Rotations at PPMC
Our curriculum is fine-tuned with ongoing resident involvement allowing
residents to develop top quality skills in both the inpatient and outpatient
setting. Residents are simultaneously challenged and supported –
creating a vibrant learning environment. Each subspecialty elective includes:
Inpatient Medicine Teaching Service
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Progressive Responsibility
- Unique team structures linked to resident development
- Step-wise increase in patient census as PGY-2
-
Diversity of patients
- Varied demographics
- Wide range of diseases
-
Emphasis on autonomy
- 1:1 linkage with hospitalist
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Interactive teaching conferences
- Dynamic conference series
-
Night float system
- No shifts longer than 16 hours at any PGY level
- Superb ancillary support services
First Year House Officers
Duration: 16-18 weeks
Varying Team Structures
- Interns work with upper-level residents in two different team structures:
First-year residents may either be paired alone with an upper-level resident
or be part of a two intern, one resident team. One of the senior house
staff is from Oregon Health & Science University (OHSU) and represents
part of our formal affiliation with its medical school.
- Teams usually have either one junior medical student or a fourth year sub-intern
for each intern on the team.
- Teams average six to eight patients for each intern on the team.
- Interns on the inpatient teams admit every other day. There is night float
cover every night.
- We believe that a teaching service team overwhelmed with too many patients
serves neither the best interests of the resident nor of the patient.
So, a teaching service is closed to admissions when a team accrues a predetermined
number of patients.
- The 24/7 availability of personnel doing IV catheters, EKGs, arterial blood
gases, blood drawings and transport markedly enhances the resident's ability
to manage teaching service patients efficiently.
- In addition to daily teaching during work rounds, the dynamic and interactive
noon-conference series occurs daily.
Teaching services
- Designed to ensure that house staff is responsible for patient management.
- For the patients on teaching service the physicians agree that only house
staff will write orders on those patients.
- Patients on the teaching services have either a full-time hospitalist or
a core medical education faculty as their attending.
- Each teaching service also admits patients from our own faculty resident
practice. Whenever possible, residents follow their patients as the primary
physician.
- A full-time faculty member supervises all hospitalized patients.
Second and Third Year Residents
Duration: 18 weeks. The call schedule for residents on the wards is identical to
that described for interns. Upper-level residents may accept 1 transfer
when the intern on a single-intern team is off. Residents have no call
shifts longer than 16 hours.
Team Structures
- Second-year residents in the beginning of the year start on a team with
no intern and are paired 1:1 with a single hospitalist or Medical Education
faculty member whose focus is to provide meaningful observations and feedback
to the resident.
- This unique structure allows the new second-year resident to gain comfort
with expanded responsibilities while intensely focusing on the continued
development of excellent clinical skills and efficiency prior to assuming
the added responsibility of managing teams with interns and medical students
later in the fall of their second year.
- Becoming an R2: prior to the start of PGY2 housestaff participate in a
formal seminar series that focuses on the management and education skills
needed to optimally run a teaching service.
- Second-year residents then move on to lead the teams on work rounds, coordinate
patient care and teach both interns and students during in patient rotations.
Night Float
Duration: Average 4 weeks for all PGYs
- Monday night through Friday night the night float team (one resident and
one intern) evaluates medicine admissions coming to the hospital.
- The team cross-covers teaching service patients, between 7:00 p.m. and 7:00 a.m.
- A float resident covers Saturday and Sunday nights for cross-covers and
admissions weekend.
Intensive Care Unit
Duration: 6 weeks for all PGYs
- A combined medical-surgical ICU with 24/7 on-site support from board-certified
intensivists.
- The ICU allows our residents to gain tremendous experience in the assessment
and management of critically ill patients.
- Managing both medical patients and complicated post-operative patients
gives residents the experience that will be invaluable in their future careers.
- The high census, high acuity, create a vibrant learning environment.
- Daily, multidisciplinary rounds with a board-certified intensivist allow
house staff to learn both the latest in ICU management techniques and
how to lead a multidisciplinary team.
-
The two hour rounds provide a strong foundation to house staff rotating
in the ICU. Educational experiences in the ICU include:
- Rounds with board-certified intensivist, daily
- X-ray rounds, daily
- ICU didactics, daily
- Infectious disease rounds, daily
- Ethics rounds, weekly
Team Structure
- Two interns and a senior resident staff the unit each day.
- Second year residents assigned to the ICU cover the unit five nights each
week. A float resident covers the other night.
- Each intern takes overnight call once every other week.
Procedures Rotation
Duration: 2 weeks for PGY1
- This experience is designed to give interns comfort and competence in a
broad range of experiences.
- High-volume, hands-on learning allows rapid acquisition of technical skills
such as intubation, central lines and paracentesis.
- Point-of-care ultrasound training is incorporated.
Team Structure
- Working one-on-one with interventional radiologists, anesthesiologists,
and experienced nurses creates mentored experiences to learn best techniques.
Subspecialty Rotations and Electives
Duration: Average of 16 weeks for all PGYs
- Full range of medical and surgical electives available
-
1:1 with subspecialty faculty
- Personalized teaching
- Opportunity for procedures
- Most rotations combine inpatient and outpatient experiences
We encourage house staff to tailor elective choices to meet their personal
goals. The proportion of inpatient versus outpatient can be adjusted.
Specific faculty can be requested. Every month of residency training is
precious. We want to maximize every elective’s value to every resident.
The associate program director works directly with each resident to maximize
elective education.
Geriatrics
Duration: 2 weeks is an ACGME program requirement and scheduled during R2 year
During the rotation:
- The resident will spend at least half of their time doing outpatient skilled
nursing facility visits with a geriatrician. This will expose the resident
to potential pitfalls in transitions from the hospital setting, as well
as the scope of care available in skilled nursing.
- Focused didactics on geriatric assessment, delirium and falls will be part
of this experience.
- Additional time will be spent in inpatient rehab at Providence Portland
with a physiatrist and the therapy team; the resident will be exposed
to the hands-on assessment by PT and OT.
- The resident will also go to Providence Elderplace, a unique care model
for frail elderly.
- Finally to gain exposure to care of healthy elderly living in the community,
the residents spend time with Marian Hodges, M.D., director of geriatric
education, seeing patients in her practice.
- During the rotation, the resident will also do some home hospice visits
with a nurse and a social worker.
- Time permitting, they will work with the inpatient palliative care consult team.
Primary Care Elective
Residents on the primary care elective spend time with primary care physicians
in a variety of settings. They learn the pros and cons of individual practice,
midsize physician-owned practices, and large multi-location practices.
Hospitalist Elective
The department has created a 2-week hospitalist elective for third year
residents interested in hospital medicine. This elective allows the residents
to gain unique experiences to help prepare them for work as a hospitalist.
Residents carry a full hospitalist team for 5 days under the direct supervision
and support of a full-time hospitalist. They will also have the opportunity
to experience triage and cross-cover for a large hospitalist group. We
have also built in time to experience a system outside of Providence which
is tailored to each resident’s interest. Finally, each resident
has an opportunity to participate in hospital wide meetings and get didactics
on topics like inpatient billing and inpatient vs observation status.