Mission

To develop full-scope family medicine physicians and medical corps officers who are ready to join the Military Health System and operational force to serve anywhere the Army and country need them, and to support their wellness while doing so.

Vision

Our graduates will be highly professional, highly skilled primary-care providers who are additionally proficient in inpatient medicine, clinic-based procedures, uncomplicated obstetrics, across a range of procedures, and with medicine on the battlefield. They will be part of the Ready Medical Force who sustains a Medically Ready Force.

Aims

• Our graduates will be prepared to fill a wide variety of roles within the military, including as primary care physicians for units, as clinic- or hospital-based providers, as operational unit physicians, as teachers in medical education, and in further fellowship or other training.
• Our graduates will be prepared to fill important leadership roles within their institutions and the MHS overall.
• Our graduates will provide excellent care for military Service-Members along with their families, retirees, and other beneficiaries.
• Faculty and residents will remember that it our great privilege and responsibility to train some of the most versatile physicians in the country in the high calling of service to the nation.

Morning Report

Monday-Friday from 7:15-7:45 a.m. Led by a resident or faculty. Focused on case presentation for developing clinical reasoning, differential diagnoses, work up and management.

Academics

Every Wednesday from 12:30 - 4 p.m. we have academics. This varies week-to-week and includes lectures from residents, faculty and/or specialists and is designed to cover core topics for family medicine over the year. It also includes procedure simulations, journal club, and special longitudinal curriculums focusing on behavioral health, health inequities, diversity, equity and inclusion, military medicine and professionalism. Following academics, we have dedicated time for physical training and sports together from 4 - 5 p.m.

Hospital Grand Rounds

Each month, the hospital hosts lectures series by our Women in Medicine Group and our DEI Committee.

Other

You will attend other didactics within other residency programs at Madigan when on other rotations such as pediatrics, OBGYN, and ICU.

Medical Selectives

• Cardiology
• Pulmonology
• Gastroenterology (outpatient clinic-based)

Medical Elective Options

Above selectives, and many other options including:

• Ultrasound
• Sports Medicine
• Procedures
• Obstetrics
• Dermatology
• Rheumatology
• Neurology
• Endocrinology
• Infectious
• Disease
• Emergency Medicine
• Palliative Medicine
• Research
• Faculty Development

Pediatric Elective Options

• Adolescent
• Developmental
• Cardiology
• Pulmonology
• Infectious Disease
• Genetics
• Gastroenterology

Surgical Elective Options

• General
• Vascular
• Urology
• Ophthalmology
• Otolaryngology
• Plastics

Other options can be added/created! Residents have also completed electives in addiction medicine, pain management, tropical medicine, and wilderness medicine.

Each PGY2 and PGY3 resident has two 2-week night float rotations per year where they cover our inpatient team to include admissions and laboring patients. During night float, residents work six nights each week (Friday-Wednesday) for a total of 24 nights per year. Thursday night call shifts are split amongst all PGY2 and PGY3 residents resulting in approximately four additional call shifts throughout the year. Our PGY1 residents work one week of night float alongside a senior resident to gain familiarity and experience prior to being on call later in residency.

There is a dedicated rotation for Military Unique Curriculum and Managing Healthcare Systems during R2 year, as well as individual lectures, simulation sessions, and other learning events which address the topic throughout the year. The Advanced Procedures rotation during R3 year is focused on procedures that are relevant to operational medicine and the Army-designated Individual Critical Task List (ICTLs) that graduates will need to have experience with prior to their first assignment after residency.

Throughout training, residents will be expected to show, and will receive feedback on, professionalism, military bearing, uniform standards, height/weight/physical fitness standards, and other relevant topics. Madigan as an institution also runs a GME central curriculum including mandatory intern lectures and required yearly conferences which cover important aspects of officership and professionalism. The graduate CAPSTONE weeklong training and field exercise provides a realistic experience for battlefield medicine/tactical combat medical care. Residents are active duty officers during training and are held to the relevant mandatory training requirements of all Soldiers.

