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

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
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.