Mercy / Methodist Hospital of Sacramento Family Practice Residency Program

Curriculum

Each column below is broken into (13) 4 week blocks.  If two titles are listed together, then the block is split into (2) two week blocks.

* One month of elective time in both the 2nd and 3rd year rotations may be taken out of the area with no Family Practice Clinic obligation. Out of town and out of country electives are allowed and even encouraged.  Our residents have done electives in such diverse locations as Honduras and India.

On an annual basis, residents and faculty get together to evaluate and modify the rotation blocks to meet the needs of the residents.

Our goal is to support each resident in becoming the best Family Physician he or she can be. We support residents in developing their own interests and styles recognizing that resident education at its best works with each person's strengths. 

Inpatient Rotations

Emergency Medicine

        Second year residents spend one month in our Level 2 trauma center at Methodist Hospital. Here, our residents obtain a variety of "hands on" experience including laceration repair, line placement, intubation, and wound care. Working closely with the emergency room physicians, our residents are allowed to participate in the care of any patient that 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 total of 8 1/2 months of inpatient experience at Methodist and Mercy General Hospital. 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. Our second and third year residents having developed a strong foundation in their inpatient skills, participate in two blocks of medicine at Mercy General Hospital (MGH) where both second and 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 MGH 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 are 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 2-3 residents. Daily rounds occur with both the Family Practice Core Faculty Attendings and with Intensivists - who are also 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 resident's clinic. The patients on the Intensivists' service are pulmonology, infectious disease and "no doc" patients admitted through 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, etc. All residents receive certification in ACLS (Advanced Cardiac Life Support).

 At Mercy General Hospital second and 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 the residents. They bring a wealth of diversity which range from private practitioners and large health care organization providers to University affiliated practitioners. Residents at Mercy General also work closely with the variety of specialty consult services including the premier MGH cardiovascular service. Mercy General is located in the upscale 'fabulous forties' region of Midtown Sacramento which provides a varied patient population. The residency service provides care primarily to the "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

        First-year residents average Q6 in-house call for the inpatient Medicine and Pediatrics services at Methodist hospital throughout the year.  There is no "specialty" call associated with monthly rotations. You are paired with the senior resident that is on night float during the week, or with the senior resident on call on weekends.  Weekday call begins at 5 pm with sign-out from the residents on those services, and ends at 7 am with sign-out to the oncoming teams. Weekend call is from 7 am to 7 am the next day.  If the patient load is high, the off-going call team on Saturday and Sunday mornings do a share of the note-writing to assist the oncoming call team in preparing for rounds.  Duties while on call include following up on labs, x-rays, etc. that are still pending, taking floor calls for the above inpatient services at Methodist, and admitting Clinic and "no doctor" adults from the ER, as well as all Pediatric admissions.  The average number of admissions is 2 to 4 per call night.  The Senior resident is responsible for supervising patient care and will see and write a back-up note on all admissions.  The call team is also responsible for providing backup assistance for emergency surgeries if called upon.
        Second and third year residents each have 2-two week blocks of night float.  This senior resident takes call at both admitting hospitals (Methodist and Mercy General), Monday through Friday nights.  The resident backs up the intern at Methodist Hospital, and takes call like a community physician at Mercy General Hospital.  The resident has no responsibilities during the day except for 1/2 day of clinic on the Monday before the night float call week starts.   For second and third year residents, the only other call during their second and third years is rotating on back-up call for the weekends.  The remaining weeknights for the rest of the year are call-free.
        On post-call days, residents are excused from service when all necessary duties are completed or at 1:00 pm .

Obstetrics

        Each resident rotates on the OB service at Mercy General Hospital for 2 months in first and second year. Our residents work directly with board certified OB/Gyn faculty along with volunteer Family Physicians and Obstetricians in the community to gain experience in labor management and deliveries. Prenatal care experience occurs as residents are assigned OB patients in their practices at the Mercy Family Health Center.  Family Practice faculty precept residents during their clinics.

        Our residents routinely first assist on cesarean sections and perform D&C's when necessary.

        During their training, our residents are encouraged to obtain certification in ALSO® (Advanced Life Support in Obstetrics). Current family practice faculty are actively involved in teaching this course.

Pediatrics

        Our residents currently spend 3 months in the inpatient service caring for patients on the pediatric ward at Methodist and in the ICN (optional). Patients come from the Mercy Family Health Center, all "no doctor" pediatric admits from the Emergency Rooms at Methodist and Mercy General, and from Family Physicians and Pediatricians in the community. Since Mercy General shifted their pediatric services to Methodist, all pediatric admissions from their ER are transferred to Methodist, with the UC Davis Medical Center (UCDMC) pediatric intensivists providing attending coverage.  With our patient base comprising most of the greater south Sacramento area, we have a fairly busy and high-volume service. During the inpatient rotations the residents  also provide care to patient in the "concentrated care" unit which is the equivalent of a PICU step-down unit. Critical care backup is always available from the UCDMC pediatric intensivists.

        Residents also admit and care for referred and unassigned newborns from the Family Birthing 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 two months on this rotation. Here, the resident works directly with a board-certified surgeon, seeing patients in conjunction with the surgeon in both the office and hospital. The residents learns how to prepare the patient for surgery, provides preoperative care, assists in a variety of inpatient, outpatient, and office procedures, and cares for the patient postoperatively, both in the hospital and later in the office.  The resident often first assist the surgeon, an advantage not often found at programs with competing residencies in surgery.