• Combat Casualty Care Course (C4): 10-day course that covers Tactical Combat Casualty Care (TCCC) topics and ATLS certification, usually done R1 year.
• Madigan CAPSTONE Course: One week course done during R3 year to help residents further prepare for operational medicines.
• Life-saving certification classes: Basic Life Support, Advanced Life Support, Pediatric Advanced Life Support, Advanced Trauma Life Support, Fetal Heart Monitoring Course, Advanced Life Support in Obstetrics, Neonatal Resuscitation, STABLE neonatal course
• Board Certification Course: Provided during R3 year

Optional Courses

• Military Medical Humanitarian Assistance Course
• Military Tropical Medicine Course
• Expert Field Medical Badge, Air Assault, and other operational courses (pending availability)

We have formal faculty-led simulation workshops as a group held once per quarter. Each quarter has a theme: obstetrics, pediatrics, adult, and trauma. These are held at the state-of-the-art Andersen Simulation Center. At least once per month during our academics we also conduct just-in-time simulations focused on emergency and critical care procedures and POCUS. Residents also have a R3 rotation dedicated to “advanced” procedures and this includes one half day per week focused on the Army-designated Individual Critical Task List (ICTLs) which includes things such as central line placement, intubations, eFAST exams, IV/IO insertion and others.

Leadership and officership topics are specifically included during institutional training sessions including the intern-lectures series, half-day workshops, and week-long CAPSTONE course for graduating residents. Within the residency, talks/discussions are provided longitudinally during academics, including sessions on operational experience and officership topics. Professionalism and leadership are modeled by senior residents and staff throughout all of residency, and informally discussed as opportunities arise. Residents have numerous informal and formal leadership opportunities withing the residency, department, and institution as well including chief resident, research resident, athletics coordinator as well as various committees such as the wellness committee.

Our program values critical thinking and use of evidence-based medicine. To do this effectively it is important for residents and faculty to continuously participate in various forms of research and to disseminate their scholarly activity. During intern year our residents have a research rotation focused on learning the fundamentals of various types of research and developing a plan for scholarly activity during residency. We require each resident to complete three projects throughout residency: 

1. A clinical inquiry such as a Help Desk Answer or Stat Pearl,
2. Original research such as a review article or case report, and
3. A practice improvement (PI) or quality improvement (QI) project.

Most of our residents go above and beyond these requirements. Each year we have multiple teams presenting their work at various conference around the country. We also have faculty that publish regularly in the American Family Physician and each year we bring nearly half the program to present at the Uniformed Services Academy of Family Physicians annual conference.

Each year we have multiple ongoing resident-led team-based PI/QI projects within our clinic that often include our nursing teams. Additionally, the hospital has a PI/QI committee where residents can be involved with patient safety and improvement initiatives throughout the hospital. Our senior residents also present a patient safety conference at the end of each family medicine inpatient-team or night float rotation to help pass on lessons learned and best practices.

Professionalism is a core ACGME focus and is incredibly important for the practice of medicine and as a military medical officer. It should be modeled daily by the faculty and residents and lapses in professionalism should be addressed appropriately and immediately. Professional development should be a frequent part of resident conversations with advisors and included in each residents individual learning plans. There are also several distinct training events with a professionalism focus.

• New Employee Orientation – All new employees (including residents) to Madigan take several courses to orient them to the medical center.
• Family Medicine Orientation – The first rotation of residency includes the discussion of professional standards and cultural norms of both medicine and being a military officer; topics also include patient-physician relationships, resident-staff relationships, and social media.
• Behavioral Health Curriculum – The intern behavioral health curriculum has a workshop on physician professionalism that discusses stressors, physician-patient relationships, and professional behavior.
• Equal Opportunity, Sexual Harassment and Assault Prevention, Resiliency Training, and other required military training – Annual trainings that are required by the military and completed by all residents and faculty.
• Monthly advisor meetings – Each month advisors discuss resident well-being and provide mentorship to their residents including professionalism and professional development.
• Didactics sessions – Occur throughout the year will focus on professional development and faculty sharing experiences/lessons learned from their career.
• The military-unique curriculum and managing health care systems (MHCS) curriculum both include topics relevant to medical officer and physician professional development.
• The GME Central Curriculum that residents are required to attend includes sessions on professionalism and military officership. Interns have monthly meetings, and all residents must complete four central workshops over the course of the residency. The graduating CAPSTONE event also contains elements of professionalism education.

