The Tulane Internal Medicine Residency Program places a strong emphasis on outpatient medicine for all residents, whether they are categorical or primary care. All residents will complete more than 200 clinic sessions over a three-year residency, far exceeding the 150 required by the ACGME. They will also have over 25, three-hour "Ambulatory School" conferences devoted to topics in ambulatory medicine. For these reasons, the primary care track does not focus on providing additional clinic time or additional time to learn outpatient medical knowledge. Instead, it focuses on providing residents with additional skills in panel management, practice management and community engagement. In short, the Tulane Internal Medicine Primary Care Track is designed to create primary care leaders, developing the management, communication, and leadership skills requisite for running a patient-centered medical home upon their graduation. Whether in academic or community-based primary care clinics, it's no wonder that Tulane graduates go on to leadership positions in primary care.
Primary Care Track Basics
As opposed to other residency programs where primary care residents are in parallel to the remainder of the residency program, the Tulane Internal Medicine Primary Care Track residents are integrally involved with all residents in the program. All interns in the primary care track do the same rotations as their non-primary care track colleagues. We believe this is important because it establishes a strong foundation in general internal medicine, and enables the primary care residents to appreciate the intricacies central to understanding successful transitions-of-care between the inpatient and outpatient environments.
Compared to categorical residents, primary care residents have one less elective month in their second and third year as well as one less CCU/ICU/Moondog rotation over the final two years. Those slots are filled with ambulatory-based rotations. In addition to the standard rotations, primary care residents (both interns and upper levels) have an exclusive specially-crafted ambulatory-based rotation called the Primary Care Core (PCC).But the PCC is just one of the many components that make the Primary Care Track unique. Becoming a great primary care physician and leader involves much more than just seeing more patients in clinic during your residency time; the primary care track is designed to accomplish so much more.
The Tulane Internal Medicine Primary Care Track is defined by much more than clinical care. Primary care residents are firm leaders interacting with colleagues and impacting especially the outpatient-based care of their firms’ patients. Collaborative skills are honed not just by interacting with co-residents but also by working with the clinics’ non-physician staff (social workers, pharmacists, nurses, nurse practitioners, etc) while coordinating continuity of care. Working with the clinic leadership, especially at the Ruth U. Fertel/Tulane Community Health Center, residents acquire valuable skills by participating in policy and procedure discussions and changes. In doing so, residents gain valuable leadership and management experience, fully preparing them to lead their own primary care enterprise as a patient-centered medical home upon their graduation.
Primary care track residents have the opportunity to work closely with the leaders in primary care in New Orleans to receive the mentorship required to advance an academic career in primary care. As the primary care track affords protected time to do so, residents have multiple opportunities to participate in outcomes-based research in primary care. By the completion of their residency, primary care track residents will have the opportunity to present such research at a local, regional or national meeting (all expenses sponsored by the program). In this way, the Tulane Internal Medicine Primary Care Track is unique: residents change the face of primary care by their scholarly pursuits, further preparing them to assume leadership roles upon graduation.
Teaching Primary Care
Valuable teaching experience is gained in the primary care track in a diversity of settings (see below). Beyond the teaching that is expected of all Tulane Internal Medicine residents when working with medical students, primary care track residents serve as preceptors for medical students in the Fleur-de-Vie free-clinic, and as primary teachers in the Ambulatory School for their categorical colleagues. Primary care residents are taught essential skills in patient education and empowerment, and their involvement with the community-based clinics provides an opportunity to hone those skills.
The Components of the Tulane Primary Care Track
- The Primary Care Core (PCC) Rotation
- The Ruth U. Fertel Tulane University Community Health Center
- Mastering Transitions of Care:
The Primary Care Track longitudinal Quality Improvement Projects
- Primary Care Grand Rounds and Primary Care Journal Club
- Meaningful Community Engagement
The Tulane Internal Medicine Primary Care Track is integrated into the remainder of the residency program. The “4+1” system is the key. Under the “4+1” system, the residency program is divided into five firms. Each week, one of the five firms devotes its time to primary care continuity clinics (the “+1 weeks”); the other four firms staff the standard inpatient ward, ICU, ER and elective rotations. During these "+1" continuity clinic weeks (ten clinic weeks per year), all residents have protected time to devote to the care of their primary care patients without the distraction of ward or elective duties. Importantly, this system enables patients to schedule clinic appointments with their primary care provider anytime within the clinic weeks, removing the guess-work that is a feature of the standard system where resident clinics are only one half day per week and frequently cancelled or moved due to post-call, on-call or ICU/ER duties.
But what happens in the four weeks that intervene between a firm’s primary care “+1” week?
The answer is Primary Care Core, an ambulatory rotation staffed by Primary Care Track residents. The PCC resident acts as the ”Patient-centered Medical Home Director” for his/her firm-mates, overseeing their patients while they are on wards/ICU/electives. These visits are generally directed towards specific tasks such as hospital discharge follow-up, blood pressure checks, or acute complaints. Because of their interest in ambulatory medicine, the PCC resident often serves as a resource for his or her colleagues, providing information on outpatient medicine guidelines, clinic functions, and community resources.
