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Salinas, California Program Helps MDs Learn Family Medicine

Family Medicine Residency Programs Family medicine may not have the same cachet as, say, brain surgery, but second-year resident Brian Recht wouldn't trade his chosen specialty for anything.

Still, there was a certain amount of culture shock, coming from the East Coast to Salinas, Calif.

"I was surprised at how many monolingual Spanish speakers there are here, " said Recht, who is learning the ropes of family medicine through the Natividad Medical Center Family Practice Residency (NMCFPR).

So in order to serve his patients better, he's become fluent in Spanish - and recently earned his bilingual certification.

"The better I get (at speaking Spanish), the easier my job is, " said Recht.

Recht is one of 24 residents in the program, which concentrates solely on family medicine. The program was launched at Salinas's Natividad Medical Center in 1975 through an affiliation with UC-San Francisco's School of Medicine.

When the three-year residency is completed, doctors are eligible to be board-certified in family medicine.

Not only does the program provide invaluable training for physicians, it also benefits Salinas and the larger Monterey County community.

"The Family Medicine Residency is committed to the community, " said Dr. Gary Gray, director of the residency program. "We believe our outreach impacts the health of the community and positively enhances the value of Natividad in the community."

Gray said residents come from all over the United States, and there are typically several hundred applications for the available spots in the program.

"The opportunities for training here are phenomenal, and the service (residents) give is excellent, " said Gray.

Recht agreed that the hands-on aspect was important to him: "I learn best by doing."

Residents divide their time between working in the hospital and providing outreach to the community, helping in causes as diverse as medical care for the homeless to programs for diabetic teens.

Gray said the program's mission is to educate residents in the principles and practice of family medicine, but also to provide culturally sensitive care. There's an emphasis on getting proper medical information and care to non-English-speaking populations.

Among the NMCFPR's many community outreach projects has been surveying the non-Spanish-speaking Oaxacan community, which has its own indigenous language. One of the residents developed a Oaxacan dictionary, surveyed the needs of Oaxacans living in Salinas, and helped develop translating services in collaboration with Clinica de Salud del Valle.

Family Practice Residency projects have included the following:

A teen pregnancy outreach effort to educate young people regarding reproductive needs, STDs and prevention.

The "Reach Out and Read" program to provide free books for each child in the Family Medicine Clinic.

Classes to educate entire families about child obesity prevention.

Development of cardiovascular programs and outreach for diabetic adolescents.

Participation in an educational conference on the needs of the elderly.

A community education program on depression.

A substance abuse project with primary focus on methamphetamine and its use in high schools.

The creation of focus groups in the Spanish-speaking community on the risk of avian flu.

Some ongoing programs include health education for participants in the Sun Street addiction treatment program, and a collaboration with California State University Monterey Bay to promote health literacy.

Individuals also initiate their own programs. For instance, faculty member Marc Tunzi started a clinic at Dorothy's Kitchen in Salinas, so that the health needs of the homeless and mentally ill could be met. Each week, a faculty member and resident see patients in the clinic at the back of the community soup kitchen.

In the agricultural sector, both at Fresh Express and at Dole, residents have taught health education classes to mid-level management, English-speaking employees and to Spanish-speaking assembly line workers.

The residency also has a long-standing relationship with environmental medicine within the Monterey County Health Department. Residents do onsite visits with a specialist in waste water management, food sanitation and land use.

Family medicine residents also participate in the Health Project AHEC Grant to gain understanding of the needs of caretakers for the disabled and elderly. There is a collaborative relationship with the Area Office on Aging and the Visiting Nurse Association.

In addition, the Family Medicine Residency is a participant in the Federal HRSA Steps Grant, which targets diabetes, obesity and asthma. Community medicine faculty developed protocols for the management of these conditions for Health Department clinics and is helping train clinic personnel to improve care.

The residency also educates peer advocates for the Center for Community Advocacy to assist in getting preventative health information to the community.

One of the interesting side effects of the Family Medicine Residency has been to entice more family medicine physicians to settle on California's Central Coast.

The residency has graduated a total of 190 family physicians since it began. Of the graduates, 115 have remained in California, with 46 practicing in Monterey County, 18 in Santa Cruz County, and one in San Benito County.

"I'd like to stay in this area, " said Recht, who hopes that will work out when he completes the program.

By Kathryn (Kathy) McKenzie Nichols - California journalist Kathryn McKenzie Nichols has been writing for newspapers and magazines for more than 25 years, and is the author of two books. She is currently a Featured Contributor in several categor...