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Our residents receive training in outpatient procedures rotating among various subspecialties at local partner clinics.
Ambulatory Subspecialty Clinics
Residents spend four weeks during their PGY2 and PGY3 years rotating among the various subspecialties at Scripps Clinics including rheumatology, pulmonology, gastroenterology, infectious disease, nephrology, neurology, endocrinology, hematology-oncology and more. Residents will develop the skills to evaluate, diagnose and manage common disorders seen in outpatient primary care and medical sub-specialty clinics in the ambulatory setting during these rotations.
First-year residents do a two-week rotation with exposure to the different mental health, substance use and social services available within our clinics and community. The rotation serves as an introduction to the mental health and psychosocial issues facing our high-risk populations. Residents rotate with FHCSD Adult and Pediatric Psychiatrists at various clinic sites, as well as with Mental Health Process Groups. They attend substance use disorder support groups such as Solutions for Recovery and AA meetings. They also learn community mapping, reflection practices, behavioral health interventions and spend a wellness day with our Director of Behavioral Health. Behavioral health training is implemented longitudinally throughout the three years of training through didactics, continuity clinic, residents’ Behavioral Health Clinic (BHC) and shadowing in the behavioral health faculty clinics.
Throughout this longitudinal curricular experience, residents are exposed to a variety of social service and community agencies that serve patients and their families in the diverse City Heights area. This rotation teaches residents how to access these services and collaborate with local agencies. Residents will learn how to provide culturally competent care for the individual patient in the context of their family situation, their local and global communities, and the larger medical context of interdisciplinary teams and public health. Rotation sites include the Syringe Exchange Program, Gender-Affirming Care Clinic, Physical Therapy, Family Planning, HIV Clinics, Refugee Health Assessment Program, Healthy Development Services, Group Diabetes Visits, Re-Entry Program for the recently incarcerated and many more.
PGY2 residents spend four weeks gaining exposure to the diagnoses and management of common dermatological conditions and receive training in outpatient dermatological procedures such as skin biopsies, cyst removals, dermoscopy, cryotherapy and more. They rotate through a local San Diego outpatient dermatology practice and do sessions with FHCSD Dermatology.
Residents have four weeks of electives during their PGY2 year and 12 weeks of electives their PGY3 year. Past elective experiences have included subspecialty services at Scripps including gastroenterology, infectious disease, endocrinology, and palliative care. Residents have created custom rotations covering multiple specialties in a four-week block by combining two-week rotations in urgent care, sports medicine, medication assisted treatment, procedures and many more. There are options to perform away rotations. Residents have done electives such as Indian Health Services within the U.S. and international experiences in Latin America and Africa.
Family Medicine Clinic
Throughout each year of training, residents have longitudinal continuity clinic, as well as blocks of clinic at City Heights Family Health Center. They practice full-spectrum family medicine covering newborn care to geriatrics and everything in between under the supervision of the precepting faculty at FHCSD. Residents manage common chronic medical conditions such as diabetes, hypertension and COPD and gain valuable experience in treating special populations such as refugees, patients with HIV and hepatitis B and C, the recently incarcerated, and homeless individuals. Within the residency clinic, in addition to their regular clinic, they do Procedures Clinic, Colposcopy Clinic, Group Diabetes Visits, Behavioral Health Clinic, and Refugee Health Assessment Program Clinic. For the 2021-2022 academic year, the program opened clinics specializing in Osteopathic Manipulative Treatment, Sports Medicine and Integrative Medicine. Upcoming specialty clinics planned for the residency clinic include HIV, Hepatitis C and Medication-Assisted Treatment.
In this two-week rotation, PGY1 residents learn about care specific to elderly populations through UCSD’s Geriatrics Department and the San Diego County Aging and Independence Services Department. They spend time at the Senior Behavioral Health Center and the Medicine for Seniors Clinic at UCSD. Residents also gain longitudinal geriatrics experience through their continuity clinic and FHCSD’s Program for All-Inclusive Care for the Elderly (PACE) program.
Second-year residents rotate for two weeks with the multi-disciplinary Palliative Care Consultation Service at Scripps Mercy, which cares for patients of all ages and cultural backgrounds facing serious illness. Residents participate in palliative care consultations within the hospital environment. Residents become part of the palliative care team at Scripps Mercy Hospital and work alongside palliative care attendings, fellows, mid-level providers and social workers. During this time, residents develop the skills to evaluate, diagnose and manage common disorders in patients nearing the end of life, learn evidence-based symptom management and gain experience in leading goals of care discussions and family meetings.
