual research and quality improvement projects.
The combination of Ziggy and Stardust rotations in addition to the standard education of the Tulane Internal Medicine Residency ensures that the Tulane Internal Medicine Primary Care Track prepares its graduates exceptionally to assume clinic responsibilities. The additional exposure to the patient-centered medical home format and work within that system further ensures that the primary care track residents will be ready to be leaders in the field.
The Tulane Internal Medicine Primary Care Track is defined by much more than clinical care. Primary care residents are firm leaders interacting with colleagues and impacting especially the outpatient-based care of their firms’ patients. Collaborative skills are honed not just by interacting with co-residents but also by working with the clinics’ non-physician staff (social workers, pharmacists, nurses, nurse practitioners, etc) while coordinating continuity of care. Working with the clinic leadership, especially at the Ruth U. Fertel/Tulane Community Health Center, residents acquire valuable skills by participating in policy and procedure discussions and changes. In doing so, residents gain valuable leadership and management experience, fully preparing them to lead their own primary care enterprise as a patient-centered medical home upon their graduation.
Mastering Transitions of Care
Meaningful training and preparation for a career as primary care leaders requires that trainees master transitions of care and learn to facilitate care with other subspecialists. At Tulane, residents manage their patients’ transitions of care between the inpatient and outpatient settings on a regular basis. Beyond arranging hospital discharges and admitting patients from clinics, residents also work directly with colleagues coordinating care for patients among the subspecialty services and clinics (which for some includes working in subspecialty clinics during the “+1” week). More than facilitating the physical transitions of patients between clinical settings, mastering transitions of care also means being able to analyze systems and identify obstacles in optimizing those same transitions. Oftentimes the best transition of care is one that does not happen, for instance, preventing (re-)admission for chronic disease management. Learning to recognize patient and system-based barriers and to identify their remedies is an important part of mastering transitions of care. These are important skills for all members of the firm, but the augmented experience the primary care residents receive as leaders in management of these transitions is invaluable to their subsequent careers as primary care leaders.
Pursuing Research & Academics
Primary care track residents have the opportunity to work closely with the leaders in primary care in New Orleans to receive the mentorship required to advance an academic career in primary care. Notable individuals in Tulane primary care fields include Dr. Eboni Price-Haywood, a leader at the Ruth U. Fertel/Tulane Community Health Center; Dr. Karen DeSalvo, a Tulane internist on sabbatical as Health Care Commissioner for the city of New Orleans; Dr. Michael Landry, a leader in the New Orleans VA; and many others.
As the primary care track affords protected time to do so, residents have multiple opportunities to participate in outcomes-based research in primary care. By the completion of their residency, primary care track residents will have the opportunity to present such research at a local, regional or national meeting (all expenses sponsored by the program). In this way, the Tulane Internal Medicine Primary Care Track is unique: residents change the face of primary care by their scholarly pursuits, further preparing them to assume leadership roles upon graduation.
Valuable teaching experience is gained in the primary care track in a diversity of settings, many of which have been noted above. Beyond the teaching that is expected of all Tulane Internal Medicine residents in the inpatient and also outpatient settings when working with medical students, primary care track residents serve as preceptors for medical students in the Fleur-de-Vie clinic while completing the Ziggy rotation. Primary care journal clubs give residents the chance to choose a topic of their own interest and effectively share and teach that information with their peers. Patient education and teaching is also a developing forum in the Tulane Internal Medicine Primary Care Track with opportunities in the community to teach computer literacy in addition to basic health care topics such as diabetes, hypertension, and many others.
Tulane Internal Medicine Primary Care Track: Why We’re Unique!
The residents in the Tulane Internal Medicine Primary Care Track reflect the diversity of the Tulane Internal Medicine Residency Program, hailing from ten different institutions in the United States. While all share the common mission and vision of better health through better primary care, each has his or her own career vision for how to accomplish that goal. If you want to learn more about our team’s individual visions, feel free to send them an email. We are looking forward to hearing from you.
Erin Dainer (Medical College of Georgia) – Med-Psych
Jane Andrews (Johns Hopkins University)
Cady Blackey (University of Kentucky)
Ryan Brown (University of Kentucky)
Andrew Burchett (University of Kentucky)
Margee Huntwork (Tulane University) – Med-Peds
Rachel Sandler (University of Iowa)
Robin Ivester (University of California-San Francisco)
Farah Kaiksow (University of Wisconsin)
Naomi Karlen (University of Hawaii)
Tony Marsh (University of Nebraska)
Scott Martin (SUNY Stonybrook)
Alix Oreck (Tulane University)
Jen Tran (Temple University)
Shenelle Wise (Georgetown University)
Meredith Barnes (2013): San Diego VA
Erin Boswell (2013): New Orleans VA Quality Improvement Chief Resident
Sancia Ferguson (2013): UCSF Rheumatology Fellowship
Reny Grundy (2012): Tulane Chief Resident; Chicago-area Primary Care
Jason Halperin (2013): NYU Infectious Diseases Fellowship
Kate Hust (2013): Tulane Chief Resident
Catherine Jones (2012): Tulane Primary Care Track Program Director
Kelli Pitt (2013): Atlanta-area Primary Care
Dr. Catherine Jones is the Director of the Primary Care Track and the Associate Program Director overseeing all ambulatory training in the residency program. Please contact her with any questions you have regarding the primary care track:
General email: firstname.lastname@example.org
Ready to Join Us?
Nowhere else will you receive the leadership, management, communication, and research skills requisite for a successful career in primary care. If assuming a leadership position in primary care is your goal, look no more…Tulane is the home for you!
While anyone can enter the Primary Care Track at any time, the program has made a commitment to ensuring that each firm has a minimum number of residents devoted to primary care by devoting at least three positions in each year’s match to those interested in primary care.
If you are interested in applying to the Tulane Internal Medicine Primary Care Track, simply complete your application (via ERAS) to the Tulane Internal Medicine Categorical Program. Once you are invited for an interview, make sure to let us know you are interested in the Primary Care Track, and we will make sure you have time to spend with the primary care residents learning more about the program.
When it comes time to submit your match list (via the NRMP), you’ll find a separate “match codes” for the Tulane Internal Medicine Primary Care Track (3073140C1) and the Categorical Program (3073140C0). Applicants are encouraged to list either or both of Tulane Internal Medicine’s NRMP match codes.
The Tulane University Primary Care Track is supported in part by the following grants:
Primary Care Expansion Grant. HRSA (#T89HP2077); $2,472,964
Transitions-of-Care for Vulnerable Patient Populations. HRSA (#D54HP23291)$875,149