KFMR Curriculum is designed to offer broad exposure and training in the field of Family Medicine. The rotation schedule and educational activities listed below give residents a solid foundation for their careers. There are 13 block rotations (4 weeks each) during each academic year.
KFMR Block Rotations
During the second year, residents will acquire knowledge of human behavior, behavioral health, mental disorders, and community mental health resources for incorporation into his/her practice of Family Medicine.
Second year residents spend a month with the Kadlec's cardiology practice. The majority of the time is spent in the outpatient setting, where residents gain experience in EKG interpretation, management of heart failure, management of valvular conditions, arrhythmias, hypertension, and coronary artery disease. There are opportunities to observe cardiac catheterizations, stress tests, and echocardiograms, as well as to discuss the interpretation of these studies with cardiologists. Hours are typically 8am-5pm weekdays.
In the third year, residents will gain knowledge in a community clinic that offers free health care to those uninsured/underinsured. Residents will gain an understanding of education, health, and social service resources within our community with an emphasis on using these resources effectively to treat patients and promote wellness. The goal is for residents to become skilled in using available community resources to facilitate the prevention, evaluation, and management of acute and chronic medical conditions commonly seen in the outpatient setting.
First year residents spend 2 weeks in a local private practice dermatology clinic. This experience gives them experience in the gamut of various skin disorders. There is also the opportunity to participate in dermatologic skin procedures.
Residents spend 2 weeks each in the first and second years at Kadlec's otolaryngology practice. During this time, they gain valuable experience in the examination of the ears, nose, and throat and in common diagnoses and therapies for pathology affecting these areas. There are also a few days in the OR observing common ENT surgeries including tonsillectomy and thyroidectomy.
Second and third year residents (1 elective in 2nd year, 3-4 electives in 3rd year) may use this time to pursue medical/surgical interests, experience and gain skill in an outpatient specialty, or experience a specialty of your choice. Subject to faculty approval, some electives which residents have done thus far include Endocrinology, Infectious Disease, NICU, Nephrology, Pulmonology, Rural Rotation, Radiology, Urgent Care, Wound Care and more.
Second and third year residents gain experience in the care of emergent and urgent issues in two different Kadlec Emergency Departments – the main emergency department located in Richland, WA and the freestanding emergency department in Kennewick, WA. Across these two months, residents gain experience in the management of various conditions and complaints in adults and children including burns, fractures, head trauma, laceration repair, strains, sprains, viral illness, pneumonia, myocardial infarction, pulmonary embolism, dizziness, back pain, abdominal pain, and more. They are supervised by board certified emergency medicine physicians.
During second year, there is one, four-week block and in the third year, there are two, four-week block rotations. FMC focuses on the ambulatory care setting which gives the resident the opportunity to build a patient panel. Residents concentrate on continuity of care of their patients and the resident will gain experience in all aspects of family medicine. From infants to the elderly, the FMC rotation gives a wide array of patient care which is essential to take care of patients in a family medicine practice.
First year residents spend a month on the general surgery service. During this time, they gain experience assisting in the OR with common general surgeries such as appendectomy, cholecystectomy, and hernia repair. They round on post-op patients, take call at least one weekend during the month, and also see patients in the general surgery clinic.
Second year residents spend a month working in Kadlec's outpatient geriatrics clinic, where they gain experience in health promotion, prevention, and diagnosis and treatment of disease and disability in older adults, from the perspective of geriatricians. Work hours are typically 8am-5pm weekdays.
Residents will gain knowledge and experience in the diagnosis and treatment of patients with gynecological issues commonly seen in the Family Medicine Setting. The primary educational purpose of the rotation is to improve the resident’s competency in office gynecology and women’s health. Residents will become familiar with those aspects of care that are appropriately diagnosed and managed by family medicine physicians and those that should be referred to, or managed jointly with, obstetrics/gynecology specialists.