This four-week rotation allows PGY3 residents to gain exposure in diagnosing and managing common outpatient gynecological conditions. Residents spend four to six half days per week rotating with FHCSD OB/GYN providers at our different clinic sites. Residents work in our FHCSD Breast Clinic learning about common breast conditions and rotate through FHCSD Family Planning clinics, learning about contraception and placing Long-Acting Reversible Contraceptives.
This two-week rotation allows all PGY3 residents to gain exposure in HIV services available through FHCSD and our community. Residents work with our HIV and HCV providers at our FHCSD Hillcrest location. In addition, they rotate at our Hillcrest Night Clinic providing HIV/PrEP and Transgender Care. Residents who wish to become boarded in HIV Medicine apply for the HIV track in the spring of their first year of residency.
This outpatient rotation, present in all three years of training, teaches residents how to diagnose and manage common pediatric conditions. In the busy pediatric clinics, residents perform well child exams, preventative care and immunizations. Residents spend time rotating with FHCSD Pediatricians at our North Park location for four weeks during PGY1 and PGY3 years, as well as two weeks during PGY2 year. In addition, residents take care of pediatric patients during their continuity clinic at City Heights.
This four-week rotation allows PGY3 residents to transition from residency medical training to their professional life post-graduation. The overarching goal is to gain the knowledge and skills needed to manage all the different components needed for a successful practice such as organization of a clinic, physician-patient communication, care coordination, cost/benefit decision making, administration and marketing. This includes both rotational and longitudinal experiences. Residents are given the opportunity to interact with various clinic and organizational administrative staff members to gain insight into the different aspects of clinical operations and health care.
This four-week rotation allows PGY3 residents to learn about and manage common musculoskeletal injuries and conditions. Residents spend three half-days per week rotating with our FHCSD Sports Medicine Department, one half-day per week rotating in FHCSD’s Podiatry Clinic and one half-day per week with our Physical Therapy/Chiropractic services. Residents spend several half-days per rotation rotating with UCSD’s and Rady Children’s Sports Medicine clinics. Residents perform procedures such as joint injections and joint aspirations, interpret radiographic imaging, use ultrasound-guided techniques, and perform sports physicals.
Adult Medicine Inpatient – Scripps Mercy Hospital
(4-week blocks, all three years)
FHCSD residents have their own inpatient teams supervised by hospitalist attendings. These two teams work alongside the internal medicine resident teams but carry their own panels of patients. The FHCSD team consists of a senior resident and two interns. In the first half of the year, a 3rd year resident will lead the team. During this time, there will also be a 2nd year resident working one-on-one with an attending on a separate team. Halfway through the academic year, the roles switch and the 2nd year resident will lead the team and the 3rd year will do the one-on-one “lone wolf” schedule. Residents triage and manage patients through all levels of acuity, from the ED to the ICU.
Cardiology – Scripps Mercy Hospital
(4-week block, second year)
The residents work with Scripps cardiologists in all aspects of cardiology including inpatient consultations and management, electrocardiogram readings, performing echocardiograms, treadmill testing, nuclear perfusion scans, catheterizations and cardiac rehabilitation.
Emergency Medicine – Scripps Mercy Hospital
(4-week block, second year)
The residents participate in shifts in the Mercy Emergency Department working with emergency physicians to triage and treat patients in this Level 1 trauma center.
ICU – Scripps Mercy Hospital
(4-week block, second year)
FHCSD residents work alongside the Scripps internal medicine residents on the ICU teams admitting and managing the intensive care patients.
Nursery & Neonatal Intensive Care – Scripps Mercy Hospital
(4-week block, first year)
Residents work with pediatric intensivists and neonatologists to take care of infants, many of whom are delivered by the FHCSD OB service. Residents learn how to do newborn exams and address concerns such as hyperbilirubinemia, infections and conditions specific to neonates and possible congenital issues.
Obstetrics – Scripps Mercy Hospital
(4-week blocks, first & second years)
The residents work one-on-one with the FHCSD OB/GYN attending physicians. The FHCSD residents are the only residents performing deliveries at Mercy Hospital, which serves the urban underserved population of San Diego County. Residents learn to assess and monitor patients in labor, perform vaginal deliveries, are first-assist in C-sections and take care of the patients in the post-partum period.
Orthopedics – Scripps Mercy Hospital & Clinics
(4-week block, second year)
Residents work with the Scripps Orthopedics service in both inpatient and outpatient settings. Residents are assigned time in the operating room but mostly in the outpatient orthopedic clinic where they learn how to diagnose and treat common musculoskeletal complaints.