• Harborview Medical Center (Trauma)
• Mary Bridge Children’s Hospital
• OB Rotations:
  • R2 year at Evans Army Community Hospital (Fort Carson, Colorado)
  • R3 year at Bassett Army Community Hospital (Fort Wainwright, Alaska)

Additional educational experiences at: JBLM Preventive Medicine and Public Health, Tacoma-Pierce County Health department, and local under-served clinic.

Our program has third-year clerkship rotations for students from the Uniformed Services University of Health Sciences (USUHS) and the University of Washington. In addition to this we offer two or 4-week elective and audition rotations. Students spend the vast majority of their rotation working closely with staff and resident family physicians in an outpatient setting seeing patients of all ages. Students are also exposed to several outpatient procedures including vasectomies, cardiac stress testing, colposcopy, osteopathic manipulation, IUDs, Nexplanon’s, joint injections, Botox, and minor skin procedures. Experience managing inpatients, obstetrical patients, inpatient pediatric patients, and newborns is gained by working under the supervision of a resident and attending physician on the family medicine inpatient team (FMIT). Students have the opportunity to spend time with residents and faculty in our sports medicine clinics. Finally, students receive didactic training through multiple modalities: daily morning report, weekly half day Wednesday CME workshops, simulation activities, and Thursday morning lectures by various residents and staff. 4th year students are also required to present a morning report while rotating with us. Our tradition rotation is three weeks in the outpatient setting and one week in the inpatient setting. We also offer a Sub-Internship Rotation which is three weeks in the inpatient setting and one week in the outpatient setting.

Unique Opportunities at Madigan

• Wellness time every Wednesday afternoon after CME activities which usually consists of playing sports and other social activities.
• Self-study time on Thursday mornings.
• Professional development sessions led by the program director or associate program director each week.
• Sports medicine workshops.
• Specialized medical student templates that provide extra time for teaching.
• Social outings with staff and residents typically every-other week.
• Interactions with the Faculty Development Fellowship and Informatics Fellowship.

The program cares deeply about maintaining fairness in interviewing and evaluating applicants. For those on a rotation, your interviews will usually be scheduled near the end of your rotation and will involve the program director and several core faculty members. Interviewees are all asked the same question to try and maintain consistency and enable access to the same discussion topics; the goal of the interviews is for the program to learn more about applicants and applicants to learn more about the program, so time for questions is preserved as part of the interview. For those not able to rotate with the program, we absolutely support virtual interviews so do not hesitate to reach out to schedule. Final applicant packet scoring is conducted with significant input from the resident body and core faculty.

Guidance for interviewees: reflect on your calling to the Army and Family Medicine and be able to discuss, consider successes and failures you have been through in life and how you have grown through these experiences, and think about what you are looking for in a residency program. Most importantly: be honest and authentic; character matters!

Family Medicine Residents take the American Board of Family Medicine (ABFM) board exam. This exam is offered twice per year, and family medicine residents usually take it during April of their R3 year. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABFM and be on track for graduation within 3 months of the usual 30 June date for completing residency. For those off-cycle or extended in residency beyond three months, there is an exam period in October.

Additional Resources:

• ABFM Certification Process and Board Eligibility 
• ABFM Resident Resources 

Residents will have numerous opportunities to teach peers/colleagues and junior learners throughout residency. This includes some resident-run didactics during morning report and academic Wednesdays as well as through teaching on the inpatient team and on rotations. The program hosts 3rd and 4th year medical students from the USUHS and the University of Washington on the inpatient team and in the outpatient clinic where they will sometimes be paired with senior residents to see patients.

