Hospital-Based Training
Hospital-based training in the Family Medicine Residency Program includes these specialties:
Adult Medicine
Residents learn how to manage acute and chronic adult medical problems at a community hospital (Highland Hospital) and at various ambulatory
office sites.
Inpatient rotations on the adult medical floors consist of two blocks
in each of the first, second, and third years. These rotations provide residents with exposure to a variety
of common and uncommon problems in adult medicine. Residents also learn the rational
use and interpretation of diagnostic procedures and tests. Teaching occurs daily during morning
report, noon conference (lunch provided!), and during sign-out rounds. The family
medicine chief residents oversee one of two intern reports each week. Reports are
attended by interns in family medicine, internal medicine and med/peds. One morning a week, there
is a joint medicine-family medicine grand rounds.
Call is
every fourth night until 10 p.m. The family medicine teams are usually comprised
of one first-year and one second-year resident, with a third-year supervisor.
The PGY-1 is paired with a PGY-3 while on call. There is no overnight call on
medicine; night floats cover 8:30 p.m to 7:30 a.m. First-year residents take
night float responsibilities for one week; second- and third-year residents
take two weeks.
The department chair of Internal Medicine at Highland has a strong
commitment to primary care and a special interest in geriatrics. Highland has a unit entirely dedicated to acute care for the elderly. It has become a
national model for elder care.
The Medical Intensive Care Unit is the setting for
training in the management of acute cardiac and pulmonary disease and other
complex medical illnesses. One pair of family medicine first-year residents
covers the service. Direct supervision comes from a third-year family medicine
resident, a pulmonary/critical care fellow, and intensivists working
in the 14-bed unit. There is no overnight call for interns. They stay
until 5 p.m. or 7 p.m., depending on their partner's schedule. The nursing
staff, along with attending physicians from cardiology, pulmonary, and critical
care, provide some of the best inpatient teaching for residents. Time away from this busy unit (for office hours) is reduced
to one half-day per week. PGY-3s do a combined ICU/Cardiology block. They spend two weeks
in each discipline, with ICU overnight call two times during the block.
The Medical Emergency Department (ED) at Highland,
site of a PGY-1 rotation, is moderately busy (24,600 visits per year).
One-quarter to one-third of the patients are referrals from private physicians; the remainder are walk-ins. When needeed, there is good backup from ED
physicians and from subspecialty attendings. There is no
overnight call. One PGY-2 in each two-resident team staffs the ED each day from 1 p.m. to
11 p.m. Monday through Saturday. Twice a week, residents participate in city-wide emergency
medicine conferences.
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Pediatrics
Historically, the pediatric training of residents at this Family Medicine
Program has been tightly integrated with the pediatric residency program of
the University of Rochester. It's a wonderful environment
for learning. The care of children is undergoing rapid transition, as new antibiotics,
immunizations, and attitudes are introduced. The care of sick children is increasingly moving to an outpatient world. But pediatrics training at Rochester still has a wide base, including inpatient and outpatient services at Strong Memorial and Rochester General
Hospitals, our office community practice, and community-based
sites.
In the last two years of residency training, there are two inpatient pediatric rotations -- one at Strong Memorial (second year) and one at Rochester General (third year). The month at Strong is on the general
pediatric service, where pediatric PGY-3s are the supervising residents. Call is
every fourth night, with backup from pediatric residents. Teaching includes attending rounds, morning sign-in rounds, and several weekly conferences.
The pediatric floors are all in one section of the fourth floor at trong,
and provide a very intimate feel that is remarkable in such a big hospital.
In the third year, residents are supervising residents for pediatric
PGY-1s on the pediatric floor at Rochester General. This rotation provides a well-balanced
mix of general pediatric problems that are characteristic of a community hospital.
The size
of the service usually allows time for using the library to pursue more in-depth answers to questions raised by patients' problems. Call during
this PGY-3 block is approximately every fourth night overnight and includes
delivery room coverage. All of the residents on pediatric services attend
morning report. This gives residents rotating in
the pediatric emergency or special care nursery an opportunity to connect
with each other.
Our residents spend one month in their first year at the special
care nursery at Rochester General, a level II nursery. PGY-1s work with a pediatric
PGY-3. They learn the essentials of care for premature infants, newborns with
sepsis, and infants with congenital problems, hyperbilirubinemia and more. They also assist with resuscitation of newborns from high-risk deliveries. The nursing staff
places most IVs. Call is every fourth night, and
includes admissions to the general pediatric floor, with resident backup.
For one block in the second and third years, residents rotate through the Pediatric Emergency Department and Pediatric
Outpatient Departments at Rochester General. The ambulatory clinic is one of the outpatient teaching sites for the pediatric residents; staff attendings are always available. The ED has attending backup 24 hours a day, so there is easy access to teaching for residents. This very busy ED provides experience in a wide range of primary care problems, including orthopaedics. Residents cover both day and night shifts (which
do not exceed 12 hours). Additional experiences in pediatrics include outpatient subspecialty clinics at Strong.
Second-year residents
do an Ambulatory Pediatrics block focusing on well-child
care, developmental pediatrics, and adolescent medicine. This rotation also
includes school health experiences and scheduled sessions in the office
of pediatric subspecialists. During this block, residents take call for the
family medicine outpatient practice.
Pediatric ambulatory
care is a focus of training in our office practices. Residents learn the essentials of well-child care, including normal and abnormal development and anticipatory guidance. They learn to manage the acute and chronic illnesses
of childhood.
Precepting is provided by the family medicine faculty and a pediatrician.
