Curriculum

We have an active curriculum in addiction medicine. All residents get training and certification in Buprenorphine/Suboxone prescribing and receive a waiver from the DEA. One of our family medicine faculty also has board certification in addiction medicine and our head of behavioral health has many years of experience working in addiction medicine. We have a well organized, multidisciplinary, best practice, screening clinic for all patients being considered for controlled substance prescriptions. Between this and a well organized Buprenorphine/Suboxone protocol, we believe that we provide a good model in the care of patients with chronic pain, anxiety, or substance use disorders that serves our patients well and leaves our graduates with a good framework that they can use in their practices. Full Circle Health follows the Centers for Disease Control Guideline for Prescribing Opioids. We try to use alternatives to opioid medications and, if opioids are needed, prescribe the lowest effective dosage. We do not prescribe chronic high dose opioid therapy for patients other than cancer and hospice patients.

Advocacy is an inherent part of being a physician and this is especially true in family medicine. It is critical trainees have a way to learn and practice the skills necessary to effectively advocate for patients in and out of the exam room. In addition to advocacy training and experience that is integrated into the didactic curriculum throughout the year, FMRI residents have the opportunity to participate in an extracurricular Advocacy 101 Course. The 10-12 session course which usually runs from September to March includes sessions on structural causes of health inequity, discussions about how to address those causes beyond the exam room, and the teaching of skills to help trainees better advocate for their most vulnerable patients and health equity in general. These skills include communicating with media, testifying in front of legislators, and working with community partners. In the second part of this class, trainees have a chance to apply learned skills (with guidance and mentorship) during the Idaho Legislative session. This class is a collaboration between faculty from the Boise Internal Medicine Residency, the Family Medicine Residency of Idaho, and the University of Washington-WWAMI program.

Behavioral Health training is at the core of our residency training program. We have integrated behavioral health faculty and LCSWs into our clinic system. This allows for warm handoffs around behavioral issues (mental health, substance abuse, motivational interviewing, etc). Our two behavioral health faculty spend time on rotation with all of our R1s and R2s to build foundational knowledge and clinical care skill sets. We additionally have psychiatry residents who do primary care based continuity clinics at our Raymond site with psychiatry faculty oversight. Formal psychiatry consult clinic occurs on Mondays.

You will have 6 blocks (or 24 weeks) of time during residency on elective training to further your specific learning goals. You can do electives away from Boise (internationally or in other US locations), as well as locally. You will have control over your elective experiences with guidance available on how to schedule and create experiences that will suit your needs. We also have several longitudinal elective opportunities that you can participate in over the course of residency. In addition to this, the three rural rotations give you the opportunity to select sites / preceptors that fit your interests.

You will spend one month in the St. Luke’s ER as an R2 and one month in the Saint Alphonsus ER as an R3. The R2 rotation builds a foundation of ER medicine. The Saint Alphonsus R3 rotation is a Level 2 trauma center providing great preparation for rural practice. Additionally, R3 residents will spend 2 weeks at St. Luke’s ER taking care of pediatric patients. Most residents also spend significant time in the ER at rural sites throughout residency training.

Full Circle Health offers two away electives to interested residents – one in the R2 year and one in the R3 year. This allows time for a global health focused resident to explore two different sites. Although residents are free to set up their own electives, we also have a variety of sites in Central America, the Caribbean, and Africa that former residents have utilized and at which we can help facilitate rotations. We offer a $500 stipend per resident to support one such trip. In addition, we have extra funding for residents who are seeking to improve their Spanish language skills locally or internationally. Full Circle Health grads tend to apply their skills broadly and internationally; we currently have four graduates working in Africa in government jobs or for faith based organizations. In addition to away electives, we have ample opportunities for residents to gain global health skills and knowledge right here at home. Boise has traditionally been one of the top five cities in the US for refugee resettlement per capita, and so we are fortunate to take care of patients with refugee status from Africa, Asia, and the Middle East. Our Emerald clinic does the bulk of this care, providing initial screening exams for all individuals with refugee status who are resettled to Boise, and then ongoing primary care for the majority of those individuals. Our Emerald clinic also houses our HIV, TB, and viral hepatitis subspecialty clinics. Interested residents can choose Emerald as their continuity clinic site, and can participate in our Global Medicine Training Track, led by Abby Davids and Margaret Mortimer. Through a longitudinal curriculum as well as electives and online modules, residents gain experience in the spectrum of infectious disease, chronic disease, cultural issues, and behavioral health care needs that are essential to provide comprehensive care for our global populations.

