The family medicine service at Providence Alaska Medical Center (PAMC) provides a comprehensive general internal medicine experience throughout the three years. Being an unopposed residency allows the residents to consult and work directly with various medical specialties in the care of our patients. In the R1 year we develop a solid base of understanding the management of the hospitalized patient. Residents have a total of 5 months inpatient adult medicine during their first year, 4 weeks of this being night float.
During the second year we solidify skills in advanced medical management, critical care, and enhanced procedural skills. During the R3 year each resident serves as the team leader on the adult inpatient service. This helps develop a broader and more sophisticated understanding of patient care while teaching interns.
As an integral part of their practice of medicine, family physicians have incorporated knowledge of human behavior, mental and behavioral health, substance abuse and addictions, and psychiatric disorders into their patient care. The behavioral science curriculum is designed to support this important component of family medicine. The curriculum provides residents with the competencies in behavioral medicine necessary for successful practice as a family physician, with a special emphasis in working with underserved and rural populations. The curriculum is both integrated and longitudinal.
Two full-time behavioral science faculty members coordinate the curriculum and assure articulation with program physician faculty, as well as community physicians and community behavioral science professionals. The curriculum aligns with guidelines provided by the American Academy of Family Physicians regarding the necessary topics for inclusion in family practice residency curricula, including patient care, medical knowledge, practice-based learning and improvement, interpersonal communication skills, professionalism, and systems-based practice. Throughout the behavioral science educational process, residents are encouraged to embrace an attitude of lifelong learning, enhancing further professional development in behavioral medicine skills through practice experience, consultation with mental health professionals, focused readings, and CME.
Much of our cardiology curriculum is longitudinal. Residents are exposed to many acute and chronic cardiac disease processes including CHF, cardiomyopathy, atrial fibrillation, and valvular heart disease in the routine care of continuity patients at the Providence Family Medicine Center. Residents help to see patients in a weekly walk-in cardiology clinic and work alongside cardiologists in a short block style cardiology experience.
Acute cardiology topics, like acute coronary syndromes, arrhythmias, new onset CHF are covered during our ER rotations and Family Medicine inpatient service, and focused on during SIMS labs, where code scenarios are practiced. Additionally, a cardiologist comes to our family medicine call-room nearly weekly to give impromptu teaching on salient topics and, of course, our weekly didactic sessions are also periodically dedicated to cardiology, including journal club and expert lecturers.
In addition to the common skin conditions residents encounter in their continuity clinic, workshops, and didactics, a 2-week rotation during the third year in Dermatology provides residents one-on-one training with a local dermatologist.
Combined, the experiences provide residents with the ability to identify and treat prevalent skin conditions, along with the ability to perform common dermatological procedures.
The emergency medicine rotations at AKFMR program occur as one four week block in the first year and two, two week blocks in the third year. The first-year rotations are at one of three hospitals: Alaska Native Medical Center, Central Peninsula General Hospital (Soldotna), and Fairbanks Memorial Hospital. Residents are supervised by Emergency room physicians and provide a wide variety of hands-on experiences. The two, two week block rotations in the third year are at Providence Alaska Medical Center, the state’s referral hospital.
In addition to these experiences, residents will participate in workshops on Emergency skills, learn core didactic materials, and complete ATLS, ACLS, PALS, and NRP during their residency. They also participate in Emergency Room care on rural rotations in small hospitals in Alaska.
The geriatric rotation at AKFMR is longitudinal, with a two, two week geriatric focused blocks during the PGY-2 year. Throughout residency, residents see geriatric patients in the family medicine clinic and on the family medicine inpatient service, as well as have core didactic lectures. PGY-2 and PGY-3 residents are assigned continuity nursing home patients and participate in rounds monthly with a faculty. In addition, residents participate in the geriatric/palliative care clinic, interdisciplinary rounds, and work closely with the palliative care department.
The gynecology curriculum is both longitudinal as well as a two, two-week blocks in the second year. The longitudinal portion includes time with consultant gynecologists in the family medicine clinic and seeing your own female patients in your continuity clinic where you’ll have the opportunity to help with panel management and perform cervical cancer and breast cancer screening on your patients.
The gynecology curriculum also consists of two, two-week rotations with a local gynecologist. During your 3 years of training you will be exposed to multiple gynecologic procedures including: colposcopy, endometrial biopsy, IUD insertion and removal, and Nexplanon insertion and removal. At the time of graduation, you’ll be prepared to provide full spectrum care for your female patients.
