Program Specifics

Advising System

Each resident will be assigned a family physician faculty member as a professional advisor, with whom they will meet once each quarter. The role of the advisor is multifaceted and includes:

• Reviewing the competencies/learning goals and expectations for the required rotations and your learning goals for electives, as described above
• Assisting with and reviewing self-assessment of strengths and areas for improvement, guiding elective choices and career planning
• Gathering, collating and analyzing data from the various parts of the evaluation system and provide meaningful feedback to you
• Providing advice, support, collaborative problem solving when necessary and balanced feedback to you during regular meetings
• Serving as your advocate within the department.

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Community Oriented Primary Care

Our residency focuses on community-oriented care. Through the course of their training, residents help lead blood pressure screenings and community health fairs, volunteer at an indigent adult clinic, perform house calls and work with local school nurses. Additionally, all residents have their membership paid to the St. Louis Academy of Family Physicians, which organizes several community events annually.

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Didactics

Balint group meets quarterly for Family Medicine PGY-1s. This group allows residents to discuss areas of mutual concern in a supportive atmosphere with the faculty psychologist.

Morbidity & mortality conference/Grand Rounds Second and third year residents are required to give one M&M Conference each year. The second-year resident presents a case from our practice in conjunction with a third-year resident who complements the case with a topic review.

Journal Club Under the supervision of Dr. Deckert, residents learn EBM principles and discuss their validity, impact, and usefulness in the practice of family medicine. All residents are required to present one Journal club per year.

Behavioral science/psychiatry conference First year residents are assigned to give one conference presentation during the Behavioral Science/ Psychiatry month to the behavioral science staff.

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Evaluations

Competency guidelines: The curriculum is based on a set of core competencies that are essential for becoming a family physician (defined by the ACGME in six areas). The residency faculty have developed statements of competencies as curricular guidelines for each required rotation, intended to focus residents' learning energies on those skills and clinical areas that are most relevant to the family physician. These guidelines are updated routinely by the faculty and residents to ensure that curriculum reflects the realities of Family Medicine in the 21st Century.

Evaluation system: Residents are asked to routinely complete evaluation forms for each rotation, commenting on the educational content of the month and on faculty supervision. This feedback is discussed with the resident's advisor during their meetings, along with evaluations of the resident's performance provided by supervising faculty for each rotation.. Our philosophy regarding evaluation is one of fostering continual improvement and life-long learning by helping our residents learn the skills needed for self-assessment of strengths and areas of improvement. Our evaluation system reflects this by allowing the resident to track his or her individual development as a family physician through a combination of self-assessment and faculty assessment of the resident's mastery of the essential competencies. Twice a year all residents are reviewed by the entire faculty.

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Evidence-Based Medicine and Scholarly Activity
Our residency focuses on teaching medical practice that is firmly grounded in available evidence from the literature. All our didactics emphasize evidence-based practice and a series of didactic sessions teach residents the principles of EBM. Annually, each resident presents a journal article and each second-year resident undertakes a scholary activity such as original research or a scholary publication.

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Hospital Admissions

The Family Medicine resident assumes responsibility for hospitalized patients in two different instances. The first is during PGY1 inpatient rotations, and the second is during the hospitalization of the Family Medicine Center (FMC) continuity patients while rotating on the Family Medicine inpatient service. He or she formulates the diagnostic and therapeutic plans in consultation with the attending physician and inpatient team. During the second and third year of residency the resident also actively participates in the supervision and teaching of students as part of the Family Medicine inpatient service.

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Moonlighting Policy

Second and third year residents in good standing with a permanent Missouri license are eligible to moonlight. All residents must notify the Program Director of where they are moonlighting. Malpractice coverage is provided by St. John's only for residents moonlighting at St. John's Mercy Medical Center. If a resident desires to moonlight at another institution, a written letter confirming malpractice coverage (occurrence type) by that institution is required. This must be reviewed and approved by our legal counsel. Each resident applying for "moonlighting" privileges should have a letter of support from the residency director. Recognizing that out-of-hospital work can provide excellent educational experience, as well as ease the financial burdens of residents with large educational debts, residents may "moonlight" under the following circumstances:

1. The resident is not under academic probation.These activities do not interfere with regular duties of the resident, including call and continuity practice.The resident has completed the internship year in Family Medicine.Has a permanent Missouri license & DEA.
2. The resident has occurrence-type malpractice coverage.

Moonlighting hours are counted towards a resident's limit of 80 hours per week per ACGME guidelines. The residency director has the authority to revoke "moonlighting" privileges if in his/her judgment the resident is allowing these activities to interfere with the goals of the residency program.

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Natural Family Planning

Residents and faculty of Mercy Family Medicine have the advantage of working with teachers of the Creighton Model of Natural Family Planning. This method can provide useful information to physicians trying to help couples with reproductive and/or gynecological problems. The science of NaProTechnology (Natural Procreative Technology) allows a physician to treat patients with these problems while maintaining the normal physiologic and reproductive potential that may still be present. Residents interested in learning more about the medical science of NaProTechnology can work with a certified Medical Consultant in Natural Family Planning (Peter Danis MD). In the second or third year, residents can pursue an elective leading to certification as a medical consultant in natural family planning.

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Nursing Home Patients

As part of the Geriatrics curriculum, 2nd and 3rd year residents make Nursing Home rounds followed by case discussion with a faculty member (Dr. Lord currently) at Delmar Gardens West at least three times yearly. In addition, residents on the inpatient Family Medicine service follow patients admitted to the St. John’s Skilled Nursing Facility. The residents are responsible for telephone and in-office management of any of their own patients currently in a nursing home.

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OB in the Family Medicine Center

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Osteopathic Medicine

Osteopathic residents are expected to develop their osteopathic diagnostic and therapeutic techniques while completing their family practice residency. Didactic lectures and workshops focus on spinal as well as upper and lower extremity manipulation. Away lective time may be scheduled in OMT. Additionally, all DO residents are encouraged to manually treat their patients with musculoskeletal concerns and accept internal referrals from allopathic residents. Allopathic residents interested in gaining additional experience in manual medicine may participate in the above activities with approval from the course director. DO residents are further encouraged to explore osteopathic CME opportunities during residency as well as pursuit of individual dual certification of their Mercy Family Medicine residency with the American Osteopathic Association. The course director is Dr. Sarah Cole, who is certified by both the American Osteopathic Board of Family Physicians and the American Board of Family Medicine.

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Procedures

The department offers training in special procedures that residents may pursue in their own practices. These include casting and splinting, colposcopy,and endometrial biopsy, in addition to training in common office procedures such as minor surgery (toenail removal, skin biopsies, incision & drainage), casting techniques, and cryotherapy, and training in inpatient procedures learned on the medical wards, such as central lines, lumbar puncture, thoracentesis, etc. Special techniques in obstetrical care are learned by residents pursuing the OB track. All residents are required to be certified in ACLS, neonatal resuscitation and ALSO (Advanced Life Support in Obstetrics). Online documentation and tracking of procedures is required.

Documentation of the types of patients cared for during residency and any procedural experience is important for obtaining hospital privileges after residency. Procedures done on inpatients should be documented, including patient name, age, and supervising resident or faculty. Common procedures requiring documentation, and for which training is possible at St. John's Mercy, include:

Inpatient Procedures:

Outpatient Procedures:

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Research

There is a growing tradition of strong scholarly activity at Mercy Family Medicine. Research into any valid clinical or epidemiological subject is supported, but not required. However, all residents are required to complete a scholarly activity project.

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