Tied closely to our Global Medicine opportunities, residents at the Family Medicine Residency of Idaho – Boise program will gain extra experience in infectious disease management. Full Circle Health Emerald Clinic houses the Wellness Center, a Ryan White funded HIV subspecialty clinic serving over 600 patients and we are a part of the HIV National Residency Pathway Consortium. All residents have basic exposure to the Wellness Center, and can do additional training either via elective rotations or by participating in our longitudinal curriculum and choosing Emerald as their continuity clinic site. Along with our HIV specialist faculty, our HIV & Viral Hepatitis Fellows are heavily involved in resident education.

We provide all inpatient care for patients living with HIV on our family medicine service at St. Alphonsus, as well. We also train all residents in evaluating and providing patients with pre-exposure prophylaxis (PrEP) for HIV. The Emerald Clinic also houses our TB clinic, via a partnership we have with the Central District Health Department. Providing care for individuals with both active and latent TB, the TB clinic is another great experience for residents wishing to gain skills applicable at both home and abroad.

Finally, as hepatitis C becomes an increasingly primary-care focused disease, we are working towards having all residents of our program trained and comfortable in the management of chronic hepatitis C. Our hepatitis C clinic serves patients from both within the Full Circle Health system and on a referral basis from other community providers. We are currently providing viral hepatitis care for prisoners via a partnership with the Idaho Department of Corrections, as well. All residents rotate through the hepatitis C clinic, and can gain extra experience via elective rotations.

We feel strongly about preparing you for inpatient medicine. We give you two blocks of experience on a VA internal medicine team in the intern year. But the core of our experience is on a busy inpatient family medicine service at St. Alphonsus. You will do 2 blocks here in your R1 year, 3 in the R2 year and 2 in your R3 year. Our senior residents run this service. We take care of a good mix of acuity and you will be in and out of the open ICU through all 3 years. We do give you an additional two weeks of ICU time in your R2 year to build your skill set working 1:1 with our critical care docs. Our patient population is underserved and you will see a great mix of pathology. Our consultants (pulm-critical care, cardiology, GI, nephrologists, and a variety of surgeons) are dedicated teachers.

We provide a rich obstetrical training environment for our residents with an average of 110 deliveries per resident. We provide full-time L&D coverage at St. Luke’s Boise, with our core maternal-child health team based there. Residents manage our Full Circle Health continuity OB patients with a family medicine faculty member, and take advantage of relationships with the OB hospitalists, the MFM consultant group, and other local obstetricians for additional patient care opportunities. Our senior residents manage the high risk service along with our MFM and OB colleagues and gain a wealth of experience there. Procedural experience is readily available with c-section opportunities with all three groups of obstetricians, and interested residents will get foundational experience in primary c-sections as well. Our FQHC clinic system generates an average of 14-17 continuity deliveries per resident, and we also manage FCH continuity patients at other local hospitals including St. Luke’s Meridian and St. Alphonsus in Boise. We partner with Terry Reilly family medicine doctors for vaginal deliveries and c-section experience at St. Alphonsus Nampa in the R2 year and on inpatient selectives in the R3 year. Two of our grads are doing c-sections at this hospital providing a model of FM with surgical OB here in the Treasure Valley. We offer reproductive health services as a wrap-around to pregnancy care. This includes contraception including LARC and vasectomy, miscarriage management and referral for additional needed services.

The Family Medicine Residency of Idaho – Boise program is recognized by the ACGME for Osteopathic Training; residents will be able to choose to enter an osteopathic track after meeting certain criteria which will provide opportunities to expand their osteopathic knowledge in a longitudinal curriculum. Longitudinal training in Osteopathic Manipulative Medicine is offered to Resident Physicians who are interested in continuing to improve their pre-doctoral skills. This includes integrating osteopathic manipulative therapy (OMT) into a resident’s own continuity clinic, as well as an OMT-focused clinic. Further opportunities include Fascial Distortion Model, trigger point injections, quarterly osteopathic journal clubs, and OMT didactics during residency-wide conference days. Three osteopathic faculty (Shepherdson / Colson / McCormick) provide oversight and mentoring. Additionally, we work hard to teach osteopathic principles and practical skills to our allopathic residents.

