The program rotation schedule gives residents the proper amount of time and responsibility needed to achieve their professional goals with excellence. Residents learn in a variety of settings including the Family Medicine Center, inpatient teams, and one-on-one with community sub specialists.
There are four residents on the service, 2 RI's, a RII and a RIII. This group works as a team and is responsible for managing adult admissions from the faculty and resident clinic population, as well as admissions from the ED. The team is directed by an inpatient Hospitalist. Sound Physicians is a national hospitalist organization who staffs this facility with Family Physician and Internal Medicine Hospitalists who are present around the clock to assist and teach the residents. The typical census is 15 to 20 patients. Usual maximum patient load for first year residents is 6-8 patients each, with overflow managed directly by the upper level. This includes ICU patients. The third year on the service is responsible for all the patients and graduates with a high degree of confidence in the area of inpatient management for most common adult problems.
This rotation takes place at Houston Methodist San Jacinto hospital in the second year. The residents admit and care for all children admitted to the pediatric unit. The most common problems seen are sepsis, dehydration, croup and asthma. A component of the rotation is time in the ER seeing ambulatory pediatric cases, i.e. lacerations, fractures, infections, and asthma. Together with a Pediatric Attending Physician from Baylor College of Medicine, you will evaluate newborns, including neonatal resuscitation, perform requested circumcisions and do new parent teaching. Our residents frequently provide neonatal resuscitation services. All pediatric admissions from our FM clinic population are managed by the team.
This 4 week rotation in first and third year takes place at our Legacy Clinic under the supervision of Family Medicine and Pediatric Faculty. There is an opportunity to have one of these experiences at a different site as well.
This 2 week rotation takes place at the San Jacinto Hospital emergency room. Residents focus on emergent pediatric problems such as trauma, severe infections, orthopedic problems, and injuries. The staff of ED physicians include several of our program graduates and faculty.
The Maternity Care team is composed of a third year and a first year, who are together for a six-week rotation. They are supervised by an OB faculty attending who are present in-house around the clock. Residents are able to follow patients from first arrival in L&D, through labor, birth, and post-partum. Experience in the management of labor and delivery on this rotation is supplemented by the experience each resident has in following his or her own clinic patients through prenatal care and delivery. The Family Medicine Center currently follows 240 prenatal patients each year. Our residents first assist on C-sections. Residents will deliver during this rotation as well as any of the on-call shifts they have throughout the year.
The first year surgery rotation is a one-on-one rotation with a private practice general surgeon. The first-year resident performs pre- and post-op care on patients and assists in surgeries. The level of skill and interest of the resident dictates the level of "hands-on" practice each resident is afforded on this rotation. Cases fall into the common, community hospital general surgery realm. Serious trauma, neurosurgical and chest trauma cases are generally transferred out to the Texas Medical Center. Residents have an opportunity to intubate patients and perform other perioperative procedures with the anesthesiologist's supervision while on this rotation as well.
The third year resident surgery experience is designed with operative experience in mind. Each resident will spend rotation time in the Houston Methodist San Jacinto Hospital operating suite following many different types of general and other surgeries to gain an appreciation for each type of procedure that his or her patients may be undergoing in the future. The opportunity for surgical assisting, multiple procedures and intubation of patients is prominent in this rotation.
The biopsychosocial approach is emphasized throughout your training. A structured block in behavioral science / psychiatry is one component. During this rotation you will work with community psychiatrists, focusing on diagnosis and treatment of behavioral problems commonly seen in a family medicine setting. We are fortunate to work with adult and, child specialists who are exceptionally skilled in psychopharmacology. Time is also spent in our clinical psychologist's office focusing on interview skills and a multi-disciplinary approach to treatment of disorders such as ADHD and learning disabilities. Training in patient-centered communication is facilitated through the use of video monitoring equipment and doctor / patient encounter review.
Four-week long rotations in cardiology, neurology, dermatology and electives in other medicine subspecialties are completed here at San Jacinto. Surgical subspecialties such as ophthalmology ENT, urology, and orthopedics are completed in rotations of two to six weeks each. These are one-on-one rotations with community physicians who have a high degree of interest in teaching and have demonstrated skill in teaching family medicine residents. Our residents are afforded the privilege of choosing their attending and arranging specific learning goals for their rotation.
Each first year serves a portion of his or her call nights during a separate night float block during which the resident is excused from usual program responsibilities. Clinic is limited to a reduced-schedule one half-day per week during this rotation. The night float resident is allowed to choose his or her call within some program guidelines. There is a similar second-year night float rotation.
The community medicine focused experience is a community project and a review of community resources. During the second-year self study time there is a series of projects culminates the learning experience to include the resident designing his or her own (community oriented primary care) COPC project.
Residents spend 1 month in the first and one month in the third year caring for geriatric patients. This learning is facilitated through the care of our hospital and clinic patients after their acute illness. We also work with physiatrists, (Physical Medicine), hospice experts and geriatricians to provide didactic and clinical teaching. Faculties provide structured readings and facilitate topical discussion. Residents learn how to negotiate the complex rules surrounding post-acute care financing as well as practice-management instruction on appropriately billing for physician services. Finally, there is an emphasis on teamwork and multi-disciplinary collaboration.
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Each fist year completes a rotation in the ER consisting of 200 hours of ER experiences. Shifts are chosen by the resident within some guidelines. During this rotation, residents manage patients under the supervision of the ER doctor and have the opportunity to perform procedures and manage typical urgent and emergent medical problems.
Unless specifically noted, night call is separate from daytime rotation responsibilities. All residents that are not on night float, ER or on an "away" rotation, come together to divide up the night coverage. On call residents attend to admissions for Children, Adults, Gynecology and OB. Because of the night float system, RI residents are on call an average of 2 -3 nights per month, and RII residents are on call an average of 3 - 5 nights per month. Third year residents slightly less.