Hospital-Based Training
Call
All second and third year residents are combined into one clinic call
system. Residents on the following rotations will not be incorporated
into the clinic call schedule due to rotational responsibilities: Inpatient
Pediatrics, ICU, NICU, Pediatric ER, Rural Rotation, and away electives.
Based on the number of residents in the program, the call frequency is
approximately once per week. There is a resident on call at all times. |
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Core Rural Rotation
This rotation is a core part of our commitment to training residents to serve
areas of need and interest and occurs at family medicine sites The faculty in those
areas are enthusiastic and seasoned teachers. Residents may locate to the rural
community or commute daily.
Emergency Department
The Emergency Department at United Hospital had 36,821 in 1997. An introductory
month is partnered with the orthopedics rotation. The Emergency Medicine rotation
includes didactics. It is four ten-hour shifts per week and two weekends in
the four-week duration. Residents participate in the monthly Morbidity and Mortality
Conference.
Family Medicine
There is a four-week family medicine rotation in the first year. In the first
year this rotation brings the entire class together to become totally immersed
in family medicine concepts, focusing on the bio-psycho-social-ethical model
in an outpatient setting. This allows faculty to highlight tenets of family
medicine, as well as outpatient procedure, and family systems and therapy issues.
Family Medicine & Internal Medicine Teaching Services
Resident and faculty patients from United Family Practice Center are managed
by residents on the family medicine and internal medicine teaching services.
The family medicine teaching service is staffed by the chief resident and a
first or second year resident, and a member of the core faculty. The internal
medicine teaching service is supervised by an internist and family medicine
physician with a CAQ in Geriatrics who is a member of the core faculty. These
busy inpatient services allow residents to manage and coordinate the care for
a diverse group of patients from our clinic. Senior level residents have an
opportunity to act in a supervisory role during their months on the inpatient
teaching services.
House Officer Coverage
All residents participate in medical and surgical House Office Coverage at United
Hospital. First year residents on house call will have a second or third year
resident back-up in-house for the first six months of the training year. Second
and third year residents participate in OB coverage daily.
Intensive Care Unit/Critical Care Unit
This is a second year rotation which takes place at Unity Hospital in one of
St. Paul’s neighboring suburbs, affording the opportunity for the resident to
work one-on-one with intensivists and nurses. Our residents are unopposed in
this training setting. Residents are able to manage a multitude of ICU/CCU patients,
combining cardiology, general medicine, and surgical/trauma medicine.
The resident is expected to handle admissions when he/she is available on the
intensive care unit and to work closely with the primary physician and/or critical
care consultant. Residents perform daily rounds with the primary care physician
and/or critical care physician. Call occurs every fifth to sixth night. Fifty
percent of the ICU/CCU patients are primary cardiology patients.
The intensive care unit admits approximately 1,200 patients per year with an
average stay of two to three days. We encourage residents to follow through
with a specific patient, including attending diagnostic procedures or surgeries.
Resident continuity of care clinic takes place one half-day per week during
this rotation.
Internal Medicine
Inpatient rotation in internal adult medicine occurs four months including one
month during the Family Medicine Service in the first year and two months, including
one month during the Family Medicine Service, in the second year. The focus
is skill-building in areas of history taking, physical examination, problem
assessment, diagnostic procedures and therapeutic decision-making. Attending
rounds occur daily. The internal medicine physician coordinating the first year
rotation has significant experience in family medicine education and is highly
respected in the hospital. The night call schedule is every fourth night in
the PGY1 year.
Newborn Intensive Care Unit
This rotation occurs for four weeks in the second year and does require every
third night call. The resident is expected to attend high-risk deliveries and
do work-ups, as well as appropriate procedures.
Obstetrics
Two months of required obstetrics occurs in the first year in labor and delivery
and the Birth Center. United Hospital has over 4,500 births in 1999 and an active
family medicine, OB, and perinatal staff. The resident spends most of his/her
time in the labor and delivery or LDRP area, maximizing the opportunity to do
as many births as possible. There is a great deal of enthusiasm for teaching
family physicians in this area, especially by family physicians and the perinatal
staff. The program is committed to making this a high quality component of the
curriculum.
Obstetrical experience is further enhanced by the significant numbers of prenatal
patients served (25 to 30 births per month) by the clinic in a longitudinal
fashion, and in attending faculty’s deliveries. Additional obstetrics training
is thought to be most appropriate in the third year as elective time where residents
can focus on tailored experiences, such as high-risk OB, additional ultrasound,
or away elective experiences. In the third year of training, residents also
have a clearer notion of their post-training practice site and can tailor their
training needs to that site.
Philosophically, the program is committed to superlative training. We wish
our graduate residents to choose to continue or not continue post-obstetrical
training based on lifestyle issues and not on adequacy of training.
The faculty is also specifically committed to family-centered perinatal care,
which is focused on the philosophy of family physicians attending births and
the perspective that this discipline brings to birthing. The LPRD Unit allows
for exploration of birthing from a low intervention model, which often is different
than the labor and delivery area where more intervention may occur if patients
are of higher risk.
Pediatrics
Pediatric training takes place during all three years of the residency. Inpatient
pediatrics occurs for two months during the first year and one month in the
second year. This is the one rotation that we coordinate with another residency
program - the University of Minnesota Department of Pediatrics. Our residents
have the same level of responsibility as do the pediatric residents.
Admissions are taken on long-call and short-call days (i.e. the call schedule
follows the sequence long-call, post-call, short-call, pre-call). The first
year resident is responsible for obtaining a history, physical and writing orders,
as well as answering questions and resolving problems of in-house patients.
The second year family practice residents primarily supervise first year residents
and medical students in evaluation and in management of patients. Pediatric
intensive care experiences are incorporated into the inpatient pediatric rotation
with a resident following selected patients in the pediatric intensive care
unit under the supervision of the pediatric staff intensivists.
In the third year the focus of the pediatric training shifts to the outpatient
setting. The third year resident spends four weeks in the pediatric emergency
room at Children’s Health Care - St. Paul and five half-days per week for four
weeks in selected outpatient subspecialty clinics. One to two half-days in pediatric
cardiology and pulmonology clinics and the other half-days elected in sub-specialty
clinics, such as endocrinology, gastroenterology, allergy and rheumatology are
required. Residents receive one-on-one supervision with the pediatric subspecialty
staff.
Pediatric Emergency Room
This is a third year rotation to supplement the first year ER rotation for adult
medicine. It occurs two evenings per week and one day per week. The resident
works at Children’s Hospital - St. Paul ER with staff pediatric ER physicians.
Resident continuity of care clinic occurs four half-days per week.
Surgery
Our first year surgical rotation is an inpatient rotation, including the operating
room with a general surgeon, gaining experience in surgical decision-making
and consultations. Our goals are to have family physicians competent in diagnosis
and management of patients with a wide variety of surgical problems, including
surgical emergencies.
Competency as a first assistant and knowing when to consult is stressed. The
second year rotation is incorporated into the rural rotation under the supervision
of general surgeons and family physicians and focuses on outpatient procedures.
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