Pediatric Emergency Medicine – Rady Children’s Hospital
(4-week block, second year)
Residents rotate through the only Level 1 pediatric trauma center in San Diego County. It is the only center in the area dedicated to the emergency care of children. Residents gain valuable experience from the opportunity to aid children in varying degrees of distress, injury and infection.
Pediatrics Inpatient – Rady Children’s Hospital
(4-week block, first year)
FHCSD residents, along with family medicine residents from other San Diego programs, perform their inpatient pediatric rotation at Rady Children’s Hospital; the largest children’s hospital in California. As a nationally ranked pediatric medical center, the residents work with highly trained specialty teams in order to treat a spectrum of illnesses ranging from common seasonal ailments to rare and unusual diseases.
Surgery – Scripps Mercy Hospital & Clinics
(4-week block, first year)
The residents work one-on-one with Scripps general surgery attendings in the hospital and general surgery clinic. This rotation allows family medicine residents to learn to recognize and triage possible acute surgical illness, gain technical skills as well as manage the post-op care of patients.
Urgent Care – Scripps Mercy Hospital
(2-week block, third year)
Residents complete shifts in the less acute area of the emergency department in order to learn how to deal with common urgent care complaints.
Specialty Tracks & Areas of Concentration
HIV Medicine Track
The HIV Medicine track provides a longitudinal experience in outpatient management of HIV infection with the goal of realizing competence that allows graduates to incorporate HIV Medicine as a portion of their Primary Care practice. Residents will participate in a supervised continuity clinic in years two and three in which they will develop a small panel of patients living with HIV. With graduated responsibility, they will manage Anti-Retroviral therapy, treat opportunistic infections and common co-infections such as sexually transmitted infections and viral hepatitis, and develop competency in managing HIV infection across the lifespan. In addition to dedicated clinic sessions precepted by Infectious Disease and HIV specialists, residents will participate biweekly in the Pacific AETC’s HIV Learning Network telehealth program and obtain access to a suite of online learning materials. Upon completion of the program, residents sit for the American Academy of HIV Medicine (AAHIVM) specialty certification exam, thus obtaining the designation of ‘AAHIVS’ or HIV Specialist.
The Sports Medicine track is for residents interested in pursuing additional experience in treating musculoskeletal issues commonly found in the outpatient setting. Family Health Centers of San Diego has a Sports Medicine department comprised of fellowship-trained family medicine doctors, physical and occupational therapists and chiropractors. All residents complete a month of Sports Medicine, but those in the track participate in additional opportunities such as local sports coverage, pre-participation physicals and monthly clinics in our Sports Medicine clinics starting in their second year. They learn how to perform ultrasounds, injections, splinting and casting. They attend musculoskeletal didactics and conferences. They work with leading sports medicine doctors in the San Diego area. Residents in this track are generally interested in pursuing a Sports Medicine Fellowship.
The Global Health Area of Concentration (GHAOC) provides residents with exposure and training in the health care of special populations of underserved patients-refugees, immigrants and asylum seekers-in the context of their home country, community and family structure. The residents develop their knowledge of the social, geopolitical and cultural aspects affecting health beliefs and practices in the US and abroad. All residents rotate through Community Medicine in their first year and work with FHCSD’s large network of local community partners who work with refugees and immigrants. Community partnerships that enhance our “glocal” experiences include: Dialogue with the Doctor monthly series with United Women’s East African Support Team, partnership with Survivors of Torture International to include training in forensic examinations for asylum seekers and Dunya Women’s Health Collaborative which focuses on Female Genital Cutting care best practices. Those in the GHAOC complete a one month Global Health Community Medicine “glocal” elective in their second year. In their third year, the GHAOC residents complete an elective abroad and are encouraged to present their scholarly or QI project at a Global Health scholarly conference.
The Integrative Medicine Track provides residents with exposure and training that seeks to integrate the best of western scientific medicine with the broader understanding of the nature of illness, healing and wellness. Those in track will complete the University of Arizona Online Integrative Medicine in Residency online curriculum. They will also complete a two or four week month Integrative Medicine elective either with San Diego-based practitioners or at the University of Arizona in Tucson campus. Residents will have Integrative Medicine patients scheduled in their Family Medicine clinic as part of the recurring Behavioral Health schedule providing an opportunity for continued practice. In their third year, the residents are encouraged to present their scholarly or QI project at an Integrative Medicine-oriented scholarly conference.