Curriculum

Family Medicine Residency Program

Inpatient Medicine

Family Medicine at Northridge is always described in superlatives: The most challenging, the most interesting, the most educational … and the most fun!

While our Family Medicine Center is at the heart of the residency, the inpatient family medicine service allows residents to gain experience in disease diagnosis and management in a compressed process of care. Residents work in a team with one-on-one supervision from a faculty attending providing care for adults: from adolescents to the elderly.

Just like practicing family physicians, our residents manage - at any one time - medical, surgical, orthopedic, neurologic, and even gynecology patients. And not unlike family physicians in practice, patients are managed by residents from admission to discharge, including critical care medicine.

Faculty attending's not only teach in rounds and morning report, but at the bedside. The hospital faculty attending's are both family physicians and internists. Critical care specialists are available for consultation in the ICU and CCU. Daily radiology rounds are conducted with a radiologist attending along with a medicine attending.

During these rounds patient imaging is projected onto a 60 inch screen in the radiology conference room. While viewing the images with the radiologist, residents are encouraged to ask questions about images as well as discuss the future management of the patients. Patient loads are kept manageable by graded experience with service caps.

Our residency is in the enviable position of having no other competing residency yet being at a referral hospital with a wealth of pathology. Residents learn to manage patients with pneumonia, cholecystitis, stroke, and hip fractures while caring for patients diagnosed with CNS lymphoma or dengue fever.

Sports Medicine

Sports medicine is an exciting and integral part of the curriculum at the Northridge Family Medicine Residency Program. The sports medicine program is headed by our very own primary care sports medicine specialist, Dr. Mandeep Ghuman. Residents, as well as rotating medical students under the supervision of Dr. Ghuman, have the opportunity to gain first-hand experience in evaluating and managing a variety of musculoskeletal conditions through our sports medicine clinics, which are held twice a week at the Family Practice Center.

In addition to these clinics, residents also rotate through dedicated sports medicine and orthopedic electives in their third and second year of residency, respectively. At the completion of their residency training, residents have successfully attained and honed skills in such areas as the orthopedic physical exam, the evaluation, management, and rehabilitation of musculoskeletal injuries and conditions, splinting and casting of fractures, and joint aspiration and injection.

Residents have ample opportunity to enhance their sports medicine experience, while at the same time performing a valuable community service, by serving as team physicians and participating in athletic event coverage. Dr. Ghuman is one of the team physicians for California State University Northridge, a nearby NCAA Division 1 level college. 

The residency program under the supervision of Dr. Ghuman serves as the team physician for James Monroe High School. Through these affiliations as well as many others within the local community, residents are actively involved in covering events and treating athletes at the recreational, high school, and elite levels. Among the many sports that the residency program is involved in covering are football, basketball, soccer, and track & field.

With the experience and skills gained in sports medicine through the course of their residency training, many of our residents have gone on to be team physicians in their own right upon graduation. In fact, if you were to drive around Southern California on a Friday night in the fall, there’s a good chance that a graduate of our program is out there covering a game!

Fellowships in Primary Care Sports Medicine are increasingly popular and competitive in recent years. Residents who want to specialize in this dynamic and growing field have taken the knowledge and experience they attained during residency to successfully pursue additional fellowship training. No matter what your career path may be, the ability to care for musculoskeletal conditions and athletes is a vital and rewarding aspect of any practice. Sports medicine is a skill in which we are confident that you are competent upon the successful completion of your residency training at the Northridge Family Medicine Residency Program.

Surgery Rotation

• Consists of both inpatient and outpatient surgical experiences, as the curriculum is designed to give residents a broad exposure to the breadth and depth of the surgical specialty.
• During the rotation, residents see a variety of cases and gain competence in the diagnosis and care of common surgical problems, learn to perform basic surgical procedures and perfect their techniques.
• Additional reading materials from books, journal articles, and other current literature are provided to further supplement the residents knowledge.
• Inpatient setting: Residents have numerous opportunities to scrub into a wide range of general surgeries as well as more specialized procedures in the hospital on a daily basis.
  Through direct patient care, residents learn the principles of pre-operative evaluation and preparation of patients, as well as post-operative care.
• Outpatient setting: Surgery Clinic is one of several specialty clinics available in the Family Practice Center, which offers residents the exciting opportunity to gain hands-on surgical experience and learn common office procedures – including incision and drainage of abscesses, skin biopsy (excision, punch, shave), skin lesion removal, cryotherapy, and toenail avulsion.
  Surgery clinic is supervised by one of our faculty members who has a special interest in outpatient surgical procedures (Dr. Cindy Yang), in conjunction with additional expertise from two surgeons in the community.
• Upon completion of training here at the Northridge Family Medicine Residency Program, graduates have extensive exposure to both inpatient and outpatient surgeries and are highly competent in their surgical skills.

Maternity Care at Northridge Family Medicine Residency

Caring for your pregnant patients can be one of the highlights of your residency experience!

