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Curriculum

Innovation in Education

The curriculum at Providence St. Vincent Medical Center provides residents with a comprehensive exposure to all aspects of internal medicine. We are uniquely poised to provide a balance between inpatient, outpatient, intensive care and consultative medicine to our residents who benefit from supported autonomy with no competing training programs.

One thing that makes us unique is our innovative inpatient experience which promotes team-based bedside rounding with graduated levels of responsibility, allowing residents to progress to manage their own hospitalist team.

With excellent subspecialty consultation services, our residents benefit from 1:1 mentorship with academic faculty. Compared to other programs, we place a greater emphasis on ownership of patients in the ambulatory setting through our innovative medical home model. Our residents develop leadership and communication skills which allow them to excel whether they pursue careers in primary care, hospitalist medicine or a medical subspecialty.

Schedule at a glance:

Rotation
First Year
Second Year
Third Year
Wards/ACU combined
16-20 wks.
12-16 wks.
12-16 wks.
ICU
8-12 wks.
4 wks.
0-4 wks.
Night Float
4-6 wks.
2-4 wks.
0-4 wks.
Ambulatory Block /
Primary Care
Categorical: 4-8 wks.
Prelim: 2 weeks
4-8 wks.
4-8 wks.
Emergency Medicine
None
4 wks.
0-4 wks.
Quality Improvement (QI)
Categorical: 2 wks.
Prelim: None
2 wks.
2 half-days
Cardiology
4 weeks
4 weeks
0-40 weeks
Elective
6-10 wks.
10-12 wks.
16-20 wks.
Outpatient Clinic
1 half-day per wk.
2 half-days per wk.
2 half-days per wk.

* there are 13 4-week blocks in the academic year.

Inpatient Medicine: Accountable Care Unit

PGY-1: 3-4 blocks
PGY-2: 2 blocks
PGY-3: 2-3 blocks

A substantial portion of your intern year will be spent on our Accountable Care Unit (ACU). This innovative inpatient medicine service gives our residents a "home" in the hospital by placing them on a single geographic unit, which is designed to deliver patient-centered, multi-disciplinary care. This unique model, which has shown improvements in provider satisfaction and patient mortality, also offers a superior educational environment with daily bedside rounds and teaching.

See what life is like on the ACU: How We Care: A team approach to bedside rounds

Inpatient Medicine: Traditional Wards

PGY-1: 1-2 blocks
PGY-2: 1-2 blocks
PGY-3: 1-2 blocks

Our ward teams are one of the key places where our residents develop essential patient care skills, diagnostic acumen and interpersonal skills. We draw from a wide patient population including cardiac telemetry, neurology, complex pulmonary, hematology and surgical consults, to provide residents with the greatest depth and breadth of educational experiences available. With graduated levels of responsibility, residents progress to master management of their own hospitalist team, fully preparing them for future careers in inpatient medicine. Resident educational focus is supported on wards with protected teaching time and limited service size.

Intensive Care Unit (ICU)

PGY-1: 2-3 blocks
PGY-2: 1 blocks
PGY-3: 1 blocks

We have an impressive ICU experience which promotes confidence in managing complex, critically ill patients in a safe and supported interdisciplinary setting.

The ICU team is comprised of a full-time intensivist, senior resident (PGY 2 or 3), three interns, and is often joined by a fourth year medical student. Multidisciplinary rounds are held daily, and include, but are not limited to, the following:

  • Director and/or intensivist
  • House staff team
  • Nursing
  • Respiratory therapy
  • Social & pastoral services

The primary responsibility of the senior resident is teaching the intern and medical student. There is no overnight call for the senior resident in the ICU.

Interns are on call every third day with call days ending no later than 10 p.m. They have one day off each week.

Night Float

PGY-1: 1-1.5 blocks
PGY-2: 1 blocks
PGY-3: 1 blocks

The night float team (an intern and one senior resident), handles admissions and cross-coverage issues from 7 p.m. and 7 a.m., Sunday through Thursday nights.

Intern responsibilities include admissions and cross coverage on the wards. This rotation helps to develop essential communication skills among physician colleagues and provides an opportunity to improve efficiency during the admission process.

The senior resident supervises the night float intern and the on-call ICU intern and manages overnight ICU admissions. This is a demanding role, but it is highly valued due to the autonomy it fosters.

Primary Care

Categorical intern: This rotation is dedicated to allow the Intern a structured approach to the medical home model of primary care. Time is spent in 1:1 mentorship with their clinic faculty learning the nuts and bolts needed to be successful in the clinic patient encounter. Dedicated time is provided for population management of their patient panel and integration with support staff of the medical home including clinical pharmacy, behaviorist, social worker and clinical EMR analyst. Interns leave with an understanding of their responsibility as the primary physician for their patients and knowledge of how to be facile in the system of the medical home.

Resident PGY-2 (Optional PGY-3): Residents spend one block focusing on outpatient primary care, systems-based management and population health. Mornings are devoted to office-based primary and urgent care in the clinic. Residents also spend time completing cultural competency curriculum, root cause analysis pertaining to patient morbidity and mortality, and enhancement of outpatient EBM skills with one on one mentorship.

Ambulatory

Resident PGY-2: Second year residents spend two weeks focusing on outpatient geriatric care which includes geriatric assessment, neurocognitive assessment, in-home visits, hospice and nursing home care. Residents take advantage of experiencing care of the elderly at Providence ElderPlace, a PACE (Program of All Inclusive Care for the Elderly) program.

Resident PGY-3: Third year residents spend four to six weeks in a variety of ambulatory care settings including women’s health, podiatry, pre-operative clinic, orthopedics, HIV medicine, psychiatry, geriatrics, eating disorders, wound care, ophthalmology and ENT, allowing residents flexibility to pursue areas of interest pertaining to their future careers.