In addition to seeing their colleague’s patients at two outpatient clinic sites (the VA and the Medical Center of Louisiana-New Orleans), PCC residents also see new patients entering these systems, increasing overall access to these healthcare systems and providing important learning opportunities for the PCC resident, who needs to evaluate a patient’s medical and social needs in order to provide comprehensive care and the moment care is established.
Primary Care Core also incorporates a number of rotations that are unique to the Primary Care Residents. Among these are the opportunity to precept at the Tulane student-run free clinic and to help facilitate Krewe de Lose, a community-led weight loss program. More information on these opportunities is below.
2. The Ruth U. Fertel Tulane University Community Health Center
Tulane Primary Care Track interns and residents have the unique opportunity to have their own panels of patients at The Ruth U. Fertel Tulane University Community Health Center. Ruth Fertel was the founder of Ruth’s Chris Steak House, and after Hurricane Katrina her family donated the building that had been the original restaurant to Tulane University to serve as a community health center. Fertel is a Federally-Qualified Health Center and is recognized as a National Committee for Quality Assurance patient-centered medical home. In addition to the primary care provided by Primary Care Track interns and residents, Fertel provides pediatric, ophthamology, and HIV services. The interns and residents at Fertel are led by Dr. Jonathan Gugel.
Housed within the Fertel building, upstairs from the clinic services, is the Brinton Family Health and Healing Center. The Brinton Center provides a wide variety of community services, from weight loss classes, smoking cessation classes, a walking group, mental health counseling, case management, computer classes, and job search services. The Center is staffed by a number of Community Health Workers, a Social Worker, a Case Manager, and a volunteer from AVODAH. Interns and residents work closely with this interdisciplinary team to provide comprehensive care to their patients. The Center staff can find a resource for almost any problem you can think of!
3. Mastering Transitions of Care: The Primary Care Track longitudinal Quality Improvement Projects
Meaningful training and preparation for a career as primary care leaders requires that trainees master transitions of care and learn to facilitate care with other subspecialists. At Tulane, residents manage their patients’ transitions of care between the inpatient and outpatient settings on a regular basis. Beyond arranging hospital discharges and admitting patients from clinics, residents also work directly with colleagues coordinating care for patients among the subspecialty services and clinics (which for some includes working in subspecialty clinics during the “+1” week).
More than just facilitating the physical transitions of patients between clinical settings, mastering transitions of care also means being able to analyze systems and identify obstacles in optimizing those same transitions. Learning to recognize patient and system-based barriers and to identify their remedies is an important part of mastering transitions of care. These are important skills for all members of the firm, but the augmented experience the primary care residents receive as leaders in management of these transitions is invaluable to their subsequent careers as primary care leaders.
To consolidate these skills, the Tulane Primary Care Track residents participate in a longitudinal quality improvement project focused upon transitions of care and meaningful integration of patients into primary care homes, either at Tulane’s affiliated clinics, or in the community-based FQHCs through which we provide care. Once a month, Primary Care Grand Rounds is dedicated to maintenance and updates on this project. As a community and patient-centered medical home clinic, Fertel provides an excellent source of data for these projects.
4. Primary Care Grand Rounds and Primary Care Journal Club
Becoming a great primary care physician and leader involves more than just excellent clinical exposure. The primary care track residents have additional learning opportunities through weekly Primary Care Grand Rounds and monthly Primary Care Journal Clubs.
Primary Care Grand Rounds occurs each Monday during the noon hour. The first two weeks are reserved for speakers from a variety of areas; examples of speakers include:
- Mark Keiser, CEO of Access Health Louisiana, the FQHC that runs Fertel, discussed health care delivery systems and the challenges faced by FQHCs.
- Dr. Anjali Niyogi, Tulane University Clinical Assistant Professor of General Internal Medicine, discussed the physician’s role in assisting immigrant patients who are asylum-seekers.
- Ashley Wennerstrom, PhD, MPH, Tulane University Assistant Professor of Medicine, discussed the role of Community Health Workers in health care provision.
The third Monday of each month is dedicated to a combined conference with Medicine-Pediatrics residents, and the fourth Monday is devoted to the Primary Care Transitions of Care Quality Improvement project.
Primary care journal club, which occurs in addition to the all-program journal clubs, occurs in the evening of the first Tuesday of each month. These meetings provide a relaxed learning environment and are held over a dinner at a resident or faculty member’s home. The topic and reading material is resident-selected and the discussion is resident-led, with guidance from a faculty member as needed. As applicable, guest speakers are invited to enhance the learning opportunities. Although journal club is held “after-hours,” it is well-attended for its social-support value as much as its educational content.
Taken together, Grand Rounds and Journal Club provide a “home within a home” in the residency program, allowing residents interested in primary care to have additional opportunities to gather around their common interests.
