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Family physicians are specialists in primary care for individuals of all ages. Our intention is to train family physicians who can provide this personalized care within the context of their families and the communities. Residency is a crucial step of professional development between medical school and autonomous clinical practice as a family physician.
Our curriculum by providing a broad and extensive inpatient and outpatient experience helps our residents achieve this goal of holistic, compassionate, and culturally-aware care to patients across a broad spectrum of society. We have rotations in medicine, pediatrics, neonatology, obstetrics, dermatology, eye care, ENT, behavioral medicine, community medicine, urology, sports medicine, and orthopedics. A didactic conference is held each Tuesday afternoon. We have several options in both inpatient and outpatient electives for residents to choose from.
A particular strength of the program is the intensive nature of its training in a number of areas. The obstetrics experience is extensive because of the large number of deliveries at Mercy Medical Center Merced (MMCM). Our residents work with both family physicians and laborists to manage and deliver both uncomplicated and complicated obstetric patients. With this background upon graduation, many residents feel comfortable providing a variety of services often routinely relegated to other specialists. Many resident graduates go on to practice in both inpatient and outpatient settings as faculty, hospitalists, and outpatient only. Graduates are also competent to assess psychological and emotional problems and respond with various forms and degrees of treatment. Residents are well prepared to practice in rural and underserved areas.
Curriculum
Medicine
During the first year, residents spend approximately twelve weeks on the Inpatient Medicine Service. Residents acquire experience in EKG interpretation, gain expertise in procedures, and manage patients with both acute and chronic complex conditions. During the second year, residents spend an additional six to eight weeks on the medicine rotation supervising the first year residents. This training is supervised by family medicine attendings, who round daily on the medicine wards. Each resident is responsible for an average of six to eight patients while on the service. In the third year, residents will spend four weeks on the medicine service supervising and teaching the first year residents. At this time, they have an opportunity to refine skills and study further to fill any gaps in knowledge. For those residents who want to pursue a career as a hospitalist, the resident will use some of their elective time for an ICU rotation to enhance their skills.
Pediatrics
During the residency, each resident will spend eight weeks in inpatient settings and 8 weeks in the outpatient setting. The inpatient experience is divided into two weeks in the NICU in each academic year and a 2 week rotation in an emergency room at Valley Children's Hospital in Madera during the second year. The outpatient pediatric rotation includes a primary care clinic with a faculty pediatrician and specialty clinics at the Valley Children’s Outpatient Clinic in Merced. Specialties include cardiology, gastroenterology. The residents follow newborns on the obstetric service and see children of all ages in their continuity clinics.
Obstetrics/Gynecology
In the first year, residents spend eight to nine weeks on the busy obstetric and gynecology service at MMCM. Training emphasis is on prenatal care, normal delivery, post-partum care, and recognition of obstetrical emergencies. In both the second and third year the resident on the obstetric rotation assists (depending on experience or level of training) cesarean deliveries, induction of labor, and tubal ligation. During the night rotation, the third year resident is responsible for deliveries at night under the supervision of the in house Laborists or Faculty attending. Residents also follow pregnant patients in Family Practice Center and go on to deliver them. They will continue to follow the mom and baby in their outpatient clinic. Residents who desire to have obstetric privileges after residency get additional rotations and experiences.
Emergency Medicine
The resident spends four weeks as a member of the emergency room staff learning the immediate diagnosis and management of a wide variety of medical and surgical emergencies. Our residents gain many opportunities to manage critically ill patients and perform procedures under the supervision of the Emergency Department physicians. Experience and teaching in the emergency room is provided continuously through the second and third years.
Behavioral Science
The Behavioral Science experience is a longitudinal rotation over the course of the residency program. Every Wednesday afternoon, residents on outpatient electives participate in a didactic session on a behavioral science topic for an hour and then spend the rest of the afternoon counseling patients who have been referred for crisis intervention or brief therapy sessions. Residents learn counseling skills, the basics of DSM-IV diagnoses, use of psychiatric medications, and assessment of psychological issues with their patients. Supervision is provided by a faculty family physician, and a Behaviorist. Residents are encouraged and expected to incorporate the principles that they have learned in the Behavioral Science experience into their own practice of medicine in the Family Practice Center.
Outpatient Services (Community Medicine)
During our outpatient services rotation, our residents will participate in a variety of clinics which include MAT clinic at a local FQHC, Dermatology clinic, Procedure clinic, Eye clinic, and spending time with our local foundation to explore philanthropic work in our community. Our residents will be rotating at the University of California, Merced Student Clinic and also rotate on the Mobile Clinic.
Geriatrics
Geriatrics is a four week rotation during their second year, managing predominantly geriatric patients with a faculty physician who is the Medical Director of the facility. They also see patients with a faculty physician in his practice of older adults. Residents learn through a combination of patient care duties and focused tutorials about the unique aspects of the care of an aging patient.
Surgery Subspecialties
Residents will rotate four weeks in their office and the hospital with a general surgeon gaining direct experience on managing patients with surgical problems. Residents will also have two week rotations in ENT and Urology during their first or second year. The resident is assigned to a private attending in the respective specialty area. Emphasis is primarily on the outpatient aspect of these specialties with the resident spending the majority of the time in the physician's office.
Musculoskeletal
Our residents will rotate with several of our local orthopedic surgeons in their offices seeing patients with a variety of musculoskeletal conditions. Further, residents will spend time at our local community college working with the trainer evaluating and treating sports injuries. Residents will also rotate with a local rheumatologist in his office to gain experience assessing patients with rheumatologic conditions. Our residents will go to our local high schools in the Fall with our faculty and perform sports physicals.
Electives
Our residents get elective time throughout the three years but the majority of elective time is available in the third year so that residents may select clinical areas of concentration with the purpose of adjusting their training to anticipate future practice settings. Because of our long-standing relationships with our community physicians, we have developed electives in the following areas: Anesthesiology, Cardiology, Emergency Medicine, Hospital/ICU Medicine, Gastroenterology, Infectious Disease, Interventional Radiology, Nephrology, Outpatient Pediatrics, Outpatient Procedures, Public Health, Pulmonology, Rehab Medicine, Woman’s Health, and Wound Care. We also have a process in place if the resident wants to create a new elective.
Other Areas of Curriculum
We have incorporated POCUS curriculum into both didactics and our inpatient and outpatient clinic experiences. We have a Wellness curriculum that is integrated in the didactics and is led by two third year residents. This year we are working with several other residency programs in developing a formal Street Medicine curriculum.