Health Equity Curriculum

Providence St Vincent Internal Medicine Residency is committed to developing a work force for the future that is prepared to recognize and mitigate health inequities. As part of our commitment, we have a continually developing health equity and cultural humility curriculum that features the following:

  1. Our faculty are trained in recognizing and mitigating the effects of implicit bias in both patient care and resident and faculty recruitment.
  2. We incorporate education about health disparities both through didactic lectures and interactive conferences
  3. Each resident uses a health equity lens to examine the baseline data for their Quality Improvement project, working with our data analyst to detect differences based on race, ethnicity and primary language, as well as considering how their project is affecting health inequities in the PDSA cycles.
  4. We use on-line modules to bring all residents up to the same knowledge level early in training.
  5. Our residents participate in DEA X-waiver training and gain proficiency in caring for patients with Opioid Use Disorder both in the hospital with our growing Chemical Dependency Service and in our Primary Care Clinic.

As a health system, Providence St. Joseph Health has always had the mission to care for the poor and vulnerable. In addition to health equity research and publications, Providence St Joseph health has recently announced a new investment of $50 million over the next five years as part of an effort to reduce health disparities and achieve health equity. "Population health is focused on understanding the whole population and the health disparities within that population, and then working to improve health outcomes for everybody," said Rhonda Medows, M.D. president of population health at Providence. "Existing health disparities are being amplified and exacerbated by the pandemic, so it is critical that we take immediate steps to support minority populations who have been disproportionately impacted by COVID-19 as part of our commitment to health equity."

https://www.instituteforhumancaring.org/About-Us/Stories/2020/June/Providence-in-solidarity-with-Black-Lives-Matter.aspx

https://www.prnewswire.com/news-releases/providence-commits-50-million-to-address-racial-disparities-in-health-care-301133300.html

Emergency Medicine

PGY-2: 1 block
PGY-3: 1 block

Providence St. Vincent is a referral center for coastal Oregon and southern Washington, with over 73,000 emergency room visits a year. Residents work one-on-one with full-time, board-certified emergency medicine physicians in both their second and third year. Residents are supervised to perform many bedside procedures and there are ample opportunities to perform procedures and interact with the Providence Stroke Team and Providence Heart Call Teams.

Electives

PGY-1: 1.5 - 2.5 blocks
PGY-2: 3 - 4 blocks
PGY-3: 5 - 6 blocks

Providence St. Vincent has a broad complement of subspecialties which comprise the core Internal Medicine Elective Rotations. Excellent relationships with prominent academic subspecialists provide for a varied and rich experience combining both an inpatient and outpatient experience with direct mentorship by senior subspecialist faculty. Residents have significant flexibility and are encouraged to tailor electives to their own needs and interests.

Opportunities for electives in the following areas exist:

  • Addiction Medicine
  • Cardiology
  • Cardiac Critical Care
  • Electrophysiology
  • Endocrinology
  • Gastroenterology
  • Hematology oncology, bone marrow transplant
  • High-risk breast cancer and genetic counseling
  • Infectious disease, HIV clinic
  • Inpatient Psychiatry
  • Medical ethics
  • Nephrology, interventional nephrology
  • Neurology, neuro-critical care, Multiple Sclerosis specialty clinic
  • Ophthalmology
  • Orthopedics sports medicine
  • Otolaryngology
  • Pain management
  • Palliative care and hospice
  • Pathology
  • Point-of-Care Ultrasound
  • Pulmonology
  • Radiology, interventional radiology
  • Vascular medicine, vascular surgery
  • Women’s health

Point of Care Ultrasound

We are excited to offer an expanded POCUS curriculum. POCUS is enjoying a rapid expansion in use by internists and hospitalists.

Our residents have comfortably used bedside ultrasound for years in the intensive care unit for the placement of central lines. The residency program now has its own handheld GE Sonosite iViz, and residents will learn the basics of cardiac and pulmonary ultrasound through on-line learnings, small group teaching, and direct patient care.

Cardiology Selective

  • Providence St. Vincent receives top national recognition for excellence and is the most innovative and comprehensive cardiovascular care available in Oregon.
  • Residents are lucky enough to share in the excellent teaching offered by our subspecialty cardiology colleagues during this four-week selective
  • Resident and Intern pair manages a panel of patients with complex cardiovascaular diseases in conjunction with the cardiology consultation service, advanced heart failure team, and electrophysiologists.
  • Residents will be on the front lines of a new $25 million grant to Providence Heart and Vascular Institute to promote
    • Cardiovascular specialty care
    • Center for Innovation and Research
    • Center for Prevention and Wellness
  • Many opportunities for mentorship and inclusion in active and ongoing research are available for residents who express an interest in cardiology

Evidence-Based Medicine

Our robust Evidence-Based Medicine curriculum has multiple components and includes didactic sessions from core faculty who are trained in teaching EBM. Monthly Journal Club or EBM Workshops give residents an opportunity to teach other residents tools for understanding the medical literature.

Quality Improvement

PGY-1: 0.5 block
PGY-2: 0.5 block

Our Quality Improvement Curriculum is unique because each resident has the opportunity to design and lead a project aligned with their career interests over 3 years. The curriculum director, Dr. Shelley Sanders is fellowship trained in quality improvement and the only Oregonian to be named an Innovation Advisor to the Center for Medicare and Medicaid Innovation. With the support of faculty mentors and data analysts they gain a unique set of skills including a deep understanding of the systems of care delivery so they can implement real change.

Outpatient Clinic in the Innovative Medical Home

PGY-1: Categorical: 1 half-day per week
PGY-2: 2 half-days per week; or one full day per week
PGY-3: 2 half-days per week; or one full day per week