Longitudinal Experiences

Longitudinal experiences throughout the three years (e.g. Family Medicine Center; nursing homes, didactic presentations) are essential components of the curriculum in all areas, including those with block rotations described elsewhere.  However, several elements of the curriculum are provided entirely in a longitudinal manner without time specifically devoted to block rotations.  The lack of block rotations in these content areas is a reflection of our belief that they are best addressed progressively throughout the three years rather in short intensive blocks.  For residents with special interests in these areas, elective block rotations can also be scheduled.

Behavioral Medicine - Beginning in the first year, residents work in multidisciplinary teams, including physicians, behavioral medicine faculty, social workers, case managers, and nursing to enhance their ability to meet patients’ psychosocial needs.  Through the use of direct observation, videotape reviews, role play, and OSCE's (objective structured clinical evaluations), residents are assisted in developing more effective communication skills.  Assigned readings and didactic presentations provide a foundation for increasing cognitive knowledge in the behavioral sciences.  Specific clinical activities that allow residents to become more proficient in addressing mental health needs of patients include experiences in nursing home settings and home visits and collaborative work with a variety of mental health professionals in the family medicine center and the palliative care professionals in the hospital and outpatient settings.

Evidence Based Medicine/Medical Informatics - Residents are expected to become proficient in using the latest evidence based information in their approach to caring for patients.  Lectures and hands-on workshops focused on these skills are held on a regular basis.  Identification of readily available bedside acquisition of this information is paramount to quality patient care.  Along with personal data devices, the Family Medicine Center is well equipped with computers and high-speed internet connection that allows access to the many resources of the College of Medicine Library.  These resources include online evidence-based databases such as Cochrane, TRIP, and InfoRetriever, as well as full-text online access to most major medical journals.

Medical Ethics - The teaching of ethics takes place through continuing, longitudinal discussions of the ethical significance of patient-physician relations and interactions.  These discussions occur on a regular basis in the following settings: office precepting, teaching rounds in the hospital, formal didactic sessions involving case presentations and interactive discussions and clinical teaching on specialty rotations with other faculty. Additionally, a palliative care rotation allows in-depth discussion and application of medical ethics principles in the hospital setting, stressing rural concerns for the terminally ill and dying.   Opportunities exist for residents wishing to explore these issues further through electives.

Practice Management - Throughout the three years, didactic presentations cover a wide variety of practice management topics including such topics as clinical productivity, staff acquisition and management, clinical benchmarks, coding, and leadership.  During the R 2 Family Medicine Skills rotation, residents attend a two-day seminar on practice management.  Practice management didactics form the basis of the R 3 Peer Group sessions to prepare for practice after residency.   Biannual practice retreats and quarterly multidisciplinary practice team meetings allow for structured application of management principles and techniques.

Sports Medicine - In addition to the R 1 orthopedics rotation (which includes experience working with a sports medicine physician) and the R 3 Sports Medicine rotation, didactic presentations frequently cover sports medicine topics.   Hands-on experience is gained by serving as team physician for a local high school at varying sporting events, assisting with community-wide pre-participation physical exam events, and participating with team physicians at East Tennessee State University.

Osteopathic Curriculum - Throughout the three years, Osteopathic Manipulative Medicine is taught through didactic presentations and workshops, one-on-one tutorial instruction, direct application of osteopathic manipulative treatments, and other appropriate formats in the continuity clinic and the inpatient setting. A-OPTIC provides live Osteopathic grand rounds several times a year via web based media.  Additionally, access to their entire didactic video library of lectures is provided which is available on their website and included in assigned readings and didactic sessions.

Human Clinical Simulation – Throughout the three years, access to experiential learning is provided through access to computer-driven clinical simulation addressing the six core competencies as well as forming the basis for procedure acquisition.  Clinical simulation provides for team building, practice of and acquisition of communication skills, procedural practicum, and application of patient care and medical knowledge in a safe, structured format.  Scenarios help to build confidence and communication, improve diagnostic skills, and advance critical thinking.