Program Structure and Curriculum

Overview

• There are 24 residents in the program, 8 in each year.
• Each DGM class rotates through their ambulatory blocks together across all 3 years of residency and becomes a cohesive cohort. Twice per year, DGM interns, juniors, and seniors rotate together on ambulatory allowing opportunities for supplemental curriculum, peer mentoring, and community-building. Program-wide retreats occur twice per year during these two blocks. The program also sponsors special events bringing together the DGM faculty and residents to foster mentoring, collaboration and social connections.
• DGM residents have almost twice as many ambulatory blocks across the three years of training as their categorical colleagues, allowing more in-depth ambulatory training, a comprehensive curriculum tailored to the future PCP, and relevant elective experiences including homeless medicine, addiction medicine, women’s health, adolescent health, LGBTQ health, primary care innovation, and others.
• DGM residents chose among a wide array of practices for their primary continuity clinic. Most DGM residents elect to participate in a second continuity clinic (either in a different primary care setting or sub-specialty) in their junior and/or senior year.
• DGM residents may elect to participate in one of the Pathways available through the larger residency.

Year-By-Year

Intern Year

Seven 2-week primary care blocks

DGM internship is focused on providing a firm grounding in clinical practice through a foundational curriculum and through ample time in continuity clinic. Each block also contains protected time to cultivate mentoring relationships and to explore extra-clinical areas of interest. Interns meet with their Program Director multiple times over the course of the year for additional mentoring and guidance.

Junior Year

Eight 2-week primary care blocks, plus 2-4 weeks of elective

The clinical curriculum for junior residents emphasizes case-based teaching of more advanced clinical topics in primary care and evidence-based practice. Junior residents are given protected time to begin work on their longitudinal projects. To underscore the program’s commitment to professional development, all primary care junior residents travel to the Society of General Medicine Annual Meeting. Many of our DGM residents have presented their work at this national meeting. Many junior residents elect a second continuity clinic at a different primary care site, or in a sub-specialty area of interest.

Senior Year

Five 2-week primary care blocks, plus 10-12 weeks of research/elective

As many of our graduates seek primary care jobs immediately after graduation, we dedicate time to professional development in the senior year with a curriculum focused on preparing residents for independent practice and professional skills including CVs, public speaking and job negotiations. Senior residents have ample time to complete their projects and explore how to make their projects sustainable.

We strongly emphasize teaching skills among our residents, helping them to hone their skills as educators regardless of their own fields of interest. Many of our residents have served as tutors in Harvard Medical School courses and as chief residents at the West Roxbury VA Hospital and Faulkner Hospital during their senior year.

Curriculum

Our clinical curriculum follows a three-year progression, with each year’s content tailored to the developmental stage of the resident. The curriculum emphasizes both evidence-based medicine as well as the pragmatic approach to clinical problems.

Highlights include:

Intern “Bootcamp”

• a peer-led series of sessions focused on the evaluation and management of the most common entities in primary care medicine

Social Justice and Advocacy

• The social justice and advocacy curricula are 3-year, longitudinal programs that arm our residents with the knowledge and skills to address health inequities and serve as effective advocates at every level. Through curricula, skill-building workshops, and facilitated discourse, residents cultivate a justice-oriented approach to the provision of healthcare in both clinical and systems-level domains. As part of the advocacy arm, residents make a yearly visit to the State House to meet with legislators and advocate on a relevant health-related issue.

Quality Improvement

• A longitudinal skill-based curriculum focusing on quality improvement and patient safety, including opportunities for learning population health and panel management.

…and more:

• Buprenorphine waiver training, plus case-based learning on the care of patients with substance use disorders
• Reflective practice sessions (“Balint group”)
• Advanced communication skills, including motivational interviewing and communication in serious illness
• “Primary Care Roundtable” - multiple PCPs talking through common challenges and controversies in primary care medicine
• “Clinical conundrums” case review with program director
• Clinical epidemiology
• Health policy

Personal Projects

Each resident is provided time and mentorship to undertake a longitudinal project. The project can be any piece of work that fulfills the following objectives:

• To improve the care of patients
• To inspire the resident and re-connect them with their sense of purpose in medicine
• To live on after graduation, either as a sustainable program, integrated curriculum, or published/presented findings

Residents’ projects have encompassed a wide range of domains, including medical education, community engagement, research, humanities, and QI. Many residents’ projects have become permanently integrated into the program’s formal curriculum. Examples of recent projects include:

• Creation of a Latina women’s group focusing on improving health literacy and self-empowerment for patients at the Phyllis Jen Center
• An innovative curriculum on long-acting reversible contraception
• A research project developing a patient-centered discharge toolkit to facilitate patient engagement in safe transitions of care

Many of our residents have presented their projects as scholarly work at SGIM or other national conferences and receive mentorship and financial support to do so.

Program-Wide Longitudinal Project – Community Engagement

In 2018, residents in the DGM and HVMA/Atrius Health primary care programs, came together and identified community outreach and engagement as a core tenant in their training which could benefit from further education and hands-on experience.

Sportsmen’s Tennis and Enrichment Center is a tennis club located in Dorchester. Sportsmen’s has been serving Boston’s inner city since 1961, as the first indoor non-profit tennis club built by and for the African American community. The Brigham and Women’s (BWH) Center for Community Wellness (CCW) was launched at Sportsmen’s in 2015. CCW’s mission is to advance resident health and chronic disease prevention in the underserved communities of Dorchester, Mattapan, and Roxbury. At the CCW, Sportsmen’s now offers free multidisciplinary health & wellness programs to help community members to better understand and address the social determinants of health.

Through a joint longitudinal project, the primary care residents are working to develop a curriculum aimed at teaching the best practices of community engagement and to create a successful and sustainable relationship and learning opportunities with the CCW and the Dorchester community. In addition to these primary aims, our collective longitudinal project builds teamwork and fosters collaboration between the two primary care programs.