We have a strong inpatient and outpatient pediatrics curriculum that is spread across all 3 years. We believe that consistent exposure to all aspects of pediatrics throughout residency will help prepare you to care for kids in less resourced settings. During your R1 year, you will spend two 4 week blocks on pediatrics. Each block is split between Newborn Nursery, Pediatric Hospitalist, and Outpatient Pediatric Clinic (acute and well child visits). In your R2 year, you will return to the inpatient setting with 4 weeks in a supervisory role on the Pediatric Hospitalist team. As an R3, you will have 2 weeks in the NICU, 2 weeks of Pediatric ER, a month of Outpatient Pediatrics split between Subspecialty and General Pediatrics, and 2 weeks on Pediatric Evening Float where you will supervise R1s admitting pediatric patients. While on your pediatric rotations, you will have supervision from pediatric and core family medicine faculty. In addition to these focused experiences, throughout your MCH (OB) rotations you will cover nighttime pediatric admissions. Spread over all 3 years, the pediatric outpatient curriculum is built around our own Full Circle Health Pediatric Clinics in Boise, Meridian, and Nampa and augmented by time in Pediatric Subspecialty and General Practice clinics in the Treasure Valley. In addition, some of your elective time can be spent deepening pediatric skills – there are opportunities to work in a behavior health and trauma informed clinic, school based clinics with a focus on group visits, the PICU, or specific subspecialties.

Family Medicine Residency of Idaho – Boise program provides training to perform all office-based and inpatient procedures needed to feel comfortable in a broad-spectrum practice. In 2018, we will be focusing on expanding our bedside ultrasound curriculum. See the list below for examples of the procedures we are performing at all training sites.

We actively seek to provide our patients with a full spectrum of reproductive healthcare options, including all forms of contraception for both men and women. There are many opportunities for procedures such as colposcopy, LEEP, Endometrial Biopsy, vasectomy, LARC placement, and tubal ligations through partnerships with our hospital sites. We have also continued to maintain our designation as a RHEDI site. For those interested in supplemental training on reproductive health care, there is an optional reproductive health track that meets monthly to cover a variety of topics. Additionally, there are opportunities at partnering care facilities outside of Idaho for reproductive health care training.

You will spend two weeks in the R1 year and four weeks in both the R2 and R3 year at rural sites in Idaho. You will work with our rural focused faculty and coordinator to select sites that fit your training goals. Sites offer a variety of combinations of clinic, ER and hospital experiences that will help you understand the breadth of rural medicine. Rural family physicians from 30 communities participate in our rural training so the offerings are extensive. Housing is provided at sites distant from Boise. Sites close to Boise allow residents with families to balance rural experience and the need to be home at night.

Full Circle Health is dedicated to providing a broad skill set in obstetrical and point of care ultrasound training. We have ultrasound capabilities across all of our clinic sites and subsidize purchases of handheld ultrasounds (Butterfly). Specific training is offered in trans-abdominal and trans-vaginal obstetric ultrasounds for dating as well as limited training on fetal anatomy. Additionally we encourage point of care ultrasound use for joint injections, central line placement, CLUE, FAST, DVT, lung pneumo/ pneumonia, and amniotic fluid evaluation.

We acknowledge that many of our medical students, residents, faculty and graduates recreate throughout the state and seasons, so we feel it is important to develop proficiency in managing out of hospital emergencies. To achieve this goal we are incorporating Wilderness Medicine training into our curriculum. Currently, we have developed a 3 day course that is protected time during the R2 year at the remote and stunningly beautiful Burgdorf Hot Springs, near McCall, Idaho. This site is unique in that it is only accessible by snowmobile during the winter, is rustic yet comfortable with wood stove heated cabins and a large geothermal hot spring which we utilize both for water based training and relaxation. Our plan is to develop this course into a nationally recognized certification course such as AWLS (Advanced Wilderness Life Support) and to expand the curriculum to include a summer course as well.