Family Medicine Office

PGY1 residents will spend one half-day per week in the Family Medicine Center seeing patients; this increases to 2-3 half-days per week in the second year and three to four half-days per week in the third year.

Family Medicine Orientation (July of 1st postgraduate year)

Community Medicine

This month will focus on ambulatory care of patients using community resources with additional focus on Occupational Medicine, Behavioral Science and Geriatrics. There will be structured experiences in these areas, including work with preceptors, community health providers, home visits and readings. Dr. Sarah Cole is Course Director.

Family Medicine Inpatient

Internal Medicine

Under the supervision of the Department of Internal Medicine, this rotation involves direct patient care on the medical wards. Residents are responsible for initial history and physical examination of housestaff-covered patients, daily assessments and notes, and discharge summaries. Family medicine PGY1 residents work under the direct supervision of a PGY-2 internal medicine or family medicine resident, or a PGY-3 internal medicine resident. Responsibility as a PGY2 resident on this rotation will be predominantly a teaching and supervisory role over your PGY1 residents and helping them to maintain good patient care, as well as providing current articles or readings on topics pertinent to the patients on your service. PGY2 residents may have one or two interns, and may work with transitional year interns. PGY2 Family Medicine residents take call at the resident level. In-house call for the Medicine service will average every 4th to 5th night and includes time in the Coronary Care Unit. Attending rounds take place on a daily basis, departmental lectures are daily, and medical grand rounds are given each week.

Behavioral Science/Psychiatry Curriculum

The goal of this rotation is two-fold: to increase cognitive knowledge in Behavioral Science/Psychiatry, and to help residents develop skills for patient counseling, diagnosis, and treatment. 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 your residency here at St. John's Mercy Medical Center. There is no in-house call this month, and weekends are free. A presentation by the resident to psychiatry staff physicians is required at the end of the month.

Pediatrics

Two months in the PGY1 year are spent at Cardinal Glennon Children's Hospital. The program there consists of one month spent in the Outpatient Department and Emergency Room and a second month spent on the wards. The month in the Outpatient Department and Emergency Room involves a varied experience in the ER and a variety of outpatient clinics including Dermatology, Cardiology, Adolescent Medicine, etc. Residents on the outpatient service will be supervised by Pediatrics attendings. ER shifts include morning, daytime, evening, and night hours.

During the time on the floor residents work under the supervision of a pediatrics resident and attending physician, and function as a first year post-graduate in Pediatrics. In-house call is every fourth night. While on the outpatient service, residents continue to work in the Family Medicine office one day per week. The PGY2 month at Cardinal Glennon Children's Hospital is similar to the first year outpatient rotation.

One month is with Mercy Pediatrics at St. John's during the PGY3 year. This is a ER rotation. Morning office hours are spent in Family Practice Clinic. There is evening or weekend call in the Emergency Room working with pediatric ER staff physicians.

One additional month may be spent in ambulatory pediatric training in the pediatric subspecialties of cardiology, neurology, and heme/onc.

Obstetrics (PGY-1)

During the first year OB is required for one month, Family Medicine interns function as PGY1 residents in the OB/GYN Department with a near total emphasis on obstetrics. The only time spent regarding gynecology patients will be emergencies during the time on night call. Residents are supervised directly by OB/GYN residents and will have attending rounds daily. (see description of further OB training)

Emergency Room

Surgery

The PGY1 month is a structured preceptorship with a teaching surgical group, and is guided by a list of 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 come to the hospital in "off hours" to see interesting cases. The second month of surgery in our overall curriculum is designed to be a time that you will spend with a preceptor with emphasis on office procedures, general diagnosis of conditions requiring surgical intervention, and preoperative evaluation.

Dermatology

Dermatology is a preceptoral type learning experience in a dermatologist's office. Residents will focus on diagnosis and management of common dermatological conditions.

ICU

Patient care this month in the combined medical and surgical intensive care unit will be directly supervised by a Critical Care fellow. Attending rounds with specialists in Critical Care and or Pulmonology will occur daily. In-house call is every 4th night. This month traditionally provides the resident with many opportunities for procedures, such as central lines, intubation, etc.

Orthopedic and Sports Medicine (PGY-2)

This time is 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 morning Sports Medicine workshops taught by Dr. Lord and Dr. Deckert; including casting workshops; residents may attend these anytime besides during their required month rotation.

Neurology

Residents will work with a hospital-based group of neurologists evaluating and following outpatient problems in their office, and are responsible for helping evaluate many inpatients referred to the neurology consult service.

ENT/Ophthalmology

During this month residents will obtain experience in the office of both an ENT physician and an ophthalmologist. Two weeks are spent with each specialty. Emphasis will be on common conditions.

Gynecology

This is a rotation which emphasizes outpatient gynecology. The resident will spend time with private gynecologists as well as seeing patients in their offices). The resident will also participate in the colposcopy curriculum which is structured by Dr. Marsha Mertens.

Orthopedics (PGY-3)

This is an outpatient rotation emphasizing outpatient management and treatment of orthopedic problems, with additional training in casting techniques. Time is spent with private orthopedists in a preceptoral experience.

Urology

The time will be spent with a urologist in private practice, predominantly in an office setting. Emphasis is on outpatient urological problems and procedures.

Electives

The Family Medicine Department makes every effort to be flexible, and therefore elective time is 3 1/2 months for those residents choosing to do additional OB and 5 1/2 months for those not pursuing OB. Electives may be chosen from any of a number of opportunities at the medical center or may be used as time on away rotations, such as those with the Indian and Public Health Services. Residents will be responsible for designing their own learning objectives, in conjunction with their advisor, during these months.