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Inpatient Rotations


Emergency Medicine         

Second year residents spend one month in the Level 2 Trauma Center at Methodist Hospital. Here, residents obtain a variety of "hands-on" experience including laceration repair, line placement, intubation and wound care. Working closely with Emergency Room physicians, residents are allowed to participate in the care of any patient who comes through the door. ATLS (Advanced Trauma Life Support) certification can be obtained by any resident who wishes to do so.         

Internal Medicine

Our curriculum is composed of a total of 8 1/2 months of inpatient experience at Methodist and Mercy General Hospitals. As a first year resident, inpatient medicine takes place solely at Methodist Hospital where there is a higher level of supervision from senior residents for the R1. Second/Third year residents, having developed a strong foundation in their inpatient skills, participate in two blocks of medicine at Mercy General Hospital where both second/third years function as senior residents and have increased autonomy over decision making in patient care and management. Staffing at Methodist Hospital is composed of core Residency Faculty and Intensivists/Hospitalists. Staffing at Mercy General is composed of community Family Practitioners and Internists. 

Because we are the only residency in each hospital, there is no competition with others for admissions and procedures. Some inpatient procedures that residents routinely perform include: 

  • Lumbar Puncture
  • Arterial Line Placement
  • Central Line Placement
  • Paracentesis
  • Thoracentesis
  • Intubation and Ventilator Management
  • Swan-Ganz Catheterization

At Methodist Hospital there is a primary medicine team composed of 3 residents. Daily rounds occur with both the Family Practice Core Faculty Attendings and with Intensivists (board certified in Pulmonology and Infectious Disease). The Family Practice Service is composed of patients who receive their primary medical care from the Mercy Family Health Center residents' clinic, as well as newborns and pediatric patients (age >14). Patients on the Intensivists' service are pulmonology, infectious disease and "no doc" patients admitted through the Methodist ER. Residents learn management of critically ill patients in ICU/CCU and participate in supervised ICU procedures such as placing central lines, managing mechanical ventilators and more. All residents receive certification in ACLS (Advanced Cardiac Life Support). 

At Mercy General Hospital, second/third year residents work closely together in managing the medicine service. Each resident carries 5-8 patients. Community family practice physicians and internists participate in overseeing the service and rounds with residents. They bring a wealth of diversity ranging from private practitioners and large healthcare organization providers to university-affiliated practitioners. Residents at Mercy General also work closely with a variety of specialty consult services, including the premier Mercy General Hospital cardiovascular service. Mercy General is located in the upscale "fabulous forties" region of midtown Sacramento, providing a varied patient population. The residency service provides care primarily to "no doc" (patients who do not have doctors or their doctors do not admit to the hospital) and indigent patients. 

Night Float and Call Schedule

A night float system has been implemented eliminating any 24-hour calls throughout the three years. The system has been very popular among residents and ensures adherence to all ACGME guidelines. First-year residents see adult Inpatient Medicine and Pediatrics (age >14 and newborns) services at Methodist Hospital. There is no "specialty" call associated with monthly rotations. Residents are paired with the Senior Resident with a similar schedule creating less sign-outs to oncoming physicians without knowledge of the patients. 

Duties include following up on labs, X-rays, etc. that are pending, taking floor calls for inpatient services, admitting Clinic and "no doctor" adults from the ER. The average nightly admissions are 2-4. The Senior Resident is responsible for supervising patient care and will see and write a back-up note on all admissions. The Team is responsible for providing backup assistance for emergency surgeries if called upon. 

The Senior Resident on night float covers both admitting hospitals (Methodist and Mercy General). The Resident backs up the Intern at Methodist Hospital and takes call like a community physician at Mercy General. The Night Float Resident has no other responsibilities during the day. 

Obstetrics

Each resident rotates on the OB service at Methodist Hospital for 2 months in first/second years. 

Residents work directly with OB Fellowship trained Family Medicine Core Faculty with C-section privileges, board certified OB/GYN faculty, and volunteer Family Physicians and Obstetricians in the community to gain experience. The resident on obstetrics is involved in triaging, delivery, and postpartum care of the mother as well as newborns. Prenatal care experience occurs as residents are assigned OB patients in their practices at the Mercy Family Health Center. Family Medicine Faculty precept residents during their clinics. Residents routinely first assist on Cesarean sections and perform D&Cs when necessary. 

During their training, our residents receive training in ALSO and can become certified in ALSO® (Advanced Life Support in Obstetrics) via core faculty training and completion of an ALSO course. 

Pediatrics

Residents currently spend 2 months in second/third years rotating on inpatient service caring for patients in Mercy San Juan's pediatric ward - the only Sacramento Mercy hospital with pediatric services (age <14). Patients come from the Mercy Family Health Center, all "no doctor" pediatric admits from the emergency rooms and from family physicians/pediatricians in the community. All attendings are from the UC Davis Medical Center pediatric hospitalists and intensivists. With our patient base comprising most of the greater Sacramento area, we have a fairly diverse, busy and high-volume service. During inpatient rotations, residents also provide care to patients in the concentrated care unit which is the equivalent of a PICU step-down unit. 

In the first year and during the FM/Newborn rotation, residents care for referred and unassigned newborns from the Family Birth Center at Methodist Hospital. Residents receive certification in PALS (Pediatric Advanced Life Support) and NALS (Neonatal Advanced Life Support) paid for by the program. 

Surgery

First year residents spend 2 months on this rotation. Here, residents work directly with a board-certified surgeon, seeing patients with the surgeon in both the office and hospital. Residents learn how to prepare the patient for surgery, provide preoperative care, assist in a variety of inpatient, outpatient, and office procedures, and care for the patient postoperatively, both in the hospital and later in the office. Residents often first assist the surgeon, an advantage not often found at programs with competing surgical residencies.