Senior residents have a wide range of elective options that can be utilized to provide further teaching opportunities including in clinic or on the inpatient ward. They can also do elective rotations with the Madigan Faculty and Leadership Development Fellowship and apply for a USUHS faculty development rotation. Madigan as an institution offers numerous faculty development opportunities including fall and spring faculty development conferences, monthly faculty development sessions run by the fellowship, and courses such as Arbinger and Crucial Conversations which senior residents are welcome to take.

Current faculty within the residency have the following subspecialty training:

• Hospitalist
• Sports Medicine
• Point-of-Care-Ultrasound
• Obstetrics
• Faculty Development

Adjunct faculty have additional palliative care and geriatric fellowship training.

We also have a prescribing psychologist as a Behavioral Health Core Faculty, and also a pharmacist on the Family Medicine Inpatient team and as adjunct faculty.

Our program values mentorship as this is critical for one’s professional development and career goals. Residents are assigned an advisor who helps assist them throughout residency, however, each resident has multiple mentors. We work hard to link residents with staff physicians around the base who may have similarities with them whether it is their medical career aspirations, military career goals, or gender/ethnic/religious and other background considerations. Having good mentors has helped many residents match directly into desired fellowship programs, military assignments, and opportunities to publish and present at conferences.

The most important wellness foundation is having a culture in which we care about each other, supports each other, and respond to the education and wellness needs of each other. We commit to being fair, transparent, and truthful to maintain psychological safety in the program. We want to help residents stay connected to the sense of purpose and values that are inherent in caring for patients and serving in the military. We encourage our residents to maximize their leave to have time away from the hospital; we attempt to space out rotations that are particularly rigorous or non-leave eligible; we will help you develop efficiency skills so that you can maintain boundaries between work and non-work life. Being able to improve the environment around you is a key part of wellness. The faculty and leadership of the residency and department maintain open-door policies and are highly receptive to feedback on the culture and processes of the residency. The PD/APDs will also conduct intermittent sensing sessions to solicit feedback, and we welcome feedback given through the chief residents, internal surveys, and external surveys. We strongly believe that together we can build and maintain the culture we want. Each day we get to choose what to focus on and how we regard, talk with, speak about, and work with each other. Residents also have the opportunity to take on several leadership positions within the residency that enable further opportunity to provide feedback and contribute to the culture of the residency. These leadership positions include two chief residents, two medical student coordinators, an athletics coordinator, and membership on the wellness committee.

Program Wellness Committee

This committee is made up of several residents and faculty (and specifically not the PD/APD) that meets quarterly throughout the year to help ensure our curriculum, policies, and procedures align to support resident, fellow, and faculty wellness. It is resident driven with support and participation from the faculty; resident participation includes at least one chief resident, one medical student coordinator, the athletics coordinator, and a wellness director/liaison for each class. Faculty participation is primarily from the R1 to R3 Balint leaders. Areas that are discussed and about which recommendations are made include medical student social events, retreats, athletics, holiday/graduation/orientation events, fatigue/work hours, family wellness, and any other situations or circumstances that may significantly affect wellness.

Balint Groups and Faculty Support

The R1 class meets once/week over lunch for a Balint session to explore challenges, uncertainties, difficulties that arise in patient care, and to further develop a sense of understanding and meaning in the practice of medicine. These sessions are facilitated by the residency psychologist and an additional faculty member. The R2 and R3 classes will continue to have one per month Balint/support sessions under the facilitation of the class faculty Balint leader. We also encourage residents and advisors to discuss wellness challenges and strategies for maintaining wellness as part of their monthly advisor-advisee meetings.

Retreats

Several retreats are conducted to help cultivate a sense of belonging amongst the residency, promote wellness, have fun, and provide a venue to discussing our culture. Currently, our retreat schedule is as follows. We have a Fall retreat for the entire residency from Friday afternoon through Sunday for residents and faculty (including families). A few faculty stay behind to cover the inpatient service. We also have a Spring retreat that is resident-only. This also runs from Friday afternoon through Sunday and faculty remain behind to cover the inpatient team and call shifts. Lastly, quarterly, the chief residents will organize off-site activities in place of academics which includes community service events and other outings such as bowling, laser tag, etc.