The program rotation schedule gives residents the proper amount of time and responsibility needed to achieve their professional goals with excellence. Residents learn in a variety of settings including the Family Medicine Center, inpatient teams, and one-on-one with community sub specialists.
There are four residents on the service, 2 RI's, a RII and a RIII. This group works as a team and is responsible for managing all admissions except maternity care, newborn nursery, and pediatrics from the faculty and resident clinic population, as well as a share of admissions from the ER if the patient requiring admission does not have a regular physician. The team is directed by a rotating member of our family medicine faculty. The typical census is 15 to 20 patients. Usual maximum patient load for first year residents is 10 patients each, with overflow managed directly by the upper levels and an overall team patient cap of 25. The third year on the service is responsible for all the patients and graduates with a high degree of confidence in the area of inpatient management for most common adult problems.
This rotation takes place at San Jacinto Methodist hospital in the second year. The residents admit and care for all children admitted to the pediatric unit. The most common problems seen are sepsis, dehydration, croup and asthma. A component of the rotation is time in the ER seeing ambulatory pediatric cases, i.e. lacerations, fractures, infections, and asthma. Together with Family Medicine faculty, you will evaluate newborns, perform requested circumcisions and do new parent teaching. Our residents frequently provide neonatal resuscitation services. All pediatric admissions from our FM clinic population are managed by the team. Residents also have opportunities to work closely with the neonatology team that is available for consultation. Residents on this rotation take call at San Jacinto Methodist.
This 4 week rotation takes place at a private community physician's office located nearby in our adjacent professional building. Residents enjoy the outpatient teaching from this physician, and he has been voted as favorite non-family medicine teacher many times.
This 2 week rotation takes place at the San Jacinto Hospital emergency room. Residents focus on emergent pediatric problems such as trauma, severe infections, orthopedic problems, and injuries.
For most of the year, the Maternity Care team is composed of a third year and a first year, with a FM faculty attending. For 4 blocks, two second years rotate together. Our rotation simulates "real" practice as closely as possible. Residents are able to follow patients from first arrival in L&D, through labor, birth, and post-partum. Experience in the management of labor and delivery on this rotation is supplemented by the experience each resident has in following his or her own clinic patients through prenatal care and delivery. The Family Medicine Center currently follows 240 obstetric patients each year. Our residents first assist on C-sections. Residents on this rotation take call at San Jacinto Methodist.
The first year surgery rotation is a one-on-one rotation with a private practice general surgeon. The first-year resident performs pre- and post-op care on patients and assists in surgeries. The level of skill and interest of the resident dictates the level of "hands-on" practice each resident is afforded on this rotation. Cases fall into the common, community hospital general surgery realm. Serious trauma, neurosurgical and chest trauma cases are generally transferred out to the Texas Medical Center. Residents have an opportunity to intubate patients and perform other perioperative procedures with the anesthesiologist's supervision while on this rotation as well.
The third year resident surgery experience is designed with operative experience in mind. Each resident will spend rotation time in the San Jacinto Methodist Hospital operating suite following many different types of general and other surgeries to gain an appreciation for each type of procedure that his or her patients may be undergoing in the future. The opportunity for surgical assisting, multiple procedures and intubation of patients is prominent in this rotation.
The biopsychosocial approach is emphasized throughout your training. A structured block in behavioral science / psychiatry is one component. During this rotation you will work with community psychiatrists, focusing on diagnosis and treatment of behavioral problems commonly seen in a family medicine setting. We are fortunate to work with adult and, child specialists who are exceptionally skilled in psychopharmacology. Time is also spent in our clinical psychologist's office focusing on interview skills and a multi-disciplinary approach to treatment of disorders such as ADHD and learning disabilities. Training in patient-centered communication is facilitated through the use of video monitoring equipment and doctor / patient encounter review.
Four-week long rotations in cardiology, neurology, dermatology and electives in other medicine subspecialties are completed here at San Jacinto. Surgical subspecialties such as ophthalmology ENT, urology, and orthopedics are completed in rotations of two to six weeks each. These are one-on-one rotations with community physicians who have a high degree of interest in teaching and have demonstrated skill in teaching family medicine residents. Our residents are afforded the privilege of choosing their attending and arranging specific learning goals for their rotation.
Each first year serves a portion of his or her call nights during a separate night float block during which the resident is excused from usual program responsibilities. Clinic is limited to one half-day per week during this rotation. The night float resident is allowed to choose his or her call within some program guidelines.
The community medicine curriculum is designed as a two-week block experience for PGY-II residents. The curriculum has several components such as Occupational Medicine, Public Health, a visit to the county coroner's office, a school speaking engagement, hospice care, a community project and a review of community resources. A holiday home self study project culminates the learning experience to include the resident designing his or her own COPC project.
Residents spend 1 month in the first and one month in the third year caring for geriatric patients. This includes patients in the rehabilitation, skilled nursing unit, nursing home, long term acute care hospital and hospice settings. As patients transition from the acute care hospital to the appropriate discharge setting, our residents learn how to anticipate and structure the necessary arrangements to maximize their symptom control and function. This learning is facilitated through the care of our hospital and clinic patients after their acute illness. We also work with psychiatrists, hospice experts and geriatricians to provide didactic teaching. Faculties provide structured readings and facilitate topical discussion. Residents learn how to negotiate the complex rules surrounding post-acute care financing as well as practice-management instruction on appropriately billing for physician services. Finally, there is an emphasis on teamwork and multi-disciplinary collaboration.
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Each fist year completes a rotation in the ER consisting of 200 hours of ER experiences. Shifts are chosen by the resident within some guidelines. During this rotation, residents manage patients under the supervision of the ER doctor and have the opportunity to perform procedures and manage typical urgent and emergent medical problems.
Unless specifically noted, night call is separate from service responsibilities. All residents that are not on night float, ER or on an "away" rotation, come together to divide up the night coverage. In other words, you might be on one rotation during the day, but be on call for our admissions, deliveries and ER visits at night. Because of the night float system, RI residents are on call an average of 2 -3 nights per month, and RII residents are on call an average of 3 - 5 nights per month. Third year residents are mostly on home-call after August.
First year residents receive their orientation to our and the discipline of Family Medicine during Family Medicine month. During the month of July, RI residents rotate for 1 week through the adult inpatient, maternity care, outpatient and geriatric areas. Afternoons are spent learning nuances of the computer system and attending workshops. Some workshops are procedural such as colposcopy, stress test and colonoscopy, and some are geared to develop cognitive skills necessary to become successful Family Physicians, such as patient centered communication, end of life care, contraceptive management, and the art of consultations.