Dr. Claudia Rico, second year resident said, “Our family medicine attending's who share our OB patients are really there for us. They are always there teaching and supporting the residents and the pregnant patients. They are available and ready to help.”

We have a strong team of five experienced family medicine faculty who provide low risk maternity care. Dr. Diana Lev completed a maternity care fellowship prior to joining the Northridge faculty. She runs the obstetrical ultrasound clinic in our office and rounds on the postpartum floor with the residents. Dr. Joni Zapata has delivered babies for twenty five years and still loves coming in for one of her patient’s deliveries. Dr. David Yamada is a loyal private practice attending who leaves his practice to follow patients with the residents. The team is rounded out by Dr. Kathy Cairo, an experienced family physician faculty member and the newest member, Dr. Cindy Yang.

Residents care for their continuity maternity patients during their family medicine continuity sessions in our family medicine center, where they learn about and model whole family care. All family medicine patients deliver at Northridge Hospital, located next door to the campus of the residency program where we have a busy labor and delivery unit with the latest in remote fetal monitoring and excellent nursing staff.

Residents round out their experiences in maternity care through following patients of select OB teaching staff. Residents can easily deliver 100 patients during their three years. Daily teaching rounds with family medicine or OB faculty occur on the maternity care rotation. These rounds include practice reading fetal monitor strips, discussion of active inpatient cases and lectures on a core of other maternity care topics. All deliveries are attended by the attending physician in addition to the resident. Residents learn to assist in Caesarean sections and tubal ligations and see a wide spectrum of patients.

Dr. Apurva Samant, second year resident said, “My patient told me how happy she was to have the two doctors who cared for her during her pregnancy be there for the delivery in the middle of the night. That made it feel rewarding for me.”

Inpatient Pediatrics

Our pediatric inpatient rotations here at Northridge provide residents with an exciting and unique educational experience. Northridge Hospital houses a full complement of pediatric care including general pediatrics, an NICU and a PICU. Additionally, Northridge Hospital is currently the only Level II pediatric trauma center in the San Fernando Valley.

As a result, our hospital annually sees a large volume of pediatric illnesses that span the breadth of different diagnoses from common “bread and butter” cases to the more exotic. During their 1st year, residents rotate through our general pediatrics ward where they work directly with Dr. Catherine Cho, our pediatric coordinator, or one of the Family Medicine attending's. Daily rounding consists of walk rounds with the residents, where teaching is integrated into every patient case through article reviews, short didactic sessions, review of interesting physical findings, or discussions about new up-to-date perspectives on management.

During their 2nd year rotations, residents rotate through our PICU where they work one-on-one with the pediatric intensivists and get valuable exposure to PICU and trauma patients. The intensivists have a flair for teaching and add a different perspective to the approach of the more critically ill patient. They are in house and available 24 hours a day. Residents consistently report that they enjoy the teaching they receive during their PICU rotation.

Additional electives are available in the PICU for interested third-year residents. Another benefit of Northridge is the availability of pediatric specialists for consultations and recommendations. Residents will work directly with these specialists and on their cases. Residents are also offered the opportunity to be involved in doing procedures done by the specialist.

When residents relay an interest in doing more procedures, the staff is more than happy to accommodate them. Finally, all of the pediatric floors are staffed with nurses who are skilled in the care of pediatric patients and also like to teach our residents. Our hospital has a child life specialist, a pediatric dietician, social workers and volunteers who work together to improve our patient’s quality of life during their stay here with us. Residents frequently report that they receive the biggest hugs from their patients as they leave the hospital.

Outpatient Pediatrics

Inpatient acute care of pediatric patients is only one aspect of the pediatric educational experience here at Northridge. Although it is important to know how to manage sicker hospitalized patients, much of the family doctors future involvement with children will actually be in the outpatient setting. Fortunately for us, we have a busy outpatient practice with a large population of pediatric patients.

Residents manage their own panel of patients, of which a significant number are children. Residents can expect many pediatric visits encompassing both routine well child and acute care. Additionally, we have dedicated a set amount of lecture time towards pediatric topics. Finally, each second year resident rotates at the NEVHC Federally Qualified clinic in ambulatory pediatrics with a staff Pediatrician.

Community Medicine Rotation

We believe that developing competence in community medicine is key in preparing residents to enhance the health of the communities they serve. Understanding how culture and economics affect availability and delivery of health care services, working effectively with existing community partners, and developing competence in health education are key in delivering high quality cost-effective health care.

This year’s revamping of the Community Medicine curriculum aims to create a more longitudinal experience during the first and second years. Introduction to the rotation is with our behavioral health faculty. One of our goals is exposure to a wide range of resources in the community. 

• Nutrition/ Diabetes counseling with our dietician/diabetes educator.
• Sports medicine and musculoskeletal clinics.
• Northeast Valley Health Center ( A FQHC) is a site where learn about the non-profit organization’s mission for the underserved and includes breastfeeding and childhood nutrition programs.
• Palliative care education is offered right here at Northridge Hospital.
• Child abuse screening center ( CATS) a service provided through Northridge hospital.
• Elementary and Middle School projects for diabetes and obesity prevention programs.
• Geriatrics care including home visits and skilled nursing home center visits.