Outpatient Rotations

Behavioral Science/Psychiatry

        Our exceptional behavioral science training is longitudinal and  involves ongoing incorporation of behavioral medicine into the daily clinical education in both inpatient and outpatient settings. Residents work closely with Dr. India Fleming, our behavioral scientist/clinical psychologist, on physician patient communication, health behavior change, understanding and working with psychosocial aspects of medical illnesses, assessing and treating psychiatric disorders and counseling skills. We believe that knowledge and skills in the behavioral sciences are critical to providing effective care in family practice and regard our training in these areas as a particular strength of the MHS Family Practice Residency Program.

        Additional focused psychiatric experience, both inpatient and outpatient, is accomplished at Sierra Vista psychiatric hospital during a two week rotation in first year.

Cardiology

        First year residents spend two weeks with the Mercy Cardiologist at Mercy General Hospital and in the office. The Mercy Cardiology program has been well recognized as one of the best in California. 

Community Medicine 

         During the three years of residency, our residents work with numerous health and service agencies.  In the second year a 4-week block is spent with home health, hospice care, occupational medicine, HIV/AIDS clinic (CARES), physical therapy, rehab center and homeless and domestic violence shelters. Our residents work closely with the schools in the area and participate in the Adopt a School program with the local elementary and junior high schools in providing health education lectures to the students.

        Because the population we serve is diverse, both culturally and socioeconomically, this curriculum allows our residents to gain insight in particular areas that will allow them to serve their patients better.

Community Practice Experience (CPE)

        Third year residents spend two weeks with their choice of a private or group practice family physician in the community. Here our residents get the chance to experience what it is like to be a family doctor in the real world. Seeing patients along with working with the front office and billing departments are just a few areas our residents are gaining real world experience.

Dermatology

       Second year residents spend four weeks working directly with community dermatologists. Here the resident gains experience in the management of common dermatological problems and minor dermatological surgical procedures.

Electives

        Four months of elective time (including a one-month selective) is included in the curriculum.  This time is used to gain additional experience in any particular area that a resident has an interest. Residents can spend 2-two-week blocks of the elective time outside the Sacramento community. International electives are encouraged.  In the past, residents have traveled to the Azores, mainland China, India, Africa, Israel, Pakistan, and Honduras.

ENT

        First year residents spend two weeks with local otolaryngolgists learning about common ENT problems that a family physician will come across over a lifetime in practice.

Family Practice Clinic Block

        Second and third year residents each spend a full month in the family practice clinic during this rotation at the Mercy Family Health Center. This experience is in addition to the time spent in the regular continuity clinic at the Mercy Family Health Center. The month consists of urgent care (same day) clinics and specialty clinics such as procedure, weight management, sports medicine, Gyn (colposcopy), perinatal, vasectomy and flex sig clinics. In addition, this resident is in charge of triaging all incoming labs and pharmacy requests.  See our web page on the Mercy Family Health Center for more information.

Gynecology

        During this rotation, third year residents spend four weeks at the Student Health Center in Sac State University as well as with a community Gynecologist in office and hospital. Our residents have primary responsibility of the patient and gain hands-on experience managing a variety of gynecological conditions in both the outpatient setting and the hospital OR and wards. Coloposcopy, endometrial biopsies, and IUD placement are just a few of the procedures that a resident will perform during this rotation.

Neurology

        First year residents spends two weeks with local neurologists working in their offices and in the hospital. During the rotation, residents become skilled in conducting a complete neurological exam, use of imaging studies such as CT/MRI and EEG, and gain knowledge in managing common neurological problems such as migraines, seizure disorders, and radiculopathies.

Ophthalmology

        First year residents spend two weeks working with several board-certified Ophthalmologists in their offices gaining knowledge in a variety of conditions that a family physician will see in their own practice.

Orthopedics

        First year residents spend four weeks working with a couple of local orthopedic surgeons in their office and in the hospital. Residents also attend the Fracture Evaluation Clinic at the emergency department in MSJ hospital and become skilled at casting and splinting, setting simple fractures, and managing strains and sprains.

Pediatrics

        Second and third year residents each spend a month in several busy private pediatricians' offices as well as community clinics where residents typically see 10-12 patients per half-day. At these sites, family physicians and pediatricians are available for questions and teaching opportunities.

Practice Management

        A longitudinal didactic curriculum, covering a broad range of current practice management material, prepares the residents for this third-year, two week rotation.  Following an experiential, data-gathering effort in the Community Practice Experience rotation, residents incorporate that data into a selection of projects completed with the Residency Practice Administrator.

Radiology (Diagnostic Imaging)

        First year residents have two weeks where they spend time one-on-one with a radiologist at Methodist Hospital. Here they review daily X-rays, CT scans, sonograms and more. A teaching file is available for additional experience.

Sports Medicine

       Second and third year residents rotate through the Sports Medicine clinic one day per week during the Family Practice Clinic block. In addition a 4 week block in third year is spent in two sports medicine clinics with sports medicine fellowship trained physicians. All residents serve as the team physician on site at the high school football games. They also provide yearly sports physicals for the team athletics at local schools and a community college.

Urology

        Third year residents spend two weeks with a local urologist in the office seeing common urology pathology. Management of BPH, impotence, chronic UTI's and other disease states are encountered.

Didactics

Below is the weekly conference didactic schedule for the residents.

Noon conferences are held three times a week with scheduled speakers from core faculty, University faculty and community physicians. The core educational curriculum (including the medical disciplines, behavioral sciences and practice management) are given in an 18 month cycle.