Nurse practitioners are also a valuable resource, particularly for well-child care and anticipatory guidance.
The Special Care Nursery rotation
at Highland is required for third-year residents who have opted to not pursue obstetrical
training beyond the required two blocks of obstetrics and one block of
gynecology. Residents work with a perinatologist and neonatal nurse practitioner. They manage common newborn problems and practice assessing the newborn.
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Obstetrics and Gynecology
OB/GYN training, one of the strengths of the Family Medicine Program, occurs at Highland
Hospital. OB/GYN residents are usually scheduled for surgeries during
the day, so it is primarily the Family Medicine residents who run the deck during
the day. Both departments long ago realized this interdependence, so congenial relations between residents and
attendings is the rule, not the exception. Nurse-midwives are also a constant presence
on the labor deck and add to the rich diversity of obstetrical approaches.
In this busy service, residents generally experience 100 to 150 deliveries in their six blocks on service over three
years. That number includes a modest number of
vacuum-extraction deliveries. It is common for interns to have over 80 deliveries
in their first two months.
As of July 2006, the rotation is completed in a series of day and night shifts with no 24-hour calls. The role of the residents is split into First Call and Second Call, with specific pagers and responsibilities assigned to each. First Call is responsible foe the care of the patients on the labor floor, OB triage, the postpartum unit, the GYN
pre-op/post-op floors, and the GYN ED. Often there are multiple residents who divide the responsibilities with the non-call residents seeing patients in OB triage or the ED, so that the First Call can focus on labor management and deliveries. The Second Call role is taken by senior OB Track Family Medicine residents, Fellows, or OB/GYN residents and involves the management of high-risk patients and first-assisting at Caesarean deliveries. An attending obstetrician is
in the hospital 24 hours a day for emergency backup. All Family Medicine
residents do two blocks on the OB/GYN service and one block of GYN, during which they take some of the shifts on labor and delivery (see below). Those planning
to provide maternity care in their practices generally take the OB Track and do an additional three
OB blocks—for a total of six. After four blocks of first call, residents
take second call on the labor and delivery service.
Most residents who pursue OB training manage deliveries for 15 to 25 of their
own patients over the three years. Dr. Eisinger, the obstetrician on our faculty, is available
for consulting on OB and GYN problems encountered in the office. Family Medicine faculty are present to assist in all continuity deliveries, and Dr. Eisinger attempts to provide dedicated backup in the event of problems during labor and delivery. Having an obstetrician on faculty allows us to follow high-risk
patients at Lovejoy Family Medicine.
Additionally, our Assistant Residency Director, Dr. Smith, has Caesarean privileges at Highland Hospital, supervises the care of prenatal patients at our Brown Square site, and assists in the outpatient management of high-risk pregnancies at Brown Square.
Residents from Lovejoy Family Medicine may participate in an optional maternity training experience at Brown Square. Four to five senior residents provide
continuity OB care to patients whose pregnancies are often complicated
by either medical or psychosocial factors at a federally designated Community Health Center. This training counts as a required Community Medicine
project, and the deliveries count towards a resident's continuity panel. Residents say this additional training among a less-served population greatly enhances their OB experience.
Our Gynecology teaching is concentrated in a block rotation during the second year. This block includes experiences in areas such as reproductive endocrinology, colposcopy, OB ultrasound, contraception, and urology. Residents take first call on the labor floor during the rotation. Residents can elect to be scheduled for longitudinal training in medical and surgical abortions. Other residents, who choose not to participate in abortion training, can be scheduled for alternative gynecological experiences.
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Surgery
Our surgical training is focused on assessment and management of surgical
problems in the ambulatory setting. We also provide experience in assisting
in the operating room.
During
the first year, residents work for one block in a busy emergency room at
Rochester General. They evaluate and treat surgical
problems under the supervision of an emergency room surgical attending. Emphasis is on the management
of wounds and fractures. Shifts are scheduled in the afternoon
and evening, with no overnight call. During the surgical emergency block rotation,
residents work two weekend shifts in the Highland emergency room. They see surgical patients under the supervision of an emergency room attending
physician.
The first year also includes a second surgical block rotation. The family
medicine resident becomes a member of the inpatient surgical team at
Highland Hospital. During the rotation, the resident assists in general surgeries
and learns how to care for pre- and post-operative patients.
Finally, our South Avenue ambulatory care site is equipped for outpatient
surgical procedures. We routinely suture lacerations, excise skin lesions,
and perform other minor surgeries.
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Geriatrics
Training
in geriatrics is one of the lesser known strengths of the Family Medicine Residency Program and occurs
in a variety of settings. It uses both continuity and block experiences,
and relies heavily on the resources of the Jewish Home of Rochester and
the Highland Family Health Center.
In the third year, residents do a one-month Block Rotation in Geriatrics. It provides training in geriatric mental health care, rehabilitation,
and end-of-life care. Add to that a more intensive experience in day-to-day
nursing home care. Family Medicine residents are encouraged and expected to
become part of the clinical-care team, addressing day-to-day as well as long-term
needs of the nursing home residents and the facility. Several specialty clinics are held at the Jewish Home. Residents also work one-on-one
at the bedside with nurses and medical assistants.
In the outpatient setting, our residents see a wide range of ambulatory
geriatric medical issues. They also participate in functional assessments and home
visits for the elderly. A fellowship-trained geriatrician, a graduate
of our program, supervises residents on home visits.
Electives are available for residents with an interest in geriatrics. They are typically designed by the resident and a geriatrician.
