Family Medicine Residency Curriculum

Our Family Medicine Resident Inpatient Medicine Service was started in July 2021 in order to provide comprehensive care to the patients of our Family Medicine Practice, and to provide residents with a special opportunity to develop cohesive teamwork and leadership training. Residents are trained to identify the conditions for which patients require hospitalization and provide high level care to those patients while supervised by senior residents and generalist faculty members. Bringing a generalist approach to the care of inpatient adults allows us to support our patients at their most vulnerable time and ensure their goals of care are maintained as they transition to life after hospital discharge. Through the inpatient medicine residency team experience, graduating family medicine residents are capable of recognizing which patients require admission and can provide in-hospital care for those patients if they choose. Alternatively, for outpatient focused graduates, they remain equipped to care for ill patients who can be safely managed in the community, helping to reduce cost of care while staying patient-centered.

Our inpatient medicine residency service team is made up of two interns (who provide the majority of direct patient care), a PGY-2 (who supervises students, cross covers and does morning admissions), a PGY-2 resident on night float, and a PGY-3 senior who runs the service. Faculty attendings are board certified in either Family Medicine or Medicine-Pediatrics and are passionate about teaching residents in the inpatient setting. Each junior resident carries 5-8 patients and is responsible for providing all care with the support of their senior, attending and team. The PGY-3 senior resident organizes patient care and daily education, supports the juniors in their duties and ensures quality care delivery. Admitted patients represent a diversity of medical conditions. Residents work six 12-hour days per week over four months during intern year. PGY-2 and PGY-3 residents complete a total of two months of inpatient medicine days, and 2 two-week night float shifts. All day-time residents attend FMP continuity clinic one afternoon per week, Noon Conference on Wednesday and Fridays at lunch, and Thursday afternoon education didactics weekly. Residents interested in including inpatient medicine in their future practice will also receive support in completing additional elective rotations in the hospital prior to graduation.

Residents spend a total of three and a half months focused on the care of children during their residency at Meritus. In the intern year, PGY-1s spend two months rotating within a community pediatrics practice providing care for patients mostly in the office setting, including Saturday mornings. Six weeks of experience in the Meritus Emergency Room requires care of adults and children suffering from medical emergencies. In the spring, PGY-2 residents provide care for hospitalized pediatric, newborn and NICU patients. Opportunities for experiences in a dedicated Pediatrics Urgent Care are also available. Some residents have opted to pursue high volume inpatient pediatrics experiences during elective time at a regional pediatrics hospital.

Meritus Family Medicine residents spend two months with our dedicated OB-GYNs, Midwives and Family Physician. The first month introduces the PGY-2 resident to office-based prenatal and postpartum care, continuity deliveries and a few 12-hour L&D calls. The second obstetrics month is focused on the labor and delivery floor where PGY-2s work with midwifes and our faculty FP to manage labor, delivery and the immediate post-partum period. Residents interested in practicing family medicine plus non-operative obstetrics after graduation will need to have participated in at least 80 deliveries prior to graduation and allocate two additional elective months towards that goal. Approximately 2,000 babies are born at Meritus every year.

Residents spend one month in the PGY-1 year with OB-GYN faculty caring for women’s health issues. The resident is responsible for rounding on any (usually 1-3) admitted Gyn patients in the morning, meeting patients scheduled for surgery in pre-op, and attending scheduled surgeries for that day. The focus is on developing a deeper understanding of patient presentations, stories and exams, and a basic understanding of common Gyn procedures. Three days per week, the resident attends afternoons in the OB-GYN office seeing a handful of patients and generating assessments and plans under the supervision of their attending. These days the resident also is available for Gyn consults from the ER in the early evening. Family practice continuity clinic and Thursday didactics make up the remainder of the week. Gyn procedures are also performed longitudinally in the resident’s family medicine practice.

Residents complete a dedicated Geriatrics rotation in their intern year and complete longitudinal training during the PGY2 and PGY3 years for their patients who live at Homewood Retirement Center, a local nursing home known for its quality of care. Working with the medical director, Dr. Stephen Metzner, interns admit new patients, make daily rounds, and participate in the full spectrum of services provided there. This comprehensive experience also includes rounding with a physician specializing in wound care as well as interacting with physical, occupational and speech therapists. Residents participate in discharge planning as well as the monthly interdepartmental Quality Assurance Meeting. Working with Dr. Metzner, the intern will experience the full range of pathology that affects our senior citizens and become more comfortable in handling multisystem disease, polypharmacy, de-prescribing, palliative care, hospice care, and post-operative care. Residents have an excellent opportunity to diagnose and manage dementia, and interact with the geriatric psychiatrist who also cares for patients at Homewood. During the longitudinal geriatrics experience, the resident has an opportunity to gain an appreciation for nursing home practice as they take responsibility for the patient’s care including routine and acute care, family conferences, and end-of-life decision making.