In the first year, residents have two rotations. The schedule includes time dedicated to planning a research project. Residents spend about three half days a week in office, where part of their training is learning about the referral resources available to our patients. Some of their patient visits are observed via video by behavioral health or family practice faculty so they can get feedback on their interactions with the culturally diverse patients of the Family Practice Center.

We are striving for better health outcomes for our patients as well as higher levels of satisfaction for our residents.

Geriatrics

The geriatric experience at Northridge is strong both in the hospital and in the office; both populations are about one-third seniors 65 and over. With their attendings help, residents on the inpatient service gain experience holding family meetings and discussing code status with patients and families. Each second and third year resident has continuity nursing home patients.

Residents do introductory skilled nursing home visits with an attending physician in the first year and attend multi-disciplinary rounds at Northridge Care Center during their first year; they also do home visits starting that year and continue with their own patients as needed.

Geriatric topics are included as part of the lunch-time lectures as part of the medicine and behavioral health curricula. Third year residents have the option of an elective in geriatrics at locations including the Motion Picture and Television Fund in Calabasas, the Jewish Homes, and Northridge Hospital with the palliative care team.

Elective Experiences at Northridge Residency

Each resident has an opportunity for an independent elective rotation during there senior year. Residents have the opportunity to explore areas of interest in family medicine, areas that they want more experience, rural or community health, future practice site experiences or research.

All electives must have educational value and be preapproved by Dr. Zapata. Past Elective experiences include:

• Rheumatology
• Podiatry
• Infectious Disease
• Outpatient Surgery
• Geriatrics/ Hospice medicine
• Pain management/addiction medicine
• Diabetes camp in Lake Arrowhead
• Global health relief experiences
• Rural/Indian health
• Future practice site experiences
• Research/scholarly projects

Night Float

Northridge Family Medicine Residency Program has a long history of night float experiences. Float originally started as a solution to decreasing in-house overnight call for senior residents, we are able to smoothly transition into the new work hour restrictions with this system. Our program also has the unique addition of a faculty member who is available weeknights in-house until 10 p.m. as well as full time intensivists who are available to teach inhouse 24/7.

The float residents are a team of a PGY-1, 2, and 3 during the first six months, and a team of PGY-1 and PGY-2 during the second six months. There is gradually increasing amounts of responsibility throughout the rotation.

• Excellent experience and education in the admission and the management of inpatient and outpatient overnight issues, including adult, pediatric, and obstetric patients.
• Additional experiences in assisting in emergency surgeries and cesarean-sections.
• Daily structured education time with an attending one-on-one as well as further lectures and discussions during medicine morning sign-out.
• Team approach including PGY-1 and senior residents.
• Skills learned include teamwork and time management.
• Weekly outpatient clinics ensure continuity of care of your panel patients.

Call

Call at Northridge Family Medicine Residency is a smooth transition for ACGME work hour restrictions with our current well-tested night float system already in place. The call team always consists of a PGY1, 2, and 3, as well as a faculty member who is available 24/7.

• Call for PGY-1 and 2, is every 5 nights for 9 months of the year.
• PGY-1 takes call until 9 p.m. through out their the year and night float resident takes over.
• First half of PGY-3 call is every 5 nights and PGY-2 and 3 residents take call until 9 p.m. on weekdays and overnight call on Friday and Saturday nights.
• Second half PGY-2 resident takes overnight call every 5 nights, and the PGY-3 resident takes at-home call every 4 nights for 3 months only. This allows for the PGY-3 resident to model his/her future practice, and also for the growth of the PGY-2 residents who now have increasing amounts of responsibility and independence.

Being on call not only allows for comprehensive management of patients across the age spectrum but also gives added experience in fielding, managing, and prioritizing inpatient and outpatient issues. It is an invaluable experience that helps to create well-rounded family physicians.

Information Technology

Our Family Medicine Center

• Since 2007, we have been using the Cerner “PowerChart Office” EMR system in our Family Practice Center. Significant features of our EMR that help improve both patient care and resident education include:
• Electronic prescription writing.
• Remote access outside the clinic (including via smart phones & tablets).
• Interfaced lab and radiology results.
• Productivity and PQRI compliance reporting capabilities. To access the system, residents are provided with a laptop computer for their personal use during their three years of residency.

Our Hospital

Although it does not yet have a fully integrated EMR, the Hospital does have a web portal through which all inpatient labs, hospital dictations, and radiology reports can be accessed. For those with an iPhone or iPad, the data can be downloaded for review on these devices.

Residency Management

System New Innovations, a web-based residency management system, allows residents 24 hour access to their call and office schedules and lets them report work hours, review rotation curricula, access the educational calendar, complete rotation evaluations and view their performance evaluations.