The adult critical care rotation takes place at Providence Alaska Medical Center. Residents are supervised directly by Critical Care Specialists in managing and caring for a variety of critically ill patients. As PAMC is the largest hospital in Alaska, residents are exposed to a variety of illnesses and pathology.
During this one month rotation residents will develop and refine their procedure skills, as well as increase their knowledge and competence in treating the critically ill patient.
Musculoskeletal and sports medicine are integral parts of our residency training due to the community’s active lifestyle. Residents will spend a total of eight weeks on musculoskeletal rotations throughout their training. We work with two large orthopedics groups, sports trainers, and physical therapists to provide residents with comprehensive training. Residents learn detailed exam skills, casting techniques, X-ray interpretation, and surgical management. Sports medicine experience is gained through sideline participation with trainers at high school sporting events.
At our Patient-Centered Medical Home, residents learn prenatal care while developing relationships with their continuity OB patients and their families. Each patient is paired with a primary and a backup resident for their prenatal care, one of whom will plan to be present for delivery. During delivery, senior residents have the opportunity to play an important teaching role; the residents perform deliveries for their clinic patients side-by-side with family medicine and OB-Gyn faculty.
While on the OB rotation, they also perform deliveries with family medicine and OB-Gyn community attendings. The PAMC Maternity Center averages 230 deliveries per month; on their OB rotations, residents are involved in all aspects of low- and high-risk OB care, including surgical obstetrics.
The Alaska Family Medicine Residency is honored to have ACGME Osteopathic Recognition. Osteopathic residents have the opportunity to use and to further develop their OMT skills in all patient care settings. Our osteopathic residents are expected to integrate osteopathic concepts and OMT skills into the medical care and management of their own panel of patients at the Providence Family Medicine Center.
The center hosts an OMT clinic where appropriately referred patients can receive OMT, and our osteopathic faculty and residents can share, compare, and develop their OMT skills. Designated osteopathic residents also participate in DO Didactics and help facilitate an annual OMT workshop.
Pediatrics is taught in multiple venues throughout the three years. Training consists of treating pediatric patients in both inpatient and outpatient settings throughout all three years. Residents work closely with family physicians, pediatricians, and pediatric intensivists. Our Residents get extensive experience caring for newborns as part of the obstetrics rotation as well. Pediatric patients are also a significant part of the population served at the Family Medicine Center and on rural rotations.
The Pediatric Emergency medicine rotation takes place at the Providence Alaska Medical Center Pediatric Emergency Room. Residents work along-side (one-on-one) Emergency Room physicians to provide care to children during a variety of shifts.
In addition, residents complete the NRP, PALS, workshops, and core didactic series on pediatric emergency medicine.
The Psychiatry Rotation is a required rotation which takes place in the R2 year of training. It consists of two, two week rotations in which the behavioral science and psychiatry faculty serve as the faculty educators. During the psychiatry rotation, the residents focus on mental health and behavioral health in an inpatient and outpatient clinic setting, including direct client care, self-study activities, and shadowing of specialty clinics related to mental health and behavioral health issues.
As part of the rotation, residents will develop a knowledge base for clinical decision making with mental health and substance abuse problems, including gaining skills to better manage patients with common acute and chronic issues warranting hospitalization, understanding indications for referral of treatment and discharge planning and developing competency in psychopharmacology, including indications for use, appropriate dosages, titration schedules, side effects, and serum level monitoring.
The experience includes heavy patient volumes, health conditions rarely seen elsewhere, frequent patient transport (often in adverse weather conditions), obstetrics, village site visits, and the challenging task of evaluating patients by phone through discussions with community health aides. R3’s are assigned eight weeks of elective rural rotations (4 weeks can be an international rotation instead). They can choose where in Alaska they would like to rotate, often being one of only a few physicians, hours from the nearest major medical facility. These rotations help residents to understand the uniqueness of delivering health care in rural Alaska. Learn more here.
The 2 week rotation provides a unique, integrated experience to three surgical subspecialties during the second year. ENT, ophthalmology, and urology are taught one-on-one with the respective sub specialists in their offices. The focus is on prevalent disease states encountered in primary care emphasizing proper diagnosis, best treatment therapies, and when to refer.
The surgery rotation at AKFMR takes place at Providence Alaska Medical Center. During the PGY-1 year, the resident is the intern on the trauma surgery service and has a one month rotation in which he/she works alongside a general surgeon (one-on-one) in the operating room, inpatient and outpatient care and is actively involved in patient care.
Suture workshops and lectures during didactics as well as wound care clinic during the PGY-3 geriatric rotation supplement this rotation.