Residents complete two 4-week rotations encompassing the breadth of musculoskeletal medicine over the course of their residency. Experiences include outpatient and operative orthopedics, sports medicine, physiatry, rheumatology, physical and occupational therapy, podiatry and osteopathic manipulative medicine. The goal of this rotation is to ensure that the resident develops a good understanding and clinical proficiency in the scope of musculoskeletal medicine that will equip them to deliver high quality care for patients, pertinent to the practice of family medicine. Residents are trained to perform common injections, manage simple fractures in the office and get a good understanding of indications for surgery and other procedures. Residents also provide clinical care to adolescents at a local boarding school where many sports medicine complaints are assessed. Faculty and residents continue to develop creative ways to engage with the Washington County athletic community, such as staffing games as the team physician.

Residents complete a 4-week general surgery rotation during the first year of residency. During this rotation, they have the opportunity to work with Surgeons who provide an excellent introduction into the surgical management of common medical emergencies, and good surgical technique. The intern’s surgical experience involves both office-based care as well as completing hospital rounds, surgical consultations and working with their attending in the operating room. Residents manage patients in the pre-operative, intraoperative and post-operative periods. Longitudinal outpatient procedural experience is provided through the resident’s Family Medicine Practice, as precepted by family medicine faculty. Additional dermatology opportunities through the FMP rotations serve to expand the resident’s tool kit in each PGY year.

During the PGY-2 year, residents complete a 4-week Critical Care experience at Meritus Medical Center. Working with dedicated attendings, the resident is an integral member of the care team and also has space and time to focus on development of skills and knowledge to ascertain signs, symptoms, and laboratory abnormalities of the critically ill, to maximize high quality care. Days begin at 6:45am with pre-rounding and multidisciplinary rounds and continue throughout the day with coverage of assigned patients. There is ongoing teaching during the rounds and shifts. Residents have the opportunity to join their attending during codes, and evaluate potential CCU patients, which they will then follow. Procedures are an integral part of this rotation. Two night shifts provide the resident with an understanding of the special challenges of providing critical care during these hours. In addition to Residency Thursday didactics, the resident participates in dedicated CCU didactics on Friday mornings before continuity clinic.

Residents complete a blended psychiatry and neurology rotation in the PGY-2 year. The rotation is designed to prepare the resident to assess and manage common psychiatric conditions in primary care and to work effectively with mental health providers to provide collaborative care to patients. During the first 2 weeks residents spend mornings in the outpatient department at Meritus assessing new patients, observing a staff psychiatrist with returning patients, and attending the Intensive Outpatient group therapy program. In the afternoons, residents are part of the psychiatry and addictions inpatient consultation team at Meritus. Residents complete consultations and follow-up visits under the supervision of a psychiatrist and in collaboration with the rest of the team. Residents attend Thursday afternoon didactics and FMP continuity clinic time weekly. Residents are given enrichment readings and present topics to the team.

Senior residents spend a total of four weeks learning about the basic science behind the three macronutrients, vitamins and minerals, their interaction with the neuroendocrine and immune systems, and food’s impact on health and chronic disease. Registered dieticians, family physicians and a dedicated endocrinologist serve as attendings. Three half days per week are spent in family medicine continuity practice in addition to Thursday didactics. Flexible time allows for reading at home, meal preparation and community engagement. Residents emerge with a core understanding of nutrition and its contribution to diabetes and other chronic diseases, and the ability to properly counsel patients towards achieving their goals and returning to health.

Residents are encouraged to identify individual interests early in the course of their residency and invited to craft their elective experience. A total of six electives are scheduled; one of these can be designed as an away elective free of any clinic or call obligations. Examples include: Substance Abuse and MAT, Gastroenterology, Endocrinology, Pain Management, Pulmonology, Infectious Disease, Hospitalist Medicine, Rheumatology, Nephrology, Urgent Care, Inpatient Pediatrics, Public Health, Ultrasound/POCUS, Integrative Medicine + OMM, Obstetrics and Women’s Health, Rural Medicine, International Medicine, Palliative Care, etc.