Curriculum

Curriculum

Rotation Descriptions

Inpatient Medicine

Currently our resident inpatient team is made up of two junior residents, a senior resident (PGY2) and a hospitalist attending (Internal Medicine boarded) identified for their interest in providing resident education. Meritus is in the process of transitioning from this model to a residency inpatient residency service utilizing residency faculty providing continuity of care for FMP patients. Beginning in the fall of 2021, our service will be made up of a PGY3 senior and two PGY1 interns caring for adults. We plan to incorporate pediatric patients within a year. Faculty attendings are either board certified in Family Medicine, Medicine-Pediatrics or Internal Medicine and are passionate about teaching residents in the inpatient setting. Now and in the future, each junior resident carries 4-7 patients and is responsible for providing all care with the support of their senior, attending and team. The 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 during intern and PGY-3 years. PGY-2 residents complete two months of inpatient medicine working along-side a hospitalist or nocturnist. Interns will complete four months of inpatient medicine, and PGY-2 and PGY-3 residents complete two months. All residents attend Family Medicine Practice half days once per week and Thursday education didactics weekly. Residents interested in including inpatient medicine in their future practice will receive support in completing additional elective rotations in the hospital prior to graduation.

Pediatrics

Residents spend a total of four 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 both in the hospital and in the clinic. A few hours on Saturday mornings support the open access our community needs. During a total of two months in the PGY-2 and PGY-3 years, residents spend time in the Meritus NICU and caring for pediatric patients in the Emergency Room. These two months in the senior years are built to satisfy ACGME requirements and train the resident physician to recognize a child who can be safely managed in the office versus a child who requires emergency management or hospital admission.

Obstetrics

Meritus Family Medicine residents spend two months with our dedicated OB-Gyns, Midwives and Family Physician. The first month introduces the intern to office-based obstetrics care and continuity deliveries as well as two 24 hour Friday L&D calls. Gyn procedures are also performed longitudinally in the resident’s family medicine practice. 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 have ample opportunity for additional call and elective time throughout the course of their residency training to reach their delivery goals. Approximately 2,000 babies are born at Meritus every year.

Gynecology

Residents spend one month in the PGY-1 year with Gynecologists 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. There are no weekend obligations.

Geriatrics

Residents spend one month in their intern year on a Geriatrics rotation 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, deprescribing, 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.

Orthopedics and Sports Medicine

Residents will have two 4-week rotations in orthopedics and sports medicine over the course of their residency. The goal of this rotation is to ensure that the resident develops a good understanding and clinical proficiency in the scope of orthopedic practice that will equip them to deliver high quality care for orthopedic and sports medicine patients, pertinent to the practice of family medicine. Residents spend time with local orthopedists as well as at the Veteran’s Administration Hospital in Martinsburg managing common musculoskeletal conditions in the office and operating room. Residents are trained to perform common injections, manage simple fractures in the office and get a good understanding of indications for surgery. Residents work with physical therapists and orthopedists to manage common sports medicine conditions. Residents are invited to work with faculty to develop creative ways to engage with the Washington County athletic community.

Surgery

Residents complete a 4-week general surgery rotation during the first year of residency. During this rotation, they have the opportunity to work with General Surgeons who are passionate educators and 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 surgical 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.

Critical Care

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.

Psychiatry

Residents complete a 4 week psychiatry 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. The second 2 weeks are spent entirely with the consultation service, with the exception of didactics and FMP continuity clinic time. Residents are given enrichment readings and present topics to the team.

Pain

Meritus PGY-2 residents have a unique opportunity to spend dedicated time learning about the causes and types of pain for which their patients will come to them seeking help. During this 14 day rotation, residents work with specialists in pain management, osteopathic manipulative medicine, and integrative approaches such as acupuncture. Three half days per week are spent in family medicine continuity practice in addition to Thursday didactics. By the end of this experience, residents should be able to properly diagnose the different causes of pain and prescribe appropriate interventions.

Nutrition

Second year residents spend a total of two 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 and physicians working in metabolic health serve as attendings. Three half days per week are spent in family medicine continuity practice in addition to Thursday didactics. Two evenings will be spent with family medicine faculty providing Functional and Integrative Medicine consults in the FMP. Second year residents emerge with a core understanding of nutrition and the ability to properly counsel patients towards achieving their healthcare goals and reverse chronic disease.

Electives

Residents are encouraged to identify individual interests early in the course of their residency. They are invited to craft their elective experience. A total of five 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, Urgent Care, Free Clinic, Public Health, Ultrasound/POCUS, Integrative Medicine, Osteopathic Manipulative Medicine, Advanced Obstetrics and Women’s Health, Rural Medicine – Hancock Maryland, Frontier Medicine – Valdez Alaska, International Medicine, Palliative Care, Gastroenterology, Endocrinology, Pain Management, Pulmonology, Dermatology, Rheumatology, Nephrology, etc.