Inpatient Adult Medicine (IPAM)
Each first year resident spends 4 months on the inpatient hospitalist service. Second and third year residents spend 2 months each year. The Gold Team is a resident-run and hospitalist-supervised inpatient service caring for around 14 patients at any one time. The intern is responsible for rounding on acutely ill adult patients under the supervision of senior resident(s) and attending. Seniors both supervise interns and also are responsible for medical student rounding and teaching. Typically, most residents (both interns and seniors) will spend 2-4 weeks during the year on nights, during which they both admit patients and serve as night coverage for the Gold Team patients. Residents work 6am-7pm six days a week, sometimes leaving earlier in the day if their tasks are completed and a colleague is cross covering their patients.
First-year resident spend 2 months on the inpatient pediatric service and wellborn nursery. This is divided into 2 weeks of wellborn nursery and 2 weeks of inpatient pediatrics each month a first year is on the service. On the Wellborn service, first year residents gain experience in rounding on well newborns with neonatal nurse practitioners. They are able to gain experience in the range of normal presentations and problems in a well newborn, with issues such as jaundice, hypothermia, hypoglycemia, and transient tachypnea of the newborn. On the inpatient pediatric service, residents gain experience in common acute pediatric issues including hyperbilirubinemia, common respiratory illnesses, diabetic ketoacidosis, infections, and mental health concerns. During the Wellborn portion, hours are typically from 8am-5pm. During the inpatient pediatrics portion, hours are typically 6am-7pm with overnight call on Tuesday and Friday and weekends off.
Second year residents spend a month working on the intensive care unit. They work as part of the intensive care team, which includes an intensivist, intensive care nurse practitioners, and intensive care nurses. During this rotation, residents gain experience in the care of critically ill patients, including ventilator support, pressor support, and if desired, experience in the placement of central lines.
First year residents spend 2 block rotations on the obstetric service (4 week block rotations, 2 weeks nights). During this time, they work with obstetricians with Kadlec's Associated Physicians for Women group and participate in triage of women coming to the birth floor, vaginal deliveries, C-section assists, and postpartum rounding. Hours are 7am-7pm five days a week. Residents additionally have continuity OB patients which are seen in the Family Medicine Residency Clinic and delivered with family medicine attendings throughout the year.
Orientation, Introduction to Family Medicine (ORIENT)
Over the course of 4 weeks, first year residents are gradually acquainted to important people, places, and skills. They engage in team-building activities. Certifications are completed in NRP, BLS, ACLS, and PALS. They are introduced to life in clinic by starting with generous 2 hour appointments with direct faculty observation, and transitioned to standard 1 hour appointments at the end of orientation block. The foundations of success are built during this time with orientation to the Epic EMR, which is a continuous system between the inpatient and outpatient settings.
First and second year residents spend 1 month each year in the orthopedics clinic. During this time, they gain experience in the diagnosis of common orthopedic complaints and have opportunities to perform large joint injections under the supervision of the orthopedic specialists. Hours are typically 8am-5am five days per week.
Residents spend a month each in the first and third years at a local private practice seeing pediatric patients. During this time they gain experience in well child checks and common childhood ailments. Hours are typically 9am-5pm.
During the palliative care rotation, residents have the opportunity to work with Kadlec's palliative care team in both the inpatient and outpatient settings, gaining exposure to pain management in life-limiting illnesses and engaging in shared decision making about end-of-life care. Work hours are typically 8am-4pm weekdays.
During the second year, residents will gain experience in Quality and Safety and develop the ability to identify and institute sustainable systems-based changes to improve patient care. Residents will have the opportunity to participate in inter-professional quality improvement activities including those aimed at reducing health care disparities. During the third year, the practice management curriculum will assist residents as they move “from residency to reality”. The overall goal is to develop the knowledge and skills necessary to manage various components of a practice that include organization, administration, communication, marketing and patient care aspects.
During the third year, residents will be able to improve their knowledge of the most common urological disorders and various treatment options. During this outpatient rotation, the resident will become familiar with the diagnosis and treatment of urological disorders and the preventative and screening measures for health maintenance.
The focus of the rotation is to increase exposure to the principles of the newborn exams and newborn management. Residents will gain knowledge and skills as a Family Medicine Doctor and benefit from them in future practice. Residents will work with the KRMC Neonatology and Pediatrics Department to learn skills needed to care for newborns in a hospital setting.