5. Meaningful Community Engagement
As part of their Primary Care Track rotations, residents have the opportunity to work in a number of community programs and free clinics. A sampling of these are listed below.
- Krewe de Lose: A community-led weight-loss and health-food group based ou of the Brinton Family Center at the Fertel Clinic. Occurs weekly on Monday evenings.
- Soul Steppers: This walking group is also based out of the Brinton Family Center, but takes place at City Park each Saturday morning. This past year a number of participants participated in the Rock N’ Roll 10K race, half-marathon, and full marathon.
- Fleur de Vie: The Tulane University School of Medicine student-run free clinic operates out of the Fertel Clinic and occurs twice a month on Saturday morning. Residents have the opportunity to precept medical students at these visits, which is a great teaching opportunity.
- Rebuild Clinic: This free clinic operates out of the Harry Thompson Center, located between Tulane Hospital and UMCNO. It occurs on Wednesday and Friday mornings and is open to anyone who needs medical care.
- Adolescent Clinic: Covenant House, located in the French Quarter, provides many services to the youth and families of New Orleans, including medical services. Although not always part of the Primary Care Track rotation schedules, working in this clinic is an option for those who are interested in adolescent care and women’s health.
Tulane Internal Medicine Primary Care Track: Why We’re Unique!
The residents in the Tulane Internal Medicine Primary Care Track reflect the diversity of the Tulane Internal Medicine Residency Program, hailing from multiple institutions from around the United States. While all share the common mission and vision of better health through better primary care, each has his or her own career vision for how to accomplish that goal. If you want to learn more about our team’s individual visions, feel free to send them an email. We are looking forward to hearing from you.
Libby van Gerwen
- Jennifer Tran (2015) – Primary Care Physician, East Jefferson Health Care
- Scott Martin (2015) – Primary Care Physician, JenCare, New Orleans
- Robin Ivester (2015) – Primary Care Physician, specializing in LGBT care, Ochsner Health System, New Orleans
- Alix Oreck (2015) – Primary Care Physician, Tulane University Ruth Fertel Community Health Center, Tulane Resident Preceptor
- Naomi Karlen (2015) - Primary Care Physician, New Orleans Veterans Health Care System, Tulane Resident Preceptor
- Ryan Brown (2014) – Primary Care Physician, Internal Medicine Associates, Lexington, Kentucky
- Cady Brown (2014) - Primary Care Physician, Internal Medicine Associates, Lexington, Kentucky
- Andrew Burchett (2014) - Cardiology Fellow, University of Kentucky
- Meredith Barnes (2013) – Primary Care Physician, San Diego Veterans Health Care System
- Erin Boswell (2013) - Completed VA Chief Resident in Quality and Safety (2013-2014), currently an ID Fellow at Tulane
- Sancia Ferguson (2013) - Rheumatology Fellow, UC-San Francisco
- Jason Halperin (2013) - Outpatient HIV/Primary Care Physician, New Orleans (ID Fellowship at NYU)
- Kate Hust (2013) - Assistant Professor doing Outpatient and Inpatient medicine at Hennepin County Medical Center/University of Minnesota
- Rachel Sandler (2013) - Assistant Professor doing Outpatient and Inpatient medicine at Hennepin County Medical Center/University of Minnesota
- Irene Grundy (2012) - Hospitalist, New Orleans Veterans Health Care System
- Catherine Jones (2012) - Associate Program Director & Primary Care Track Director, Tulane Internal Medicine Residency
Dr. Catherine Jones is the Director of the Primary Care Track and the Associate Program Director overseeing all ambulatory training in the residency program. Please contact her with any questions you have regarding the primary care track:
Ready to Join Us?
Nowhere else will you receive the leadership, management, communication, and research skills requisite for a successful career in primary care. If assuming a leadership position in primary care is your goal, look no more…Tulane is the home for you!
While anyone can enter the Primary Care Track at any time, the program has made a commitment to ensuring that each firm has a minimum number of residents devoted to primary care by devoting at least five positions in each year’s match to those interested in primary care.
If you are interested in applying to the Tulane Internal Medicine Primary Care Track, simply complete your application (via ERAS) to the Tulane Internal Medicine Categorical Program. Once you are invited for an interview, make sure to let us know you are interested in the Primary Care Track, and we will make sure you have time to spend with the primary care residents learning more about the program.
When it comes time to submit your match list (via the NRMP), you’ll find a separate “match code” for the Tulane Internal Medicine Primary Care Track (3073140C1) and the Categorical Program (3073140C0). Applicants are encouraged to list either or both of Tulane Internal Medicine’s NRMP match codes.
The Tulane University Primary Care Track is supported in part by the following grants:
Primary Care Expansion Grant. HRSA (#T89HP2077); $2,472,964
Transitions-of-Care for Vulnerable Patient Populations. HRSA (#D54HP23291)$875,149