Our curriculum allows residents to develop top-quality skills in both the inpatient and outpatient setting. The curriculum is fine-tuned with ongoing resident involvement. Each subspecialty elective includes responsibility in the inpatient setting as well as outpatient experience in the subspecialists’ office. The curriculum integrates stimulating clinical experiences in a “real world” medical center and rigorous formal academic instruction by nationally recognized faculty. Residents are simultaneously challenged and supported – creating a vibrant learning environment.
* Understanding the Healthcare System **Evidence-Based Medicine
Inpatient Medicine Teaching Services
Key features
Diversity of patients - Varied demographics - Wide range of diseases
Emphasis on autonomy - Tight relationship with full-time hospitalists
Formal education rounds - 1 ½ hrs 3x/week
Night float system - Overnight call less than 2x/month
Strong ancillary services
Each first-year house officer spends four and one-half rotations on the inpatient service. Each team is comprised of one Providence Portland first-year and one senior resident. One of the senior house staff is from Oregon Health & Science University (OHSU) and represents part of our formal affiliation with its medical school. Our program also has a formal affiliation with the Providence Milwaukie Family Medicine Program. Each of the family medicine interns has experience on one of our ward services. Teams have a junior medical student and often a fourth year sub-intern. Teams average seven to 10 patients per intern.
We believe that a teaching service team overwhelmed with too many patients serves neither the best interests of the resident nor of the patient. So, a teaching service is closed to admissions when a team accrues a predetermined number of patients. The round-the-clock availability of personnel doing IV catheters, EKGs, arterial blood gases, blood drawings and transport markedly enhances the resident's ability to manage teaching service patients efficiently.
In addition to daily teaching during work rounds, formal teaching rounds are conducted three times weekly by Providence Portland faculty. Rounds include both conference room case discussions and bedside teaching. Resident evaluations are used to select those attendings most committed to training and to assure a high level of teaching expertise.
The teaching services are designed to ensure that house staff is responsible for patient management. When attendings admit to the teaching service, the physicians agree that only house staff will write orders on those patients. All physicians admitting to the teaching service must participate in Medical Education-sponsored faculty development. Most patients on the teaching services have either a full-time hospitalist or a core Medical Education faculty as their attending.
Each teaching service also accepts patients admitted from the Providence Ambulatory Care and Education (PACE) Center by other house officers who then follow their patients as the primary physician. A full-time faculty member supervises all hospitalized patients.
The five ward teams admit in rotation with each team admitting three out of every five days. Night float covers overnight admissions five out of seven nights. Each ward team stays overnight no more than than twice per month.
Second and third year residents supervise inpatient ward services at PPMC for a total of 4.5 months during the PGY-2/PGY-3 years. During these rotations, they lead their teams on work rounds, coordinate patient care and teach both interns and students. Prior to the start of the PGY-2 year, house staff participate in a formal seminar series, “Becoming an R2” that focuses on the management and educational skills needed to optimally run a teaching service. The call schedule for residents on the wards is identical to that described for interns.
The night float team (one resident and one intern) evaluates medicine admissions coming to the hospital and cross-cover teaching service patients, between 7:00 p.m. and 7:00 a.m. Sunday night through Friday morning. Each morning, admissions are reviewed with a Medical Education faculty. These rounds emphasize initial assessment of inpatient admissions, bedside physical exam skills and making effective transfers of patient care.
Interns have one month of night float. Residents have a total of 1.0 – 1.5 months of night float during their PGY-2/PGY-3 years.
Residents responsible for all patients - High census, high acuity, create vibrant learning environment
Daily rounds with board-certified intensivist
Weekly ethics rounds
The Intensive Care Unit at PPMC is a combined medical-surgical ICU. The 14-bed unit allows our residents to gain tremendous experience in the assessment and management of critically ill patients. Managing both medical patients and complicated post-operative patients gives residents experiences that will be invaluable in their future careers.
Daily, multidisciplinary rounds with an intensivist allow house staff to learn both the latest in ICU management techniques and how to lead a multidisciplinary team. These 2 ½ hour rounds provide a strong foundation to house staff rotating in the ICU. Educational experiences in the ICU include:
Two interns and a senior resident staff the unit each day.
Second year residents assigned to the ICU cover the unit five nights each week. The PGY-3 covers the unit one night per week. Each intern takes overnight call only once every other week.
Each intern spends 1.5 rotations in the ICU. Residents spend, on average, a total of 2.5 rotations in ICU during their PGY-2/PGY-3 years.
