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TFM Curriculum


The curriculum at Tacoma Family Medicine (TFM) is rigorous and progressive. It is designed to be a continuing experience over three years using a general pattern of observation, assistance, performance with supervision and autonomy with periodic evaluation in both ambulatory and hospital settings. Residents are expected to undertake increasing responsibility in a graduated fashion.

In addition to our busy OB service, TFM residents run three inpatient services – inpatient family medicine, adult inpatient medicine, and inpatient pediatrics that are truly resident panels. These services are supervised by TFM faculty, adult hospitalists, and pediatric hospitalists respectively. The TFM panel is comprised of our own clinic patients in addition to Puyallup Tribal Health patients. Admissions to adult inpatient medicine and pediatric services are selected to provide the highest educational potential. Patients are cared for and managed by residents, who function as their primary physicians. Faculty members serve to assist residents as teachers and mentors. This unique educational hybrid combines the strengths of a university style training experience with the flexibility and lack of competition characteristic of a community based program. Utilization of our call and nightfloat systems allows for round the clock resident coverage of all our patient panels. Because the call and nightfloat residents provide coverage for all three services, our pediatric and ICU experience is longitudinal. This means you will be admitting both adults and children year round.

Initially, inpatient rotations take the majority of residents’ time laying a strong foundation in medical management of complex problems. However, as residents enter the R2 and R3 years, increasing time is spent in TFM continuity clinics and on ambulatory rotations – the educational and vocational core of a family physician’s career. During this time, residents continue to develop family-based relationships with their assigned panel of patients, gaining increased insight into the unique dynamics of each doctor-patient encounter. In addition, each resident cultivates a personal practice and style under the guidance of faculty family physicians. Faculty members and community physicians in other specialties are always available for consultation.

In addition to the structured curriculum below, there are several longitudinal curricular components including weekly Thursday afternoon didactics, monthly psychiatry case conferences, and monthly nursing home rounds for senior residents. All R3s complete a scholarly project.

In 2013, Tacoma Family Medicine updated all written curriculi and posted them on the New Innovations program you can access from work or home computers or tablets. This program will prompt you two weeks before the rotation to review the goals, objectives, methods, evaluations and resources of each rotation.

New Innovations is the computer program used by most of the University of Washington-Network of Family Medicine Residency Programs and allows you to log procedures, case logs, duty hours and evaluations. It also has some smartphone apps to make event logging easy to document “as you go”.

First-Year Resident Curriculum

Rotation Components of Rotation
Family Medicine 8 weeks inpatient family medicine

2 weeks practice management

2 weeks community medicine
Internal Medicine 8 weeks inpatient adult medicine
Pediatrics 4 weeks inpatient pediatrics
2 weeks outpatient pediatrics

8 weeks working 1:1 with fellow

Rural/Urban Underserved
4 weeks at site of resident’s choosing
Sub-specialties 6 weeks orthopedics – includes pediatric casting clinic

4 weeks dermatology

Second-Year Resident Curriculum

Rotation Components of Rotation
Internal Medicine 6 weeks adult emergency medicine

4 weeks inpatient adult medicine

4 weeks geriatrics working with outpatient IM physicians
Pediatrics 4 weeks inpatient pediatrics

2 weeks behavioral pediatrics
OB/GYN 8 weeks OB

6 weeks GYN includes colposcopy clinic staffed by TFM faculty and GYN clinic staffed by OB/GYN faculty
Rural/Urban Underserved
4 weeks at site of resident’s choosing
Surgery 4 weeks either office-based with OR experience or working on trauma service
Electives 4 weeks
Night Float 2 weeks + 4 weekends

Third-Year Resident Curriculum

Rotation Components of Rotation
Family Medicine 4 weeks inpatient family medicine

2 weeks practice management
Pediatrics 6 weeks pediatric emergency medicine and integrated sports medicine

4 weeks NICU focusing of newborn resuscitation
Sub-specialties 6 weeks ophthalmology, urology, and otolaryngology

4 weeks cardiology
OB 4 weeks required in third year
Electives 16 weeks that are flexible to meet resident goals for future practice (most residents do 4 weeks OB, and 4 weeks are protected “away time” as an additional rural/urban underserved or international rotation)
Night Float 2 weeks + 2 weekends
*R3 residents are assigned to “backup” on outpatient rotations, which means they take home call and are available to help the call team or night float with admissions as needed. They also round on patients before clinic when the TFM panel is overwhelmed.