PGY1 residents generally spend one half-day per week in the Family Medicine Center seeing patients. This increases to two or three half-days weekly in the second year and four half-days weekly in the third year of residency.
Orientation introduces new interns to Family Medicine. Interns typically see patients in the Family Medicine Center two or three half-days per week during orientation. Conferences and skills workshops with Family Medicine faculty members review topics pertinent to care of our patients and help assess new interns’ readiness for supervised practice. There are also social and team building activities to allow the new intern class to get to know each other.
This rotation is designed to increase interns’ exposure to common ambulatory conditions treated by family physicians and to introduce principles of population health management. Interns escalate continuity care in the clinic and learn to promote health equity.
The pediatrics curriculum is longitudinal. It involves ~15-20% office visits to patients younger than 18 years, monthly didactics, inpatient care of infants and children on Family Medicine Inpatient, and 6 dedicated months to the care of infants, children and adolescents.
Two months in the PGY1 are spent at Cardinal Glennon Children's Hospital -- one month in the Emergency Department and the second month on the inpatient floors. The month in the Emergency Department is a varied experience in the ED and includes morning, day, evening, and night shifts with Pediatric ED fellows and attendings. During their time on the floor, family medicine residents work under the supervision of a senior pediatrics resident and attending physician.
PGY1 residents also complete a Nursery rotation at Mercy Hospital St. Louis. The rotation is focused on newborn care and is supervised by Mercy pediatricians. Mercy Hospital has the only Level III Neonatal Intensive Care Unit in St. Louis County, in addition to its very active, normal newborn nursery.
The PGY2 month at Cardinal Glennon Children's Hospital is similar to the first year ED rotation. While in the ED, first and second-year residents return to the Family Medicine Center one day weekly for continuity care of their patients and didactics.
The PGY3 Pediatric month is spent with a community general pediatrician.
One additional month is spent in ambulatory pediatric training in the pediatric subspecialties such as cardiology, gastroenterology, neurology, or hematology/oncology.
There are two rotations in the first year of residency that historically involve direct patient care within the department of Internal Medicine on the medical floors. Residents are responsible for initial history and physical examination of house staff-covered patients, daily assessments and notes, and discharge summaries. Family medicine PGY1 residents work under the direct supervision of a PGY-2 or a PGY-3 internal medicine resident. Attending rounds take place on a daily basis, departmental lectures are daily, and medical grand rounds are given each week. All residents perform two weeks of night float as part of these rotations.
In their first year, Family Medicine residents complete a one-month rotation in obstetrics, functioning at the level of PGY1 OB resident within the department of Obstetrics & Gynecology. All residents spend at least one week of the rotation evaluating and triaging pregnant patients in our women’s evaluation unit under the supervision of a certified midwife. Residents are supervised directly by OB/GYN residents and have attending rounds daily. A second rotation in obstetrics is done during the PGY2 also within the department of Obstetrics & Gynecology.
Residents also begin providing prenatal care to patients in the Family Medicine Center as well as performing the deliveries and postpartum care for those patients. Residents care of OB patients in the office is supervised by five faculty members who provide prenatal care (Drs. Hoekzema, Mayes, Phruttitum, White and Wilfling). In addition, all residents are required to successfully complete the A.L.S.O. (Advanced Life Support for Obstetrics) course. An OB/GYN group is also available for consultation on more complicated patients. In office basic ultrasound is available and higher level ultrasound and antenatal testing if indicated, is available through the Perinatal Center. Additional rotations can be set up by the individual resident as they perceive their needs.
Knowledge of Behavioral Science issues and techniques for managing "problems of daily living" are central to the family physician. Behavioral Science is therefore a longitudinal program goal covering all three years of residency. One month is spent on a dedicated Psychiatry rotation with a Mercy psychiatrist and psychologist. The goal of the rotation is two-fold: to increase cognitive knowledge in Behavioral Science/Psychiatry, and to help residents develop skills for patient counseling, diagnosis, and treatment. There is no in-house call this month. A presentation by the resident to psychiatry staff physicians is required at the end of the month.
First year residents will work 20 different shifts in Mercy Hospital's Level I Trauma Center Emergency Department. PGY3 residents also complete several shifts in the Mercy ED during their Surgical Sub-Specialty rotation for additional experience in common emergent procedures.
The PGY1 month is a structured preceptorship with a teaching surgical group, and is guided by learning topics and competencies relevant to family physicians. Residents will see surgical patients in outpatient and inpatient areas as well as the OR with the supervising surgeon. There are no night call or weekend responsibilities, but many residents elect to come to the hospital in "off hours" to see interesting cases.
First year residents complete a one month rotation with the Mercy critical care department. The rotation is completed in the cardiac critical unit as well as the medical/surgical critical care unit, directly supervised by a critical care Fellow. Attending rounds with specialists in Critical Care and or Pulmonology occur daily. This month traditionally provides the resident with many opportunities for procedures, such as central lines, intubation, etc.
During the second and third years, these six months provide residents with supervised experience in treating hospitalized children and adults and maternity patients from the perspective of a family physician. Admissions are taken from attending physicians or residents in the Family Medicine Center. Duties are shared between three residents in the PGY2/3 years. Patient work rounds and attending rounds are daily. The rotation uses a night float system which allows residents more flexibility. There is a PGY2/3 resident not on service who is assigned to take Sunday call to allow time off for the inpatient team.
These months are spent working with family physicians, orthopedists, and physical therapists in a variety of settings. Residents have the opportunity to participate as "team physicians." There is a series of Sports Medicine workshops taught by Family Medicine Faculty; residents may attend these anytime besides during their required month rotation. These rotations emphasize outpatient management and treatment of orthopedic problems, with additional training in casting techniques. Time is spent with private orthopedists in a preceptor experience.
This month exposes second year residents to local health care disparities and community resources to reduce health disparities with an additional focus on Occupational Medicine. This structured experience includes work with preceptors, community health providers and readings. Through the course of the month, residents help lead blood pressure screenings and community health fairs, volunteer at a free adult clinic and work with local school nurses.
This month is dedicated to experiencing caring for elderly patients in multiple settings, including skilled nursing facility rounds, hospice, palliative care, home visits, and a geriatrician preceptor.
This is rotation emphasizes outpatient gynecology. The resident will spend time with private gynecologists as well as seeing patients in their offices. The resident will also see patients with family medicine faculty in colposcopy clinic at the family medicine clinic weekly.
Dermatology is a preceptor-based experience with a dermatologist. Residents will focus on diagnosis management of common dermatological conditions, and office based dermatology procedures. Residents also learn dermatological procedure skills in the family medicine procedure clinic
These two month-long rotations in the third year expose the resident to the depth and breadth of subspecialty care required of family physicians as well as facilitates the resident’s understanding of team-based patient care and communication with consultants.
Mercy Family Medicine individualizes its curriculum to each resident’s future practice and learning needs by offering 6 months’ elective rotations. Electives may be chosen from a variety of clinical areas, including maternity care, away rotations or medical missions. Residents design their learning objectives for each elective in conjunction with their advisors as part of their individualized learning plans.
The critical appraisal and scholarly activity curriculum is longitudinal. Residents will present at journal club three times, complete one case report, and continuously work on a capstone research project over their three year residency.