Learn what is needed in a real general medicine practice - Efficiency - Procedures - Telephone medicine
Formal ambulatory curriculum
Diversity of experiences - Urgent care (acute chest pain, pyelonephritis) - Complicated psychosocial issues - Direct supervision by behavioral medicine specialist - Community education - Partnership with Portland Public Schools - Women’s Health Clinic - Musculoskeletal Clinic
The Outpatient Block rotation, scheduled for one month during both the PGY-1 and PGY-2 year, is designed to familiarize house staff with general medicine outpatient practice. Formal didactics and observed patient interviews by behavioral medicine faculty supplement the experience. Residents gain experience in the full gamut of outpatient experiences, including office orthopedics, women’s health, dermatology, and ENT.
During their PGY-2 rotation, residents also spend ½ day per week at a public high school performing community education. For the past decade, we have had a partnership with the Portland Public Schools to work with minority students who are enrolled in a magnet program for the health sciences. Our residents spend time in a classroom setting working with adolescents on career choices, the nature of scientific discovery, and medical issues of importance to young people. Residents also work in the county-sponsored teen clinic at a local high school as part of this experience.
Understanding the Healthcare System This half-block rotation is a supervised independent study rotation. It combines a variety of one-on-one sessions with faculty, structured reading, and a series of projects designed to familiarize residents with caring for a population of patients. By the end of the experience, residents will have learned the fundamentals of population-based health and be in a position to integrate them effectively into their own practice.
Interns collaborate to develop a shared Quality Improvement project each year.
Evidence-Based Medicine All second-year residents receive a half-block rotation experience focusing on evidence-based medicine. The rotation emphasizes asking clinical questions, becoming adept at using electronic resources to answer questions, critically appraising the literature (with a focus on reading articles about therapy, diagnosis, and overviews/meta-analyses), and applying it to patient/population care.
The resident meets one-on-one with experienced and enthusiastic EBM faculty during the rotation for one-hour article sessions and personalized (tailored to meet your needs) literature-searching sessions. The resident is given the materials for their required reading and also completes a knowledge test at the start and end of the rotation. In addition, during the rotation the resident completes and presents a research project.
The Providence Portland Emergency Department is one of the busiest in the city, with 50,000 visits per year. The ED is staffed by full-time, board-certified emergency physicians. First-year residents assess emergency patients prior to staffing them with the Emergency Department physician. For house staff in the ED, experiential learning is supplemented with one-on-one teaching, prepared didactic sessions, assigned reading materials, and hands-on instruction in emergency medicine procedures such as slit lamp examination and suturing. Residents return to the ED during their PGY-3 year for additional experience.
A formal geriatrics block rotation occurs during the second year. The learning objectives include: increased knowledge of common geriatric syndromes (such as delirium, dementia and incontinence), preventive medicine and screening issues, pharmacotherapy issues and atypical presentations of common diseases; and skills development in multiple areas including assessment of mental status, screening for depression, family interviewing, ethical decision-making, and special history and physical exam issues of the elderly. Problems specific to the frail elderly and their management in nursing homes, foster homes and other settings are also emphasized.
As part of our affiliation with Oregon Health & Science University, each senior resident spends one block on the inpatient service at the Portland Veterans Affairs Medical Center. Cardiology is emphasized. The resident is responsible for the supervision of the intern/medical student teams. Providence Portland is the only program to have a direct exchange with OHSU. One of our residents is always on their inpatient service and one OHSU resident is always on the wards at PPMC. This collaboration benefits the education of all.
Full range of medical and surgical electives available
1:1 with subspecialty faculty - personalized teaching - opportunity for procedures
Most rotations combine inpatient and outpatient experiences
We encourage house staff to tailor elective choices to meet their personal goals. The proportion of inpatient versus outpatient can be adjusted. Specific faculty can be requested. Every month of residency training is precious. We want to maximize every elective’s value to every resident.
International Elective (available PGYII/III)
We feel that the perspective added by working in a developing country is a wonderful supplement to residency training. The resident gains several important benefits:
Increased confidence in physical exam
Decreased reliance on diagnostic technology, along with a deeper understanding of the importance of cost-effective care
Exposure to a myriad of unusual tropical diseases
Most importantly, reinforcement of our need as physicians to improve the health care of the underserved. Seeing how much can be done with so few resources in a developing country strengthens our commitment to use the resources here in the United States to improve health care for every one.
“Our combined medical-surgical ICU gives residents a breadth of experience critical to their clinical development. Residents direct the care of all the patients in our ICU. After one month, their skills and their confidence have grown rapidly. The trajectory of professional growth is quite dramatic. By the end, residents are quite comfortable managing ICU patients independently.”
Dr. Thomas Shaumberg, Medical Director ICU, Prov Portland
