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Our intention is to train family physicians to provide the full spectrum and scope of family practice in areas that do not have the large number of sub-specialties found in the larger cities.
Inpatient and outpatient experience is broad and extensive, including rotations in medicine, pediatrics, neonatology, obstetrics, dermatology, ophthalmology, ENT, psychiatric and behavioral medicine, urology, and orthopedics. There are also opportunities to arrange electives in most areas of interest. A noon conference is held Monday through Friday for teaching. Specialty clinics take place one morning a week. Specialists from nearby institutions such as Stanford University and UCSF are regularly involved.
A particular strength of the program is the intensive nature of its training in a number of areas. Each resident will spend three months in the ICU/CCU working under the direction of the faculty. The obstetrics experience is also extensive because of the large number of deliveries at Mercy Medical Center Merced (MMCM). With this background upon graduation, many residents feel comfortable providing a variety of services often routinely relegated to other specialists. Many resident graduates maintain an OB practice and also feel competent providing ICU/CCU care and doing procedures such as arterial lines, central venous lines, intubations, and neonatal resuscitations. 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 areas.
During the first year, residents spend sixteen weeks on the Inpatient Medicine Service. Residents acquire experience in EKG interpretation and gain expertise in procedures, such as thoracentesis and lumbar puncture. Residents also spend one month in the ICU. During the second year, residents spend an additional month on medicine and on the ICU/CCU rotation. This training is supervised by the faculty internist, as well as family practice faculty, who round daily on the medicine wards and in the critical care unit. 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 ICU/CCU and 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.
The first year resident spends eight weeks in pediatrics. Four of these weeks are spent at the pediatric ward at MMCM. They make daily rounds with the faculty pediatricians and attend the daily pediatric clinic. The other four weeks are spent in an outpatient pediatric clinic learning from the faculty pediatricians. During the second year, residents spend four weeks on the pediatric rotation at MMCM. Residents have primary responsibility for an average of four to six inpatients on our 20-bed pediatric ward plus the infants in the newborn surgery. To give further experience in inpatient pediatrics, an additional four weeks is spent at Children's Hospital Central California in Madera during the second year. In the third year, residents spend an additional four weeks on pediatrics, assisting in the teaching and supervision of the first year residents. This gives the resident a chance to study the problems in more depth, and to participate in the teaching of his/her junior colleagues.
In the first year, residents spend eight 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 obstetrics/gynecology performs or assists (depending on experience or level of training) in gynecological surgery, such as dilation and curettage, hysterectomy, and tubal ligation. The on-call resident is responsible for deliveries at night and on weekends, and a resident may elect to deliver his Family Practice Center patients, regardless of the service he is on at that time. Under this arrangement, each resident delivers about 125 babies during these three years. If the resident desires, he may obtain additional experience in C-sections.
The first year 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. Experience and teaching in the emergency room is provided continuously through the R-2 and R-3 years.
The Behavioral Science experience is a longitudinal rotation over the course of the entire second year of the residency program. Second year residents spend every Wednesday afternoon participating in a didactic session on a behavioral science topic for 1 1/2 hours, then spends 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 faculty family physicians, and a PhD Psychologist. 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)
This is a six week rotation where the resident gains knowledge of the resources available in the community for his/her patients. These experiences include time spent with the Public Health nurse, home health nurses, visits to several local factories to learn about industrial medicine, time spent in an occupational medicine clinic, and visits to other local health resources. Sports Medicine experiences are also incorporated into the curriculum.
Geriatrics is a four week rotation at Anberry Rehabilitation Hospital, during their second year, managing predominantly geriatric patients with a faculty physician who is the Medical Director of the facility. Residents learn through a combination of patient care duties and focused tutorials about the unique aspects of the care of an aging patient.
During the first year of training, the resident takes 40 hours of ENT. In the second and third years, Urology, Ophthalmology, Orthopedics, and Dermatology are required. 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. A primary care physician or a trained emergency room physician provides on-site supervision when the resident is in the ER.
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. The format for electives may include any of the following:
- Additional time on a required service
- Away rotations
- Family or individual counseling
- Independent study of diagnostic methods, i.e., EKG interpretation, radiographic diagnosis, etc.
- Medical or surgical subspecialty training
- Opportunities available to learn Flexible Sigmoidoscopy, Exercise Treadmill, and other procedures.
- Rural practice experience